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.
Cancer Research UK CancerHelp information is examined by both expert and lay reviewers. Content is reviewed every 12 to 18 months. Further info. Statistics for the UK, including incidence, mortality, survival, risk factors and stats related to treatment and symptom relief.
NHS / ASKVisualScience An animated video about the anatomy of the breast - part of a series of videos about breast cancer aimed at general practitioners and their patients.
Breast Cancer - Module 2: Malignant Transformation and Growth
NHS / ASKVisualScience An animated video about how cancer can develop in the breasts - part of a series of videos about breast cancer aimed at general practitioners and their patients.
Breast Cancer - Module 3: Tumour Staging
NHS / ASKVisualScience An animated video about breast cancer staging - part of a series of videos about breast cancer aimed at general practitioners and their patients.
Breast Cancer - Module 4: Signs, Symptoms and Surgery
NHS / ASKVisualScience An animated video about the signs and symptoms of breast cancer and surgery for breast cancer - part of a series of videos about breast cancer aimed at general practitioners and their patients.
Think Pink Foundation An independent, volunteer based charity whose focus is to raise funds to provide financial and emotional support, information and counseling for breast cancer patients.
Understanding Pathology for Breast Cancer
Swedish Medical Center, Seattle Sean Thornton, MD, introduces the pathology and biology of breast cancer and role of the pathologist. The presenter is from Cellnetix Laboratories and Pathology / Swedish Medical Center - a not-for-profit hospital in Seattle.
What's New in Breast Cancer Care and Treatment
Cancer.Net Dr. Julie Gralow outlines recent research progress in the care and treatment of people with breast cancer. (2012)
PubMed Central search for free-access publications about Breast Cancer MeSH term: Breast Neoplasms US National Library of Medicine PubMed has over 22 million citations for biomedical literature from MEDLINE, life science journals, and online books. Constantly updated.
Cancer Research UK CancerHelp information is examined by both expert and lay reviewers. Content is reviewed every 12 to 18 months. Further info. Statistics for the UK, including incidence, mortality, survival, risk factors and stats related to treatment and symptom relief.
Gastric Breast Cancer Editorial Office Provides secondary-research articles (editorials, perspectives, news/views etc) on best practice and future clinical and research directions prevention and early detection, multidisciplinary, evidence-based management and treatment of breast cancer and gastric cancer. International editorial board, peer reviewed and open access.
breastcancer.org A nonprofit organization which aims to provide reliable, complete, and up-to-date information about breast cancer. Information is reviewed by an Advisory Board, which includes over 60 practicing medical professionals from around the world.
Against Breast Cancer a charity aiming to increase survival after breast cancer through research into secondary spread. The site includes pages about the organisation, facts about breast cancer, lifestyle, research reports etc. Research at Middlesex and UCL Hospitals.
Avon Foundation for Women Founded in 1992, this corporate organisation has raised over $780 million donated to breast cancer programs around the world. It supports awareness and education, screening and diagnosis, access to care, support services, and scientific research.
Breakthrough Breast Cancer A national charity launched in 1991 to promote breast cancer research. It supports the Breakthrough Research Centre in London and a number of other locations in the UK. The web site includes details of research, campaigns, events etc.
Breast Cancer Care A national charity promoting awareness and providing information and support to those affected by breast cancer. The Web site includes details of services; telephone helpline, volunteer and aftercare programs, on-line booklets and factsheets.
Breast Cancer Fund The Breast Cancer Fund works to prevent breast cancer by eliminating our exposure to toxic chemicals and radiation linked to the disease. The organisation has its headquaters in San Fransisco. Thw website includes information about chemicals and risk reduction.
HER2 Support Group A non-profit organisation which aims to help members by supporting concerns and by providing links to news and current research. The site includes a message board and details of clinical trials.
This list of publications is regularly updated (Source: PubMed).
Sriussadaporn S, Angspatt A Primary angiosarcoma of the breast: a case report and review of the literature. J Med Assoc Thai. 2013; 96(3):378-82 [PubMed]
Primary angiosarcoma of the breast is rare. Therefore, no randomized trial can be used as guideline for diagnosis and treatment. To achieve optimal outcome, previous reports of case series are the sources for management with expected long-term survival. The objective of the present case report is to demonstrate complete pathologic response to neoadjuvant taxanes without recurrence after two years of follow-up.
Jana D, Sarkar DK, Maji A, et al. Can cyclo-oxygenase-2 be a useful prognostic and risk stratification marker in breast cancer? J Indian Med Assoc. 2012; 110(7):429-33 [PubMed]
Cyclo-oxygenase-2 (COX-2) is a prostaglandin synthease that catalyses the synthesis of prostaglandin G2 (PGG2) and PGH2 from arachidonic acid. COX-2 plays an important role in tumourigenesis of different carcinoma types and it is thought to take part in breast carcinoma. In this study, the aim was to investigate the relationship of COX-2 with clinical parameters such as menopausal status, tumour size, grade, nodal status, Nottingham prognostic index (NPI), oestrogen receptor(ER), progesterone receptor (PR), human epidermal growth factor receptor type 2 (HER-2/ neu). The patients were divided into two groups, first group (group A) comprised 57 primary breast cancer patients and the second group (group B) comprised control group 27 patients consisting of fibro-adenoma and benign breast disease. In control groups COX-2 (0%) is not over expressed and we observed that high frequency of COX-2 (73.68%) over expressed in breast carcinoma. In high grade, large tumour size and positive lymph node metastasis, COX-2 expression rate was 78.6%, 59.5% and 90.5% respectively. COX-2 expression is directly correlated with ER negative (88.1%, p = 0.001) and also associated with higher NPI value (78.6%, p = 0.006). In invasive ductal carcinoma (IDC) COX-2 over expression had a significant relationship with HER-2/neu over expression (p < 0.001). The results indicated that COX-2 over expression correlates with aggressive phenotypic features, such as high histological grade, large tumour size, higher NPI value, ER negativity and HER-2/neu positivity.
Loganathan R, Selvaduray KR, Nesaretnam K, Radhakrishnan AK Tocotrienols promote apoptosis in human breast cancer cells by inducing poly(ADP-ribose) polymerase cleavage and inhibiting nuclear factor kappa-B activity. Cell Prolif. 2013; 46(2):203-13 [PubMed]
OBJECTIVES: Tocotrienols and tocopherols are members of the vitamin E family, with similar structures; however, only tocotrienols have been reported to achieve potent anti-cancer effects. The study described here has evaluated anti-cancer activity of vitamin E to elucidate mechanisms of cell death, using human breast cancer cells. MATERIALS AND METHODS: Anti-cancer activity of a tocotrienol-rich fraction (TRF) and a tocotrienol-enriched fraction (TEF) isolated from palm oil, as well as pure vitamin E analogues (α-tocopherol, α-, δ- and γ-tocotrienols) were studied using highly aggressive triple negative MDA-MB-231 cells and oestrogen-dependent MCF-7 cells, both of human breast cancer cell lines. Cell population growth was evaluated using a Coulter particle counter. Cell death mechanism, poly(ADP-ribose) polymerase cleavage and levels of NF-κB were determined using commercial ELISA kits. RESULTS: Tocotrienols exerted potent anti-proliferative effects on both types of cell by inducing apoptosis, the underlying mechanism of cell death being ascertained using respective IC50 concentrations of all test compounds. There was marked induction of apoptosis in both cell lines by tocotrienols compared to treatment with Paclitaxel, which was used as positive control. This activity was found to be associated with cleavage of poly(ADP-ribose) polymerase (a DNA repair protein), demonstrating involvement of the apoptotic cell death signalling pathway. Tocotrienols also inhibited expression of nuclear factor kappa-B (NF-κB), which in turn can increase sensitivity of cancer cells to apoptosis. CONCLUSION: Tocotrienols induced anti-proliferative and apoptotic effects in association with DNA fragmentation, poly(ADP-ribose) polymerase cleavage and NF-κB inhibition in the two human breast cancer cell lines.
Lamb MR, Gertsen E, Middlemas E Metaplastic breast cancer: a presentation of two cases and a review of the literature. Tenn Med. 2013; 106(2):39-41 [PubMed]
Metaplastic breast cancer has been difficult to diagnose and classify for a number of reasons. Its rarity prevents any important conclusions to be made, such as factors determining prognosis, immunohistochemistry patterns and successful treatment regimens. Here a number of studies of metaplastic breast cancer are discussed, along with the presentation of two cases.
Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013; 368(11):987-98 [PubMed]
BACKGROUND: Radiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The effect of this exposure on the subsequent risk of ischemic heart disease is uncertain. METHODS: We conducted a population-based case-control study of major coronary events (i.e., myocardial infarction, coronary revascularization, or death from ischemic heart disease) in 2168 women who underwent radiotherapy for breast cancer between 1958 and 2001 in Sweden and Denmark; the study included 963 women with major coronary events and 1205 controls. Individual patient information was obtained from hospital records. For each woman, the mean radiation doses to the whole heart and to the left anterior descending coronary artery were estimated from her radiotherapy chart. RESULTS: The overall average of the mean doses to the whole heart was 4.9 Gy (range, 0.03 to 27.72). Rates of major coronary events increased linearly with the mean dose to the heart by 7.4% per gray (95% confidence interval, 2.9 to 14.5; P<0.001), with no apparent threshold. The increase started within the first 5 years after radiotherapy and continued into the third decade after radiotherapy. The proportional increase in the rate of major coronary events per gray was similar in women with and women without cardiac risk factors at the time of radiotherapy. CONCLUSIONS: Exposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart disease. The increase is proportional to the mean dose to the heart, begins within a few years after exposure, and continues for at least 20 years. Women with preexisting cardiac risk factors have greater absolute increases in risk from radiotherapy than other women. (Funded by Cancer Research UK and others.).
Dawson SJ, Tsui DW, Murtaza M, et al. Analysis of circulating tumor DNA to monitor metastatic breast cancer. N Engl J Med. 2013; 368(13):1199-209 [PubMed]
BACKGROUND: The management of metastatic breast cancer requires monitoring of the tumor burden to determine the response to treatment, and improved biomarkers are needed. Biomarkers such as cancer antigen 15-3 (CA 15-3) and circulating tumor cells have been widely studied. However, circulating cell-free DNA carrying tumor-specific alterations (circulating tumor DNA) has not been extensively investigated or compared with other circulating biomarkers in breast cancer. METHODS: We compared the radiographic imaging of tumors with the assay of circulating tumor DNA, CA 15-3, and circulating tumor cells in 30 women with metastatic breast cancer who were receiving systemic therapy. We used targeted or whole-genome sequencing to identify somatic genomic alterations and designed personalized assays to quantify circulating tumor DNA in serially collected plasma specimens. CA 15-3 levels and numbers of circulating tumor cells were measured at identical time points. RESULTS: Circulating tumor DNA was successfully detected in 29 of the 30 women (97%) in whom somatic genomic alterations were identified; CA 15-3 and circulating tumor cells were detected in 21 of 27 women (78%) and 26 of 30 women (87%), respectively. Circulating tumor DNA levels showed a greater dynamic range, and greater correlation with changes in tumor burden, than did CA 15-3 or circulating tumor cells. Among the measures tested, circulating tumor DNA provided the earliest measure of treatment response in 10 of 19 women (53%). CONCLUSIONS: This proof-of-concept analysis showed that circulating tumor DNA is an informative, inherently specific, and highly sensitive biomarker of metastatic breast cancer. (Funded by Cancer Research UK and others.).
Haloua MH, Krekel NM, Winters HA, et al. A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects. Ann Surg. 2013; 257(4):609-20 [PubMed]
OBJECTIVE: The primary objectives of this systematic review on oncoplastic breast surgery (OPBS) were to evaluate the oncological and cosmetic outcomes of OPBS. The secondary objectives were to assess morbidity, quality of life, and applied algorithms. BACKGROUND: Breast-conserving therapy (BCT) has become the standard of care, and survival is now excellent. Consequently, the focus of BCT has increasingly shifted to cosmetic outcome, quality of life, and patient satisfaction. Nonetheless, excision of certain tumors still presents a considerable challenge. Specialized approaches combining oncological surgery and plastic surgery techniques are collectively referred to as OPBS. A summary of OPBS outcomes would facilitate decision-making and best treatment selection by both clinicians and patients. METHODS: Using specific inclusion and exclusion criteria to analyze 2090 abstracts on the topic of OPBS published between 2000 and 2011, the authors evaluated each study with respect to design and outcomes. RESULTS: A total of 88 articles were identified for potential inclusion and reviewed in detail by the lead authors. No randomized controlled trials were identified. Eleven prospective observational or comparative studies fulfilled inclusion criteria and were selected. In these studies, 80% to 93% of the tumors were invasive. Tumor-free resection margins were observed in 78% to 93%, resulting in a 3% to 16% mastectomy rate. Local recurrence was observed in 0% to 7% of the patients. Good cosmetic outcome was obtained in 84% to 89% of patients. However, most studies showed significant weaknesses including lack of robust design and important methodological shortcomings, negatively influencing generalizability. CONCLUSIONS: This systematic review reveals that current evidence supporting the efficacy of OPBS is based on poorly designed and underpowered studies. Given the increasing importance and application of OPBS, there is a pressing need for robust comparative studies, including both randomized controlled trials and well-designed, multicenter prospective longitudinal studies.
Arora R, Abou-Bakr A, Al Taleb A Fine needle aspiration diagnosis of a spontaneously infarcted fibroadenoma mimicking carcinoma: a case report. Anal Quant Cytol Histol. 2013; 35(1):57-60 [PubMed]
BACKGROUND: Spontaneous infarction of fibroadenoma is an extremely rare complication in a nonpregnant/nonlactating female undergoing first-time aspiration. It can be misdiagnosed as carcinoma in all aspects of triple approach used for evaluation of patients with breast lesions. CASE: A 37-year-old woman presented to the outpatient surgical clinic with a 6-month history of a breast lump that was slowly increasing in size and had become painful during the past month. There was no history of any trauma or fine needle aspiration, and she was not pregnant or lactating. Mammogram and ultrasound revealed a 2.9-cm heterogenous hypoechoic suspicious lesion. No lymph nodes were detected in the axilla. Fine needle aspiration cytology was performed, and a diagnosis of benign breast lesion with features of infarction was rendered on cytology. The lump was excised surgically, and a histological diagnosis of infarcted fibroadenoma was made. CONCLUSION: Careful and diligent search for preserved benign epithelial cells on smears is the key to recognize this entity and avoid serious therapeutic implications.
Allam MF, Abd Elaziz KM Evaluation of the level of knowledge of Egyptian women of breast cancer and its risk factors. A cross sectional study. J Prev Med Hyg. 2012; 53(4):195-8 [PubMed]
Breast cancer is considered the leading cause of cancer death among females in economically developing countries. Prevalence of breast carcinoma is high in Egypt and the cases of breast cancer constitute 29% of cancer cases treated at the national cancer institute. This study aimed at exploring the level of knowledge of Egyptian females of breast cancer and its risk factors. An interview questionnaire with 22 questions about breast cancer was developed. This questionnaire was previously published as a part of the German multicentre DACH study). A total of 600 female subjects that attended primary health care centres were enrolled in our study. The majority were located in Cairo with the mean age of 40.5 +/- 11.0. Most of our studied sample (94%) has heard about breast cancer as a disease. TV and radio were the main sources of knowledge about the disease (60%). The level of knowledge about breast cancer was limited in 80% of the subjects. Younger age subjects had a higher level of knowledge about breast cancer compared to older subjects with no significant difference statistically. The grade of knowledge about breast cancer was higher among highly educated subjects compared to less educated subjects with significant difference statistically. The highest known risk factors of breast cancer were exposure to X ray (79.5%), hormonal therapy (75.7%) and previous breast cancer disease (70.8%). This study clearly illustrates the need for a health education program directed to Egyptian females to improve the knowledge of breast cancer.
Colfry AJ Miscellaneous syndromes and their management: occult breast cancer, breast cancer in pregnancy, male breast cancer, surgery in stage IV disease. Surg Clin North Am. 2013; 93(2):519-31 [PubMed]
Surgical therapy for occult breast cancer has traditionally centered on mastectomy; however, breast conservation with whole breast radiotherapy followed by axillary lymph node dissection has shown equivalent results. Patients with breast cancer in pregnancy can be safely and effectively treated; given a patient's pregnancy trimester and stage of breast cancer, a clinician must be able to guide therapy accordingly. Male breast cancer risk factors show strong association with BRCA2 mutations, as well as Klinefelter syndrome. Several retrospective trials of surgical therapy in stage IV breast cancer have associated a survival advantage with primary site tumor extirpation.
Black DM, Mittendorf EA Landmark trials affecting the surgical management of invasive breast cancer. Surg Clin North Am. 2013; 93(2):501-18 [PubMed]
Significant progress has been made in the surgical management of breast cancer. Most women diagnosed with early stage invasive breast cancer can now be managed with breast-conserving therapy to include a segmental mastectomy followed by radiation. Axillary lymph nodes are routinely assessed by sentinel lymph node biopsy. Axillary lymph node dissection is reserved for patients with documented nodal metastasis; however, here too progress has been made because a population of low-risk patients has been identified in whom a complete dissection is not required even in the setting of a positive sentinel lymph node. This article details the landmark clinical trials that have guided the surgical management of breast cancer.
Redden MH, Fuhrman GM Neoadjuvant chemotherapy in the treatment of breast cancer. Surg Clin North Am. 2013; 93(2):493-9 [PubMed]
Randomized prospective trials have demonstrated that patients with early-stage breast cancer preferring breast conservation can benefit from neoadjuvant chemotherapy, achieving about a 25% complete and greater than 80% partial pathologic response. These responses do not translate into a survival advantage. For earlier stage patients, neoadjuvant chemotherapy's primary advantage is the ability to increase the use of breast conservation. Patients who opt for neoadjuvant chemotherapy should have a clinical and radiographic assessment of the axilla. The inability to predict the extent and pattern of response to chemotherapy requires that surgeons monitor patient response during neoadjuvant chemotherapy to provide optimal surgical planning.
Hernandez-Aya LF, Gonzalez-Angulo AM Adjuvant systemic therapies in breast cancer. Surg Clin North Am. 2013; 93(2):473-91 [PubMed]
Although some women with early breast cancer (BC) may be cured with loco-regional treatment alone, up to 20% of patients with early-stage BC will ultimately experience treatment failure and recurrence. A substantial portion of the success in improving clinical outcomes of patients with BC is related to the standardized use of adjuvant therapies. The identification of tumor subtypes with prognostic value has contributed to the idea of tailoring treatments using biologic predictive factors to identify the patients who will most likely respond to therapy and minimize the exposure of "nonresponders" to the side effects of the treatment.
Yang TJ, Ho AY Radiation therapy in the management of breast cancer. Surg Clin North Am. 2013; 93(2):455-71 [PubMed]
Radiation therapy (RT) plays an essential role in the management of breast cancer by eradicating subclinical disease after surgical removal of grossly evident tumor. Radiation reduces local recurrence rates and increases breast cancer-specific survival in patients with early-stage breast cancer after breast-conserving surgery and in node-positive patients who have undergone mastectomy. This article reviews the following topics: (1) the rationale for adjuvant RT and the evidence for its use in noninvasive and invasive breast cancer, (2) RT delivery techniques for breast-conserving therapy such as hypofractionated RT, partial breast irradiation, and prone irradiation, and (3) indications for PMRT.
DellaCroce FJ, Wolfe ET Breast reconstruction. Surg Clin North Am. 2013; 93(2):445-54 [PubMed]
As diagnostic technology has progressed and the understanding of the disease process has evolved, the number of mastectomies performed in the United States has increased. Breast reconstructive techniques have commensurately become more sophisticated along the same timeline. The result is that those facing mastectomy have the potential to simultaneously retain physical beauty and wholeness. Only 33% of women who are otherwise candidates for immediate reconstruction at the time of mastectomy choose reconstruction. Patients generally have a high level of satisfaction with the option they choose, contributing to a feeling of overall recovery and physical and emotional wholeness.
Zarebczan Dull B, Neuman HB Management of the axilla. Surg Clin North Am. 2013; 93(2):429-44 [PubMed]
Status of the axillary lymph nodes is one of the most important factors impacting overall prognosis and treatment for breast cancer. The sentinel lymph node (SLN) concept for breast cancer has been validated and SLN biopsy should be considered standard of care for axillary staging in patients with clinically node-negative axilla given the decreased morbidity when compared with axillary lymph node dissection. Ongoing controversy includes use of SLN in patients with ductal carcinoma in situ, prior axillary surgery, multicentric breast cancer, and large breast cancers. Determining the optimal timing of SLN in patients undergoing neoadjuvant chemotherapy and the prognostic and clinical significance of micrometastases remain areas of research.
McLaughlin SA Surgical management of the breast: breast conservation therapy and mastectomy. Surg Clin North Am. 2013; 93(2):411-28 [PubMed]
The twentieth century has witnessed dramatic changes in the surgical management of breast cancer. Herein we focus on the evolution of breast conservation surgery and current surgical trends of lumpectomy, mastectomy and contralateral prophylactic mastectomy. Margin analysis, specimen localization and processing, and the benefits of magnetic resonance imaging remain controversial. Neoadjuvant chemotherapy can offer prognostic information and aid in surgical planning while radiation therapy continues to reduce the risk of local recurrence after breast conserving surgery. Despite these advances, mastectomy remains a popular choice for many women and the use of nipple sparing procedures is increasing. Overall the low rates of local recurrence are attributed to the combination of surgery and targeted adjuvant and radiation therapies.
Bleicher RJ Ductal carcinoma in situ. Surg Clin North Am. 2013; 93(2):393-410 [PubMed]
Management of ductal carcinoma in situ (DCIS) has evolved from radical surgery to the option of a more minimally invasive approach. Data show that breast conservation surgery performed with administration of radiotherapy, like mastectomy, is feasible and safe. Because efforts to find a safe group for elimination of radiotherapy have resulted in data that conflict, radiotherapy still remains standard of care as a part of breast conservation for DCIS. Tamoxifen has also shown a significant recurrence benefit and has become standard in the treatment of receptor-positive disease. Investigation of other agents, such as anastrazole and trastuzumab, are ongoing.
Corben AD Pathology of invasive breast disease. Surg Clin North Am. 2013; 93(2):363-92 [PubMed]
Invasive breast cancers constitute a heterogeneous group of lesions. Although the most common types are ductal and lobular, this distinction is not meant to indicate the site of origin within the mammary ductal system. The main purpose of the identification of specific types of invasive breast carcinoma is to refine the prediction of likely behavior and response to treatment also offered by the other major prognostic factors, including lymph node stage, histologic grade, tumor size, and lymphovascular invasion.
Euhus DM, Robinson L Genetic predisposition syndromes and their management. Surg Clin North Am. 2013; 93(2):341-62 [PubMed]
Apart from BRCA1, BRCA2, and TP53, more than a dozen breast cancer susceptibility genes have been identified. Recognizing affected individuals depends on evaluation of cancer family history and recognition of certain phenotypic markers on physical examination. Genetic testing provides a powerful tool for individualized risk stratification. Mutation carriers have several options for managing risk, including lifestyle alterations, enhanced surveillance, chemoprevention, and prophylactic surgery. Genetic counseling and testing should be considered in the initial evaluation of patients with newly diagnosed breast cancer because this information contributes to surgical decisions, radiation therapy options, and systemic therapy choices.
Degnim AC, King TA Surgical management of high-risk breast lesions. Surg Clin North Am. 2013; 93(2):329-40 [PubMed]
High-risk lesions of the breast are lesions that confer an increased risk of breast cancer, either because of an increased probability of finding cancer associated with percutaneous biopsy findings or because of an increased probability of developing breast cancer over the long term. Atypical ductal hyperplasia found on percutaneous biopsy is generally excised, whereas lobular neoplasia lesions, including both atypical lobular hyperplasia and lobular carcinoma in situ, may be observed if radiologic and pathologic findings are concordant and there is no other high-risk lesion present.
Smetherman DH Screening, imaging, and image-guided biopsy techniques for breast cancer. Surg Clin North Am. 2013; 93(2):309-27 [PubMed]
Mammography remains the primary modality for breast cancer diagnosis. Other imaging studies, most commonly ultrasonography and magnetic resonance imaging, are also used to characterize breast lesions, stage breast cancer, and aid in surgical planning. Although mammography is the only screening examination demonstrated to decrease breast cancer mortality in the general population, other imaging studies have been shown to be beneficial for screening high-risk patients. In the future, new technologies may also improve the sensitivity and specificity of breast cancer screening and detection.
Vinayak S, Carlson RW mTOR inhibitors in the treatment of breast cancer. Oncology (Williston Park). 2013; 27(1):38-44, 46, 48 passim [PubMed]
The phosphatidylinositol 3-kinase/mammalian target of rapamycin (PI3K/mTOR) pathway is commonly dysregulated in breast cancer. In preclinical studies, hyperactivation of the PI3K pathway has been linked to resistance to both endocrine therapy and trastuzumab (Herceptin). Rapalogs, agents that primarily inhibit mTOR-raptor complex 1, have been studied in combination with endocrine therapy to overcome endocrine resistance.Trials of combination endocrine therapy and rapalogs in metastatic hormone receptor-positive breast cancer have demonstrated variable results. However, two independent trials have recently shown that combination everolimus (Afinitor) and tamoxifen or combination everolimus and exemestane (Aromasin) is more effective than either endocrine agent alone. These trials selected patients with cancer refractory to endocrine therapy, which may be important in sensitizing tumors to inhibition of this pathway. In human epidermal growth factor receptor 2 (HER2)-positive breast cancer, the early clinical data with combinations of PI3K/mTOR inhibitors and anti-HER2 therapies are encouraging. Efforts to identify clinical biomarkers of response or resistance to mTOR inhibitors are ongoing. This review will summarize results of preclinical and clinical studies aswell as ongoing clinical trials with mTOR or dual PI3K/mTOR inhibitors.
Green JM, Paladugu S, Shuyu X, et al. Using temporal mining to examine the development of lymphedema in breast cancer survivors. Nurs Res. 2013 Mar-Apr; 62(2):122-9 [PubMed]
BACKGROUND: Secondary lymphedema is a lifetime risk for breast cancer survivors and can severely affect quality of life. Early detection and treatment are crucial for successful lymphedema management. Limb volume measurements can be utilized not only to diagnose lymphedema but also to track progression of limb volume changes before lymphedema, which has the potential to provide insight into the development of this condition. OBJECTIVES: This study aims to identify commonly occurring patterns in limb volume changes in breast cancer survivors before the development of lymphedema and to determine if there were differences in these patterns between certain patient subgroups. Furthermore, pattern differences were studied between patients who developed lymphedema quickly and those whose onset was delayed. METHODS: A temporal data mining technique was used to identify and compare common patterns in limb volume measurements in patient subgroups of study participants (n = 232). Patterns were filtered initially by support and confidence values, and then t tests were used to determine statistical significance of the remaining patterns. RESULTS: Higher body mass index and the presence of postoperative swelling are supported as risk factors for lymphedema. In addition, a difference in trajectory to the lymphedema state was observed. DISCUSSION: The results have potential to guide clinical guidelines for assessment of latent and early-onset lymphedema.
Kalin A, Merideth MA, Regier DS, et al. Management of reproductive health in Cowden syndrome complicated by endometrial polyps and breast cancer. Obstet Gynecol. 2013; 121(2 Pt 2 Suppl 1):461-4 [PubMed]
BACKGROUND: Cowden syndrome is an autosomal-dominant condition associated with mutations in the tumor suppressor gene PTEN. Gynecologic malignancies are common with a 5-10% risk of endometrial cancer and 25-50% risk of breast cancer. CASE: A 37-year-old woman with a history of breast cancer, other neoplasms, and multiple skin lesions was diagnosed with Cowden syndrome after a germline PTEN mutation was identified. The endometrium had high glucose uptake on positron emission tomography scan and was irregularly thickened on ultrasonography; biopsy revealed endometrial polyps and simple hyperplasia. Fifteen months later, hysteroscopy again confirmed numerous benign endometrial polyps. CONCLUSION: Recurrent, multiple endometrial polyps portend a high risk of endometrial cancer in women with Cowden syndrome. Monitoring for malignancy and consideration of hysterectomy after childbearing is completed is warranted.
Barentsz MW, van den Bosch MA, Veldhuis WB, et al. Radioactive seed localization for non-palpable breast cancer. Br J Surg. 2013; 100(5):582-8 [PubMed]
BACKGROUND: Radioactive seed localization (RSL) is an alternative to wire localization for guiding surgical excision of non-palpable breast cancer. This review provides an overview of the available evidence on the accuracy of RSL in patients undergoing breast-conserving surgery. METHODS: PubMed, Embase and the Cochrane Library were searched systematically in January 2012 for studies that addressed localization of non-palpable breast cancer using an iodine-125-labelled seed. Studies were deemed eligible if they reported on the proportion of patients with tumour-positive margins after RSL, the proportion of patients needing re-excision after RSL, and procedural complications. RESULTS: Six studies reported data on RSL in 1611 patients with non-palpable breast lesions. Overall complete resection rates ranged from 73 to 96.7 per cent. Three studies included over 300 patients, and complete resection rates in these studies varied between 89.5 and 96.7 per cent. The risk of seed migration and failure of seed placement ranged from 0 to 0.6 per cent and 0 to 7.2 per cent respectively. CONCLUSION: Available scientific evidence suggests that RSL is a safe and accurate technique for localization of non-palpable breast lesions.
Cheville AL, Brinkmann DH, Ward SB, et al. The addition of SPECT/CT lymphoscintigraphy to breast cancer radiation planning spares lymph nodes critical for arm drainage. Int J Radiat Oncol Biol Phys. 2013; 85(4):971-7 [PubMed]
BACKGROUND: This prospective cohort study was designed to determine whether the amount of radiation delivered to the nonpathological lymph nodes (LNs) that drain the arm can be significantly reduced by integrating single-photon emission computed tomography (SPECT)/computed tomography (CT) scans into radiation treatment planning. METHODS: SPECT-CT scans were acquired for the 28 patients with stage I or II breast cancer and fused with the routinely obtained radiation oncology planning CT scans. Arm-draining LNs were contoured with 0.5-cm margins automatically using a threshold of 50% maximum intensity. Two treatment plans were generated: 1 per routine clinical practice (standard; STD) and the second (modified; MOD) with treatment fields modified to minimize dose to the arm-draining LNs visible on SPECT/CT images without interfering with the dosage delivered to target tissues. Participants were treated per the MOD plans. Arm volumes were measured prior to radiation and thereafter at least three subsequent 6-month intervals. RESULTS: Sixty-eight level I-III arm-draining LNs were identified, 57% of which were inside the STD plan fields but could be blocked in the MOD plan fields. Sixty-five percent of arm-draining LNs in the STD versus 16% in the MOD plans received a mean of ≥10 Gy, and 26% in the STD versus 4% in the MOD plans received a mean of ≥40 Gy. Mean LN radiation exposure was 23.6 Gy (standard deviation 18.2) with the STD and 7.7 Gy (standard deviation 11.3) with the MOD plans (P<.001). No participant developed lymphedema. CONCLUSIONS: The integration of SPECT/CT scans into breast cancer radiation treatment planning reduces unnecessary arm-draining LN radiation exposure and may lessen the risk of lymphedema.
Ren G, Kang Y A one-two punch of miR-126/126* against metastasis. Nat Cell Biol. 2013; 15(3):231-3 [PubMed]
MicroRNAs regulate cancer metastasis by modulating both the intrinsic properties of tumour cells and their interactions with the tumour stroma. Both strands of the miR-126/miR-126* duplex are now shown to simultaneously target the Sdf-1α cytokine to reduce the recruitment of mesenchymal stem cells and inflammatory monocytes to primary tumours, thereby inhibiting lung metastasis.
Madani SY, Tan A, Naderi N, Seifalian AM Application of OctaAmmonium-POSS functionalized single walled carbon nanotubes for thermal treatment of cancer. J Nanosci Nanotechnol. 2012; 12(12):9018-28 [PubMed]
INTRODUCTION: Single walled carbon nanotubes (SWCNTs) have distinctive physical and chemical properties. Additionally, innovative properties can be established to match the clinical need by attachment of functional groups to the SWCNT. In this experiment SWCNT was functionalized with OctaAmmonium-POSS. Evidence suggests that functionalization of SWCNT with OctaAmmonium-POSS would augment the dispersion of SWCNT. We further postulate that functionalization of SWCNT with OctaAmmonium-POSS would enhance the temperature increase of SWCNT upon exposure to NIR laser irradiation. METHODS: Functionalization of SWCNT was conferred by refluxing with acid and OctaAmmonium-POSS. Fourier Transform Infrared (FTIR) test UV-visible spectroscopy and morphology analysis using Transmission Electron Microscopy (TEM) confirmed successful functionalization of SWCNT. NIR irradiation of samples was conducted using an 808 nm laser at 1 watt. Temperature changes were documented using a thermal camera. A HT-29 colorectal cancer cell line was used as a model for photothermal ablation. Cell viability test was performed using trypan blue and fluorescence activated cell sorting (FACS) technique. Graph plotting and statistical analysis was conducted using Graph Pad Prism. RESULTS: Following the functionalization process, TEM images showed a layer on the surface of the SWCNT. In the FTIR experiment, results illustrated the presence of the -COOH group on the functionalized SWCNTs. Upon further functionalization of SWCNT with OctaAmmonium-POSS, various peaks determined the formation of amide bond between the POSS molecule and functionalized SWCNT. The UV-visible spectra also determine the successful functionalization of the SWCNT following its treatment with acid and OctaAmmonium-POSS. Upon exposure to NIR, OctaAmmonium-POSS-SWCNT was the only treatment group that illustrated significantly higher temperature increase than the other treatment groups. Additionally cell death of NIR irradiated OctaAmmonium-POSS-SWCNT was statistically significant compared to other treatment groups. CONCLUSION: OctaAmmonium-POSS was used to render SWCNT biocompatible and water dispersible. Observation from this study determines that functionalization with OctaAmmonium-POSS show greater temperature increase compared to pristine SWCNTs upon its exposure NIR. This significant temperature increase is due to increasing the solubility of SWCNT following its functionalization with OctaAmmonium-POSS.
Marcos AL, El Gaaied AB, Ayed FB, et al. Lymphedema of the arm after surgery for breast cancer: new physiotherapy. Clin Exp Obstet Gynecol. 2012; 39(4):483-8 [PubMed]
Secondary lymphedema of the upper limb is a complication which can be found in patients who have undergone surgical breast cancer treatment with an axillary dissection. Lymphedema following breast cancer treatment remains a long-term disabling complication which cannot be treated in a decisive and radical manner. The objective of the treatment is to limit complications, to try to preserve the remaining lymphatic system and to develop new anastomosis. It consists of a specific decongestive physiotherapy, which may include a specific lymphatic drainage and skin mobilization, reducing bandages including Mobiderm (Thuasne), and sub-bandage muscular exercises. However variations in the therapy have been recorded by different teams. Our experience in treating lymphedema in Tunisia takes into consideration the epidemiological, climatic, cultural and socio-economic conditions of the country. The difference in our treatment compared to what is being advocated elsewhere essentially consists of the no muscular exercise while wearing a bandage. This is compensated for by daily domestic activities, by prolonging the first two phases of treatment (the intensive phase and the stabilization phase), and by the use of the hydro gel dressing Hydrosob (Hartmann) to prevent blisters induced by the pressure imposed by Mobiderm studs of the bandage on the skin, and also by the superimposition of two types of Mobiderm bandages (small and large blocks).
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