Impact of social support on body image during chemotherapy in patients with breast cancer: The chain mediating role of depression and self-efficacy

Objective

To explore the mediating roles of depression and self-efficacy in the relationship between social support and body image in patients with breast cancer during chemotherapy.

Methods

A convenience sampling method was employed to survey 647 breast cancer chemotherapy patients. The survey included validated scales assessing social support, depression, self-efficacy, and body image. The chain mediation model was established using Mplus 8.3 software.

Results

Social support was negatively correlated with depression (P < 0.001) and poor body image (P < 0.001) and positively correlated with self-efficacy (P < 0.001). Social support indirectly affected body image through three mediating pathways: depression (β = -0.084, P < 0.001), self-efficacy (β = -0.060, P < 0.01), and the depression-self-efficacy pathway (β = -0.058, P < 0.001). The indirect effect accounted for 55.96% of the total effect.

Conclusions

The results support our hypothesis. Enhancing social support, alleviating depression, and improving self-efficacy through psychological interventions are recommended to improve body image in breast cancer patients during chemotherapy.

Intervention study of Yanghe decoction on plasma cell mastitis based on mammary microecology and metabolomics investigation

Plasma cell mastitis (PCM), a chronic breast inflammatory disease, is characterized by ductal dilatation and plasma cell infiltration. Traditional Chinese Medicine (TCM) Yanghe decoction is used to relieve mastitis symptoms clinically. However, its efficacy and mechanism on PCM remain undefined. The PCM patients receiving dexamethasone and metronidazole tablets, served as control group, with the other group receiving combination of Yanghe decoction, 15 cases each. Main symptom indicators included mass size, skin colour, skin temperature, breast pain, blood cell count (WBC), C reactive protein (CRP), interleukin (IL)-6, IL-4, serum prolactin (PRL), erythrocyte sedimentation rate (ESR), immunoglobulin A (IgA), IgM, and IgG levels. Secondary indicators included TCM syndrome and anxiety/depression scores. Breast differential flora (DF) and metabolites (DAMs) post-treatment between two groups were detected by 16S rRNA sequencing and metabolomics, with further correlation analysis. Post-treatment symptom scores exhibited lower than pre-treatment in both groups, with greater decline on WBC, CRP, IL-6, IL-4, PRL, and ESR, and enhanced IgA, IgM, and IgG levels in Yanghe decoction group than in control group. Notably, Yanghe decoction group demonstrated no significant DF, with decreased Corynebacterium and Rhodococcus, and elevated Staphylococcus, which correlated significantly with the above indicators. Moreover, 43 DAMs were detected between these two groups, with Glycerophosphocholine, 9,10-Epoxyoctadecenoic acid, Arachidic acid, and 4,5-Dihydroorotic acid showing strong correlations with the above flora. Based on the clarification of PCM improvement with Yanghe decoction, we preliminarily explored potential roles of breast tissue microorganisms and DAMs, providing scientific basis for its clinical application and potential clinical biomarkers in PCM.

Cytoplasmic and nuclear programmed death ligand 1 expression in peritumoral stromal cells in breast cancer: Prognostic and predictive value

BACKGROUND

Breast cancer (BC) continues to occupy a leading position in terms of morbidity and mortality from malignant neoplasms among the female population. One of the promising markers associated with BC progression is programmed death ligand 1 (PD-L1). Previously, we investigated PD-L1 expression in BC via a new antibody against programmed cell death protein 1 ligand 1 (PDCD1 LG1) and reported that high PDCD1 LG1 expression in tumor cells is an independent factor for a high risk of regional metastasis in patients with BC. However, the prognostic significance of PDCD1 LG1 expression in BC stromal cells has not been adequately studied.

AIM

To study the features of PDCD1 LG1 expression in BC stromal cells and its relationship with BC clinicopathological characteristics.

METHODS

In a prospective single-center observational study, tumor samples from 148 patients with newly diagnosed BC were examined. The tumor sections were immunohistochemically stained with antibodies against PDCD1 LG1. In the tumor samples, the PDCD1 LG1-positive lymphocyte (PDCD1 LG1+ LF) score, presence of nuclear PDCD1 LG1 expression in the LFs, PDCD1 LG1 expression in polymorphic cell infiltrates (PDCD1 LG1+ polymorphic cell infiltrates [PCIs]), and cells of the fibroblastic stroma and endothelial cells of the tumor microvessels were assessed. Statistical analyses were performed using Statistica 10.0 software.

RESULTS

A PDCD1 LG1+ LF score ≥ 3 was detected more often at stages N0 and N3 than at N1 and N2 (P = 0.03). Moderate and pronounced PDCD1 LG1+ PCIs and the presence of PDCD1 LG1+ fibroblastic stroma were associated with negative estrogen receptor status (P = 0.0008 and P = 0.03, respectively), human epidermal growth factor receptor 2-positive (HER2+) BC (P < 0.00001 and P = 0.0005), and luminal B HER2+, non-luminal HER2+ and triple-negative BC (P < 0.00001 and P = 0.004). The risk of metastasis to regional lymph nodes (RLNs) depend on lymphovascular invasion (LVI) and the PDCD1 LG1+ LF score. In the absence of LVI and a PDCD1 LG1+ LF score < 3 or ≥ 3, metastases in RLNs were absent in 66.6% and 93.9% of patients with BC, respectively. In the presence of LVI and a PDCD1 LG1+ LF score < 3 or ≥ 3, metastases in RLNs were detected in 82.6% and 92.7% of patients with BC, respectively.

CONCLUSION

The results indicated that the combined assessment of the PDCD1 LG1+ LF score and LVI can improve the accuracy of predicting the risk of metastasis to RLNs in patients with BC.

Financial Toxicity and Breast Cancer: Why Does It Matter, Who Is at Risk, and How Do We Intervene?

Financial toxicity, or the financial burden patients experience because of medical costs, can lead to negative patient effects including lower quality of life, compromised clinical care, and worse health outcomes. People with cancer and survivors are more likely to have financial toxicity than those without cancer, and patients with breast cancer are uniquely at risk. Patients with breast cancer often require multimodal treatment (surgery, radiation, and/or systemic therapy) and adjuvant hormonal therapy can continue for years after primary treatment. With improved disease outcomes, patients with breast cancer have prolonged survivorship often lasting decades but may carry chronic toxicities from treatment; both ongoing treatment of metastatic disease and long-term surveillance include continued tests, imaging, and medical visits that add to the cumulative burden on patients and their families. Additionally, breast cancer predominately affects women, who are more likely to have dual caregiver responsibilities, and increasingly is diagnosed in younger patients, who may have fertility preservation expenses and are more likely to experience education and/or employment disruption. When faced with high costs, patients may face difficult decisions regarding what sacrifices they are willing to endure to receive care. Interventions designed to reduce financial toxicity are moving out of the pilot phase, and ongoing randomized trials are expected to provide evidence into the effectiveness of financial navigation programs. Further work to address financial toxicity in breast cancer at the patient-provider, institutional, and governmental levels is needed for comprehensively better financial outcomes and quality of life.

Revisiting low complications of VICRYL mesh in breast reconstruction: Insights from an updated systematic review

Background

Alloplastic breast reconstruction continues to be the most prevalent breast reconstruction performed in the United States. Plastic surgeons are challenged to recreate the breast footprint after the ablative surgeon's mastectomy. Mesh augmentation has emerged as a valuable tool in controlling implant migration. Several soft tissue support breast meshes have been introduced, each characterized by a different risk profile, cost, and associated complications.

Objectives

This manuscript presents a comprehensive systematic review, with updated data over the last decade, of the use of a resorbable and less costly VICRYL (Ethicon, Somerville, NJ, USA) mesh in breast reconstruction after mastectomy.

Methods

The authors conducted a systematic review of the use of VICRYL mesh in breast reconstruction using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors queried five databases. Data was collected using a standardized form and underwent review using set inclusion and exclusion criteria. The primary outcome variable was reconstructive failure, with secondary outcomes including seroma, hematoma, skin necrosis, and infection.

Results

A total of 693 articles were found after the multi database search. Forty articles met inclusion criteria. Following full text review, six articles analyzing 511patients were included. VICRYL mesh was utilized in 711 breast reconstructions, of which 5% were complicated by reconstructive failure (confidence interval (CI): 4.75-5.25%); 1.6% by seroma (CI: 1.53-1.67%); 3.33% by infection (CI: 3.14-3.52%); 1.83% by hematoma (CI: 1.71-1.95%); and 6.33% by skin necrosis (CI: 6.03-6.63%).

Conclusion

VICRYL mesh repeatedly demonstrates low reconstructive failure in breast reconstruction with an acceptable complication profile.

Dynamic predictive power of TP53 signatures in breast cancer prognosis: Pre- and post-neoadjuvant chemotherapy insights

BACKGROUND

The TP53 signature determined using a biopsy specimen before neoadjuvant chemotherapy (pre-NAC biopsy specimens) predicts NAC response and prognosis in breast cancer. We aimed to compare the clinical utility of the TP53 signature determined using pre-NAC biopsy specimens and surgical specimens after NAC (post-NAC surgical specimens).

METHODS

This observational cohort study included patients with paired pre-NAC biopsy and post-NAC surgical specimens, analyzing the association between the TP53 signature from each specimen and prognosis (UMIN000042055).

RESULTS

Pre-NAC biopsy specimens classified 71 patients into those having a TP53 mutant signature (pre-mt, n = 47) and wild-type signature (pre-wt, n = 24), with the same for post-NAC surgical specimens (post-mt, n = 16 and post-wt, n = 55). Among the 47 pre-mt patients, 31 became post-wt (pre-mt/post-wt), whereas 16 remained post-mt (pre-mt/post-mt). All pre-wt patients remained post-wt (pre-wt/post-wt). Recurrence-free survival (RFS) was significantly shorter in the pre-mt group than in the pre-wt group, although no significant difference was observed between the post-mt and post-wt groups. Change in the TP53 signature following NAC did not affect predictive ability of the TP53 signature determined using pre-NAC biopsy specimens.

CONCLUSIONS

The TP53 signature status should be determined using pre-NAC biopsy specimens.

Role of imaging based response assesment for adapting neoadjuvant systemic therapy for breast cancer: A systematic review

PURPOSE

The objective of this systematic review is to investigate the role of imaging in response monitoring during neoadjuvant systemic therapy (NST) for breast cancer and assess whether treatment modifications based on imaging response are implemented in clinical practice.

METHODS

A systematic review was conducted, analyzing five clinical practice guidelines and 147 clinical trial publications involving NST for breast cancer. The snowballing technique was employed, using a "start set" of clinical guidelines to trace relevant trials. Additionally, a PubMed search was conducted to identify trials published between 2023-2024. The review analyzed the use of imaging modalities, timing, and response criteria, and whether escalation, de-escalation, or change of treatment occurred based on imaging response.

RESULTS

Imaging was utilized in 81 % (119/147) of the trials, with ultrasound, MRI, and mammography being the most frequently employed modalities. Mid-treatment imaging was applied in 56 % (83/147) of the trials. However, only 15 % (22/147) of the trials implemented treatment modifications based on imaging response, highlighting the limited application of imaging response-guided therapy. No standardized imaging protocols or consistent response-guided treatment strategies were identified across the trials or clinical practice guidelines, with considerable variability in imaging methods, timing, and response criteria.

CONCLUSION

This systematic review underscores the critical need for standardized imaging protocols, response assessment criteria and image-guided treatment decisions. It is therefore evident that imaging for response monitoring during treatment should preferably be performed within clinical trials.

Using Integrative Therapies to Improve Patient-Reported Outcomes in Breast Cancer Survivors: A Living Evidence-Based Clinical Practice Guideline

AIM

Breast cancer imposes a serious disease and economic burden on patients. This guideline aims to develop a living evidence-based clinical practice recommendations to guide the use of integrative therapies for the improvement of patient-reported outcomes (PROs) in breast cancer survivors.

METHODS

We searched systematic reviews and meta-analyses or conducted de nova systematic reviews and meta-analyses to support the recommendations. The grading of recommendations, assessment, development, and evaluation approach was used to rate the certainty of evidence and the strength of recommendations.

RESULTS

The guideline panel issued 17 recommendations: for alleviating anxiety, strong recommendations in favor of muscle relaxation training, yoga, acceptance and commitment therapy, cognitive behavioral therapy, psychological education, and Tai Chi in general breast cancer survivors; for alleviating depression, strong recommendations in favor of mindfulness therapy, cognitive behavioral therapy, group psychotherapy, muscle relaxation training, acceptanceand commitment therapy in general breast cancer survivors, and exercise intervention for patients received radiotherapy; for sleep quality, conditional recommendations for all therapies; for pain, strong recommendations in favor of exercise intervention for postoperative breast cancer survivors; for alleviating fatigue, strong recommendations in favor of mindfulness therapy and group psychotherapy in general breast cancer survivors; for improving the quality of life, strong recommendations in favor of mindfulness therapy in general breast cancer survivors, Baduanjin and exercise intervention for patients undergoing anticancer treatment.

CONCLUSION

This proposed guideline provides recommendations for improving the PROs of breast cancer survivors. We hope these recommendations can help support practicing physicians and other healthcare providers for breast cancer survivors.

Treatment patterns and outcomes in HER2-low metastatic breast cancer patients previously treated with chemotherapy: a US real-world cohort study

PURPOSE

Real-world outcomes are poorly understood for patients with human epidermal growth factor receptor 2 (HER2)-low (immunohistochemistry 1+ or 2+ with negative in situ hybridization) metastatic breast cancer (mBC).

METHODS

Using for the first time a nationwide electronic health record-derived de-identified database, we assessed demographics, treatment patterns, and outcomes of patients with HER2-low mBC who previously received one line of chemotherapy in the metastatic setting. The post-chemotherapy line was termed the index line of therapy (LOT).

RESULTS

3765 patients [hormone receptor (HR)-positive: 78.8%, HR-negative: 21.0%] met the inclusion criteria (1 January 2011-30 April 2023). 61.7% of HR-positive patients received endocrine therapy prior to the index LOT. The largest patient percentage received single-agent chemotherapy at the index and subsequent two LOTs. For the overall cohort, the median real-world time to treatment discontinuation/death was 4.1 months (95% CI: 3.9-4.2) and the median real-world time to next treatment/death was 5.1 months (95% CI: 4.8-5.3) from the index LOT. Median real-world overall survival (all patients) was 15.8 months (95% confidence interval: 15.2-16.5, median follow-up = 54.5 months) from the index LOT.

CONCLUSION

These data highlight the unmet clinical needs of patients with HER2-low mBC by characterizing the treatment patterns and poor outcomes in this population on the current standard of care.

Impact of risk and lifestyle factors on therapy goals in the treatment of breast cancer and gynecological cancer patients with integrative medicine

BACKGROUND

As a result of advancements in the diagnosis and therapy of cancer, the prognosis for cancer patients has significantly improved. The benefits of a significantly enhanced survival time lead to a more extensive concern with quality of life and managing the side effects during oncological treatment. Implementing integrative medicine strategies has been found to reduce the side effects of therapy and disease. In 2021 the S3 guideline on complementary medicine in oncology was published for the first time, which takes a stand on the most common aspects of complementary and integrative medicine in Germany. The aim was to see whether a previous healthy life style impacts the success of integrative medicine for patients.

METHODS

Within the framework of a cross-sectional study over 15 months, 120 cancer patients were monitored at a standardized integrative medicine consultancy service at the University Integrative Medicine Center of the University Hospital Erlangen, Department of Gynecology and Obstetrics. The basic questionnaire consisted of questions on socioeconomic background information, lifestyle factors, such as dietary habits or smoking behavior, as well as information on the gynecological situation. Furthermore, an evaluation based on patient-reported therapy goals concerning the reduction of side effects of conventional cancer treatments, enhancement of disease-related quality of life and better stress and disease management, active participation in cancer treatments, mind-body stabilization, and improvements in coping strategies were assessed. In addition, the impact of patient characteristics and lifestyle on the subjective achievement of these outcomes was evaluated to set the answers in context and show its influence. Statistical analysis was performed using SPSS Statistics for Windows version 26 (IBM Corporation, Armonk in New York, USA). Mean, standard deviation, minimum, and maximum were calculated for age and BMI. The other characteristics regarding demographics, lifestyle, tumor disease, and therapy were analyzed based on their respective absolute and relative frequencies.

RESULTS

A large majority of the patients' participation goal was to reduce cancer-related side effects (90.8%), second were the aspects of "Improvement of the disease-related quality of life "(72.5%). In both cases, this common goal was only fully achieved for about one quarter of the patients (25.7%/24.1%), but partially achieved in more than half of the asked patients (53.2%/52.9%). Half of the patients reported that they achieved active participation in cancer treatment with integrative medicine. Around 50% partially achieved stabilization of the body, soul, and spirit, stress, disease management, improvement in cancer-related quality of life, and reduced the side effects of conventional cancer therapies. The success of integrative therapy was independent of age, BMI, family status, children, level of education, insurance type, alcohol and tobacco consumption, sport, low-fat diet, daily fruit and vegetable servings, interest in diets, and previous use of diets.

CONCLUSIONS AND DISCUSSION

Using a standardized procedure in integrative medicine allows patients to receive high-quality care. The previous standard of living has no effect on the benefits of integrative medicine for the patient. The goals through the use of integrative medicine could be achieved by all patient groups. It is highly encouraged to incorporate counseling and evidence-based integrative medicine into the clinical routines of cancer centers and adapt postgraduate medical education. Finally, the evidence base for the recommendations should also be strengthened by further research into the use of integrative medicine.

Advances in understanding therapeutic mechanisms of probiotics in cancer management, with special emphasis on breast cancer: A comprehensive review

The increasing global prevalence of cancer, particularly breast cancer, necessitates the development of innovative therapeutic strategies. Probiotics, proficient in promoting gut health, have emerged as promising candidates for cancer treatment due to their immunomodulatory and potential anticancer properties. This review focuses on the therapeutic mechanisms of probiotics in breast cancer, examining their anticancer efficacy through metabolic, immune, and molecular mechanisms. Probiotics enhance cancer therapies, minimize side effects, and offer new adjuvant approaches in oncology. Recent advancements discussed in the review include the utilization of probiotics as oncolytic gene expression systems and drug delivery vectors, as well as personalized probiotic interventions aimed at optimizing cancer therapy. Clinical studies are critically evaluated, highlighting both the outcomes and limitations of probiotic use in cancer patients, particularly those suffering from breast cancer. Additionally, the review explores factors influencing anticancer effects of probiotics, focusing on their role in modulating the tumor microenvironment. Challenges in translating preclinical findings to clinical practice are discussed, along with future research directions, focusing on the relationship between probiotics, the microbiome, and cancer treatment. Ultimately, this review advocates for further investigation into the therapeutic potential of probiotics in breast cancer, aiming to harness their benefits in oncology.

Evaluating the effects of e-health interventions on mental health outcomes in individuals with breast cancer: A systematic review

Individuals with breast cancer (BC) often experience significant psychological distress throughout their cancer journey, and while e-health interventions show promise, evidence of their effectiveness remains limited. This systematic review addresses this gap by evaluating the effects of e-health interventions on mental health outcomes among individuals with BC. This study followed PRISMA guidelines and was registered with PROSPERO (CRD42024543722). A comprehensive search was conducted from July to August 2024, using Scopus, Web of Science, and Ovid Medline databases. Studies were included if they: (1) applied experimental study designs, (2) implemented e-health interventions to improve mental health outcomes, and (3) focused specifically on individuals with BC. Two reviewers used Rayyan software and the predefined criteria for article exclusion and inclusion. Seven studies, predominantly from countries with high BC incidence rates and advanced healthcare systems, met the inclusion criteria. Thematic analysis revealed that e-health interventions improved psychological well-being, coping strategies, quality of life, physical health, and cancer-specific symptom management. However, diverse intervention designs and measurement tools hindered cross-study comparison. Many studies focused on general mental health measures, neglecting crucial aspects such as help-seeking behaviors, cognitive function, and concerns about cancer recurrence. Future research should standardize intervention protocols, ensure comprehensive outcome reporting, and expand mental health measures.

Impact of methotrexate monotherapy in patients with idiopathic granulomatous mastitis

OBJECTIVES

Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It is characterized by chronic inflammation and granuloma formation. We designed this study to assess the compliance and remission status of patients with IGM on methotrexate treatment.

METHODS

The study included 114 patients who were treated with methotrexate for at least 1 year after a biopsy-proven diagnosis of IGM at a tertiary rheumatology center between January 2017 and February 2024. Demographic characteristics, clinical findings, laboratory parameters, treatment options and patient compliance with treatment were obtained from patient files.

RESULTS

The mean age of patients diagnosed with IGM was 32.3 ± 6.3 years. Patients were treated with a combination of methotrexate, and complete remission was achieved in 97 patients (85.1%) after an average of one year. When Kaplan-Meier analysis was performed for the average annual methotrexate use, the average duration of drug use in patients with IGM was found to be 11.24 (10.88-11.49) months.

CONCLUSION

The use of methotrexate treatment in IGM patients has been shown to be both successful and well tolerated when evaluated according to the duration of drug administration.

Combination therapy and dual-target inhibitors based on cyclin-dependent kinases (CDKs): Emerging strategies for cancer therapy

Cyclin-dependent kinases (CDKs) are pivotal regulators of the cell cycle and transcriptional machinery, making them attractive targets for cancer therapy. While CDK inhibitors have demonstrated promising clinical outcomes, they also face challenges in enhancing efficacy, particularly in overcoming drug resistance. Combination therapies have emerged as a key strategy to augment the effectiveness of CDK inhibitors when used alongside other kinase inhibitors or non-kinase-targeted agents. Dual-target inhibitors that simultaneously inhibit CDKs and other oncogenic drivers are gaining attention, offering novel avenues to optimize cancer therapy. Based on the structural characterization and biological functions of CDKs, this review comprehensively examines the structure-activity relationship (SAR) of existing dual-target CDK inhibitors from a drug design perspective. We also thoroughly investigate the preclinical studies and clinical translational potential of combination therapies and dual-target inhibitors. Tailoring CDK inhibitors to specific cancer subtypes and therapeutic settings will inspire innovative approaches for the next generation of CDK-related therapies, ultimately improving patient survival.

MGAT3 and MGAT5 overexpression alters the protein cargo of extracellular vesicles released by metastatic melanoma cells

Extracellular vesicles (EVs) are potential non-invasive diagnostic, prognostic and therapeutic tools. Additionally, they are important contributors to tumorigenesis. Glycosylation has been found to modulate the composition of the EV proteome. Increased amounts of β1,6-branched N-glycans, synthesized by N-acetylglucosaminyltransferase V (GnT-V), are most commonly observed in melanoma and are associated with decreased cell adhesion and increased metastasis. The opposite effect is caused by the addition of bisecting GlcNAc by N-acetylglucosaminyltransferase III (GnT-III). To date, the impact of these enzymes on EV cargo in melanoma remains unexplored. Flow cytometry was used to study the surface glycosylation of genetic variants of WM266-4 melanoma cells with induced overexpression of GnT-III or GnT-V encoding genes (MGAT3 or MGAT5) and EVs released by these cells. LC-MS/MS proteomics was applied to analyze the effect of altered glycosylation on the proteome of released EVs, followed by detailed bioinformatic analysis. Flow cytometry analysis revealed dynamic changes in the surface glycosylation of EVs derived from melanoma cells overexpressing MGAT3 or MGAT5. Induced overexpression of MGAT3 or MGAT5 also caused significant changes in the proteome of EVs. The proteomic analysis identified a total of 1770 microvesicular and 704 exosomal proteins that play different roles in melanoma progression, including those with established diagnostic/prognostic potential and those closely associated with melanoma onset. Proteomic profiling of EVs derived from cells overexpressing MGAT3 and MGAT5 revealed functional changes in EV protein content driven by glycosylation modifications. The study presented a potential multifaced application of melanoma-derived EVs for diagnostic and prognostic purposes.

Dysfunctional mismatch repair in patients with early triple-negative breast cancer

BACKGROUND

While mismatch repair (MMR) deficiency is well-characterized in several cancers, its role in triple-negative breast cancer (TNBC) remains unclear. We comprehensively assessed MMR in early-stage TNBC, examining its prevalence, clinical correlations, prognostic value, relationship with microsatellite instability (MSI), and patterns of intratumoral heterogeneity.

METHODS

Two early-stage TNBC cohorts were investigated for germline mutations using next-generation sequencing, protein expression by immunohistochemistry, and MSI status through molecular detection. Associations with clinicopathological characteristics and survival were examined. Results were validated using The Cancer Genome Atlas (TCGA) data.

RESULTS

Among 259 patients, MMR deficiency was observed in 8.2%, all showing PMS2 loss, while 2 germline PMS2 mutations (2.7%) were detected. At the somatic level, 35.8% showed heterogeneous MMR expression, more frequently in earlier stages (IA-IIA 41.4% vs. IIB-III 22.4%, p = 0.04) and smaller tumors (cT1-2 39.1% vs. cT3-4 18.5%, p = 0.01). MMR status showed no significant associations with other clinicopathological variables or survival. No MSI was detected in MMR-deficient cases. The 5-year recurrence rate was 16.0% (95% CI 10.0-24.0) for MMR-intact, 20.0% (95% CI 4.5-43.0) for MMR-deficient, and 17.9% (95% CI 9.8-28.1) for heterogeneous tumors (p = 0.75). Pathological complete response to neoadjuvant chemotherapy was similar across MMR status groups. These findings were consistent with analyses using TCGA data.

CONCLUSION

MMR system shows a low rate of alterations in TNBC, with its deficiency being infrequent and not correlated with MSI. Although MMR system isolated evaluation may not be justified in early-stage TNBC due to its limited clinical impact, its inclusion in multigene panels should be further considered.

Cost-Effectiveness Analysis of Pembrolizumab Plus Chemotherapy Compared with Chemotherapy as First-Line Treatment for Advanced PD-L1-Positive Triple-Negative Breast Cancer from a Japanese Healthcare Perspective

BACKGROUND AND OBJECTIVES

Pembrolizumab has been approved for the immunotherapy of programmed death ligand 1 (PD-L1)-positive triple-negative breast cancer (TNBC) based on the KEYNOTE-355 trial. However, cost-effectiveness evidence is limited. The purpose of this study was to evaluate the cost-effectiveness of pembrolizumab plus chemotherapy compared with chemotherapy alone for patients with PD-L1-positive inoperable or metastatic TNBC from a Japanese healthcare perspective.

METHODS

The cost-effectiveness analysis was performed for pembrolizumab, of which the drug price was determined at 214,498 Japanese yen (JPY), or 1631 US dollars (USD) (1 USD = 131.5 JPY) for KEYTRUDA® (100 mg), using a partition survival model based on the KEYNOTE-355 trial subgroup analysis in Japan. The comparison was made using quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). One-way deterministic and probabilistic sensitivity analyses (PSA), which evaluate the impact of parameter uncertainty, were performed to assess the robustness and calculate the acceptable probability, defined as the probability of the ICER being below the willingness-to-pay (WTP).

RESULTS

Pembrolizumab plus chemotherapy provided an additional 0.676 QALYs at an incremental cost of 8,503,072 JPY. The ICER for pembrolizumab plus chemotherapy compared with conventional chemotherapy was 12,577,178 JPY (95,644 USD) per QALY. The ICER per QALY was below the willingness-to-pay threshold of 15,000,000 JPY. PSAs revealed that the acceptable probability was 83.9% at 15,000,000 JPY.

CONCLUSIONS

The pembrolizumab plus chemotherapy is likely to be a cost-effective option compared with conventional chemotherapy for patients with PD-L1-positive inoperable or metastatic TNBC in a Japanese medical environment from a healthcare system.

Idiopathic granulomatous mastitis: TNFi effectivity in a retrospective inception cohort

OBJECTIVES

Idiopathic granulomatous mastitis is a rare, chronic, inflammatory breast disease that can mimic breast carcinoma. Histologicaly there are giant cells and epitheloid histiocytes forming non-caseating granulomas. Corticosteroids, methotrexate, azathioprine, intralesional corticosteroid injection can be used as the first step drugs in the treatment of patients with Idiopathic granulomatous mastitis, but the next step is unclear in a group of patients who are resistant to these treatments. Many of these patients also undergo unnecessary surgical interventions. Tumor necrosis factor-alpha (TNF-α) plays a role in maintaining the granuloma structure. There is few case reports and very limited data in the literature regarding TNF-α inhibitor treatment in resistant patients. Our aim is to show that TNF-α inhibitors may be an alternative for refractory patients in the treatment of idiopathic granulomatous mastitis.

METHODS

The data of 25 female patients with idiopathic granulomatous mastitis who were refractory to conventional therapies and started TNF-α inhibitors were retrospectively analyzed. Pre- and post-treatment M scores of the patients were calculated.

RESULTS

We observed that the M-scores of our patients decreased as the duration of TNF-α inhibitors use increased.

CONCLUSION

Our study contains the largest number of patients with data on the use of TNF-α inhibitors in the treatment of idiopathic granulomatous mastitis. We believe that our study will contribute to the development of idiopathic granulomatous mastitis treatment algorithms. Key Points • TNF-α inhibitors may be an alternative for refractory patients in the treatment of idiopathic granulomatous mastitis.

Metabolomics as a tool for understanding and treating triple-negative breast cancer

Triple-negative breast cancer (TNBC) is an aggressive and heterogeneous variant of breast cancer distinguished by a lack of targeted therapies, posing significant challenges in diagnosis and treatment. Metabolomics, the comprehensive study of small compounds in biological systems, has been identified as an instrument for revealing the metabolic underpinnings of TNBC. This review highlights recent advancements in metabolomic approaches, such as mass spectrometry and nuclear magnetic resonance, which have identified metabolic vulnerabilities, resistance mechanisms, and potential therapeutic targets. Key findings include alterations in fatty acid, amino acid, and glutathione metabolism, along with hypoxia-driven metabolic reprogramming that contributes to disease progression. The combination of metabolomics with multi-omics techniques, supported by advanced computational methods such as machine learning, offers a pathway to overcome challenges in data standardization and biological complexity. Emerging strategies, including the use of artificial intelligence and multidimensional omics approaches, are paving the way for personalized medicine by enabling the discovery of novel biomarkers and targeted therapies. Despite these advances, significant hurdles remain, including the need for robust data standardization, validation of findings in diverse patient cohorts, and seamless integration with clinical workflows. By addressing these challenges, metabolomics has the potential to revolutionize TNBC management, offering tools for early detection, precision therapy, and improved patient outcomes. This review underscores the importance of interdisciplinary collaboration to translate metabolomic insights into actionable clinical applications.

Inter-reader agreement of the BI-RADS CEM lexicon

PURPOSE

The purpose of this study was to assess the inter-reader agreement of the breast imaging reporting and data system (BI-RADS) contrast-enhanced mammography (CEM) lexicon.

MATERIALS AND METHODS

In this IRB-approved, single-center, retrospective study, three breast radiologists, each with different levels of experience, reviewed 462 lesions in 421 routine clinical CEM according to the fifth edition of the BI-RADS lexicon for mammography and to the first version of the BI-RADS lexicon for CEM. Readers were blinded to patient outcomes and evaluated breast and lesion features on low-energy (LE) images (breast density, type of lesion, associated architectural distortion), lesion features on recombined (RC) images (type of enhancement, characteristic of mass enhancement, non-mass enhancement or enhancing asymmetry), and provided a final BI-RADS assessment. The inter-reader agreement was calculated for each evaluated feature using Fleiss' kappa coefficient. Sensitivity and specificity were calculated.

RESULTS

The inter-reader agreement was moderate to substantial for breast density (ĸ = 0.569), type of lesion on LE images (ĸ = 0.654), and type of enhancement (ĸ = 0.664). There was a moderate to substantial agreement on CEM mass enhancement descriptors. The agreement was fair to moderate for non-mass enhancement and enhancing asymmetry descriptors. Inter-reader agreement for LE and LE with RC BI-RADS assessment was moderate (ĸ = 0.421) and fair (ĸ = 0.364). Diagnostic performance was good and comparable for all readers.

CONCLUSION

Inter-reader agreement of the CEM lexicon was moderate to substantial for most features. There was a low agreement for some RC descriptors, such as non-mass enhancement and enhancing asymmetry, and BI-RADS assessment, but this did not impact the diagnostic performance.

KEY POINTS

Question Data on the reproducibility and inter-reader agreement for the first version of the BI-RADS lexicon dedicated to CEM are missing. Finding The inter-reader agreement for the lexicon was overall substantial to moderate, but it was lower for the descriptors for non-mass enhancement and enhancing asymmetry. Clinical relevance A common lexicon simplifies communication between specialists in clinical practice. The good inter-reader agreement confirms the effectiveness of the CEM-BIRADS in ensuring consistent communication. Detailed definitions of some descriptors (non-mass, enhancing asymmetry) are needed to ensure higher agreements.

Radioligand Therapy in Metastatic Breast Cancer: Harnessing Precision Oncology

Radioligand therapy (RLT) represents a promising advancement in precision oncology and enables the targeted delivery of radiation to cancer cells. This approach has shown success in other tumor types, such as prostate cancer and neuroendocrine tumors. Its potential in metastatic breast cancer (mBC) is currently under investigation. This review discusses RLT mechanism of action, therapeutic potential, and integration into the existing therapeutic landscape of mBC. While clinical trials have shown promising results, challenges remain regarding target heterogeneity, implementation, and optimizing treatment strategies. Further research is essential to integrate RLT into clinical practice and improve patient outcomes fully.

Malignant upgrade in lesions of uncertain malignant potential in the breast (B3 lesions) - is open excision always necessary?

PURPOSE

Unclear or suspicious breast findings are typically clarified by interventional breast biopsy. Lesions with uncertain malignant potential are grouped as B3 lesions in histopathology. The B3 group according to the European Working Group for Breast Screening Pathology (EWGBSP) comprises various breast lesions with different upgrade rates to invasive breast cancer (BC) or ductal carcinoma in situ (DCIS) if surgical removal is performed. The objective of this study was to investigate malignant upgrade rates to DCIS and/or invasive breast cancer (BC) after open surgical excision for the different B3 lesions.

METHODS

A total of 192 patients with histologically verified B3 lesions were followed up retrospectively for this analysis. Patients with the B3 lesions atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), and classical lobular neoplasia (LN1-2) were combined into one group, while cellular fibroepithelial lesions (CFL) and phyllodes tumors without suspicion of malignancy, as well as papillomas and radial scars/complex sclerosing lesions (RS/CSL) were summarized in two other groups. We investigated the association of the different B3 lesions with invasive BC or DCIS after open surgical excision.

RESULTS

Histopathological investigation revealed in 21 (10.9%) of the 192 patients invasive BC or DCIS after open surgical excision. The rate of patients with BC and/or DCIS significantly differed between the patient groups (p < 0.01, Fisher's exact test): The highest rate was 17.5% (95% confidence interval (CI), 10.7-26.2) in patients within the group of ADH, FEA, and LN1-2. In the other two groups, fewer malignant lesions occurred. In the group with papillomas and RS/CSL the malignant upgrade rate was 4.3% (95% CI, 0.9-12.2), while within the group with CFL and phyllodes tumors without suspicion of malignancy no malignant upgrade was observed (0.0%, 95% CI, 0.0-16.9).

CONCLUSIONS

B3 lesions harbor the risk of malignant upgrade after surgical excision. In our collective ADH, FEA, and LN1-2 had significant higher upgrade rates than other B3 lesions.

Cancer and Overgrowth Manifestations of PTEN Hamartoma Tumor Syndrome: Management Recommendations from the International PHTS Consensus Guidelines Working Group

PURPOSE

PTEN hamartoma tumor syndrome (PHTS) is an autosomal dominant cancer predisposition and overgrowth syndrome caused by pathogenic germline variants in the PTEN gene, with an increased risk of both benign and malignant tumors involving the breast, colon, endometrium, thyroid, skin, and kidney. The objective of these clinical guidelines was to use the latest knowledge to generate an international consensus resource for providers, researchers, and individuals with PHTS on the best practices in the surveillance and management of cancer and overgrowth in PHTS.

EXPERIMENTAL DESIGN

The International PHTS Cancer and Overgrowth Guidelines Working Group was established, comprising a core group of six international experts in the diagnosis and management of PHTS. The working group held joint meetings with individuals with PHTS and their advocates. Informed by the literature, the working group met regularly between 2022 and 2024 to produce guideline statements, refined through iterative feedback. A modified Delphi approach was used with an independent external panel of PHTS, genetics, and cancer experts to establish final consensus guidelines.

RESULTS

Clinical consensus recommendations for the surveillance and management of cancer and overgrowth in individuals with PHTS were formed. The guidelines encompass the recommended practices in cases of breast, colon, endometrial, thyroid, and kidney cancers, as well as overgrowths.

CONCLUSIONS

The clinical management of individuals with PHTS is complex and necessitates a multidisciplinary approach. We generated international consensus guidelines for the surveillance and management of cancer and overgrowth in PHTS, aiming at improving care for affected individuals and families.

IORT-photon boost plus hypofractionated whole breast irradiation in patients with breast cancer after primary systemic treatment: feasibility, safety and clinical results

AIM

To assess for the first time the safety and feasibility of combining photon-intraoperative radiotherapy (ph-IORT) with hypofractionated whole breast irradiation (h-WBI) in patients referred to primary systemic therapy (PST).

METHODS

From March 2019 to December 2020, patients referred for breast conservative surgery (BCS) after PST in our institution were prospectively included in the present trial. PST was prescribed to all patients according the ESMO-SEOM guidelines. Once the PST was completed, BCS was discussed in the multidisciplinary tumor board (MTB). 20 Gy were prescribed to the surface of the applicator of an Intrabeam®photon-IORT during BCS. h-WBI (40.5 Gy/2.67 Gy/15frx) was planned to be administered 3-5w after BCS. All patients were treated with hWBI VMAT-Rapid-Arc&Daily Exac-Trac-IGRT. The primary end points of the study were feasibility and safety (grade 3 toxicity rate CTCAE.5.0-scale) of the proposed treatment protocol. The secondary end points included cosmetic results (Harvard Scale), local relapse rate and overall survival.

RESULTS

Thirty-five patients were included in the trial. The median age was 54 years. Tumor size was > 2 cm in all cases. Eighteen patients were N + (51.4%). There was no disease progression during PST. All patients received the planned 20 Gy-ph-IORT boost at the time of BCS and the proposed h-WBI. 31/35 (88,6%) patients started h-WBI within the predefined time period (3-5w after BCS). No patient showed ≥ G3 acute toxicity 3 months after the end of h-WBI. No ≥ G3 late toxicity was observed at 12 months of follow-up and thereafter. Cosmetic results were scored excellent/good in 26 patients (74.2%). After a median follow-up of 52 months, a TNBC patient locally relapsed at 13 months of follow-up.

CONCLUSION

We demonstrated for the first time that ph-IORT + hWBI is feasible and safe in patients referred to BCS after PST.

Harnessing hematological ratios: prognostic insights for breast cancer management

BACKGROUND

Breast cancer is one of the most lethal diseases affecting women globally. Its progression is influenced by various factors, including the immune system's ability to combat cancer cells. While hematological indices have been recognized as valuable biomarkers for monitoring patients with different types of neoplasms, there remains a considerable gap in research concerning their application in breast cancer.

MATERIAL AND METHODS

To address this, we conducted a systematic review of studies examining hematological indices as prognostic predictors in breast cancer patients.

RESULTS

The majority of studies demonstrate a significant correlation between these indices and survival outcomes, underscoring their potential utility in patient monitoring.

CONCLUSIONS

Hematological-based indexes can be valuable tools for monitoring breast cancer, especially those ongoing poor prognosis scenarios.

Preferences of patients with high-risk HR + /HER2- breast cancer for adjuvant endocrine treatment: an adaptive choice-based conjoint analysis study from Germany

PURPOSE

This study aimed to identify preferences of patients with high-risk hormone receptor positive/human epidermal growth factor receptor 2 negative (HR + /HER2-) early breast cancer (EBC) related to adjuvant endocrine therapy (ET) using the Adaptive Choice-Based Conjoint (ACBC) method.

METHODS

A stepwise multimodal study was conducted in Germany between October 2021 and March 2022 consisting of desk research, qualitative interviews, and quantitative online surveys. Included patients had a high risk of recurrence at the time of their HR + /HER2- EBC diagnosis, completed primary therapy (surgery ± radiation + (neo)adjuvant chemotherapy), and were prescribed or undertaking adjuvant ET. In the desk research phase, online resources, patient material, and existing studies were reviewed. In the qualitative phase, interviews were conducted with 6 gynaecologists, 6 oncologists, 20 patients, and 5 caretakers. In the quantitative phase, 85 patients completed the ACBC analysis survey.

RESULTS

Included patients were aged 49.4 years (mean) among which 69.4% were still working. In the ACBC absolute rating, diarrhoea, arthralgia, and nausea were least relevant attributes to patients. Relative assessment of ET attributes against each other revealed that achieving the ET goal, namely the reduction of risk of tumour recurrence, had the highest relevance, while avoiding side effects and maintaining quality of life were less relevant. Overall, 35% have considered taking a break or discontinuing adjuvant ET due to side effects.

CONCLUSION

Reduction of tumour recurrence was the attribute of highest relative importance for patients with high-risk HR + /HER2- EBC followed by side effect avoidance and quality-of-life maintenance, reflecting their importance in treatment decisions.

Psychological distress, sexual satisfaction and quality of life of gynaecological cancer patients and their spouses during cancer survivorship: A comparison of husbands and wives

AIMS AND OBJECTIVES

To investigate the psychological distress, sexual satisfaction, and quality of life of gynaecological cancer survivors and their spouses during cancer survivorship.

BACKGROUND

The survival rate of patients with cancer is increasing owing to advances in medical treatment technology. Spouses are the closest companions of gynaecological cancer survivors. Patients with gynaecological cancer and their spouses face different situations and challenges after experiencing cancer invasion.

DESIGN

Questionnaire-based cross-sectional study.

METHODS

Convenience sampling was employed, and 180 participants, including patients with gynaecological cancer and their spouses, were enrolled. A structured questionnaire was used to investigate the psychological distress, sexual satisfaction, and quality of life of gynaecological cancer survivors and their spouses during acute, extended, and permanent survivorship. The STROBE checklist guided the study preparation.

RESULTS

For gynaecological cancer survivors and their spouses, (1) severe psychological distress was present during acute survivorship, with anxiety extending until permanent survivorship; (2) no significant differences were observed in pre- and post-treatment sexual satisfaction, although pre-treatment sexual satisfaction was higher than post-treatment sexual satisfaction in all three cancer survivorship stages and (3) quality of life decreased during acute survivorship and gradually improved with time.

CONCLUSIONS

Psychological distress, sexual satisfaction and quality of life of gynaecological cancer survivors and their spouses worsened during acute survivorship and improved over time until permanent survivorship.

RELEVANCE TO CLINICAL PRACTICE

Gynaecological cancer survivors and their spouses experience anxiety and depression from diagnosis confirmation until permanent survivorship (>5 years survival). Therefore, clinical nurses' sensitivity to emotional distress in cancer survivors and their spouses can be improved and a consistent and routine evaluation method has been established for the early detection of such emotional distress. The results of this study can provide a reference for clinical healthcare professionals and contribute to a better quality of care.

Evaluation of HER2-Low breast carcinoma in metastatic settings: a cytological approach to proliferation and survival

INTRODUCTION

Human epidermal growth factor receptor 2 (HER2)-low breast cancer, defined by HER2 immunohistochemistry scores of 1+ or 2+ without gene amplification, represents a unique subgroup with emerging therapeutic implications. Limited data describe the behavior of HER2-low tumors, particularly in metastatic settings. This study evaluated the frequency of HER2-low expression, Ki-67 proliferation index, and survival outcomes across HER2 subtypes in metastatic breast carcinoma using cytology specimens.

MATERIALS AND METHODS

A 3-year retrospective analysis identified 43 patients with metastatic breast carcinoma diagnosed via fine-needle aspiration or exfoliative cytology. HER2, ER, PR, and Ki-67 status were determined by immunohistochemistry, with equivocal HER2 cases assessed by in situ hybridization. Survival outcomes were estimated using the Kaplan-Meier method, with Cox regression identifying predictors of survival.

RESULTS

Among 43 cases, 31 (70.5%) were HER2-low, 6 (13.6%) HER2-positive, and 6 (13.6%) HER2-zero. HER2 discordance between primary and metastatic lesions occurred in 19%, mainly involving transitions to HER2-low status. Hormone receptor positivity was more frequent in HER2-low tumors (71%) than HER2-zero tumors (33%) (P < 0.001). Mean Ki-67 was highest in HER2-low (45%) versus HER2-negative (34%) and HER2-positive (33%) cases (P = 0.549). Median survival was 13 months for HER2-low and 5 months for HER2-negative patients; survival differences were not significant (P = 0.225). Younger age (HR = 0.240, P = 0.048) and hormone receptor positivity (HR = 0.273, P = 0.011) were significant predictors of survival.

CONCLUSION

HER2-low expression is prevalent in metastatic breast carcinoma with a unique hormone receptor profile. Findings highlight the need for reassessment of HER2 status in metastatic settings, with potential therapeutic implications.

Completion of Distress Screening and Correlates of Distress Score in Patients With Multiple Myeloma at Initial Evaluation at a Transplant Center

OBJECTIVES

We describe the completion of the National Comprehensive Care Network's distress thermometer (DT) survey for multiple myeloma (MM), quantify, and identify factors influencing distress score.

METHODS

We assessed DT completion for MM patients' first consultation at an academic center between January 1, 2015, and December 31, 2022. Multivariate logistic regression was conducted to identify factors associated with survey completion and distress.

RESULTS

Of 1011 new patients, 683 (68%) completed the DT survey. Noncompletion at initial consultation was associated with non-Hispanic Black patients [AOR 0.50 (95% CI 0.32-0.79), p = 0.003], socially vulnerable neighborhood residence [AOR 0.54 (95% CI 0.39-0.76), p = 0.0004], Karnofsky Performance Status < 90 [AOR 0.60 (95% CI 0.43-0.86), p = 0.005], and recent years of consult [AOR 0.38, (95% CI 0.28-0.52), p < 0.0001]. Nonrespondents were less likely to receive a subsequent autologous stem cell transplantation (71% vs. 79%, p < 0.01). The median distress score among respondents was 3% with 22% reporting 0 distress. Distress was associated with female sex [AOR 1.48, (95% CI 1.07-2.04), p = 0.017] and stage [stage 2 vs. stage 1, AOR 1.76 (95% CI 1.20-2.57), p = 0.004].

CONCLUSIONS

Disparities in nonrespondents of the DT survey at initial consultation suggest the limitations of relying on the screening tool to assess unmet needs among high-risk patients.

Exploring immune checkpoint inhibitors: Focus on PD-1/PD-L1 axis and beyond

Immunotherapy emerges as a promising approach, marked by recent substantial progress in elucidating how the host immune response impacts tumor development and its sensitivity to various treatments. Immune checkpoint inhibitors have revolutionized cancer therapy by unleashing the power of the immune system to recognize and eradicate tumor cells. Among these, inhibitors targeting the programmed cell death protein 1 (PD-1) and its ligand (PD-L1) have garnered significant attention due to their remarkable clinical efficacy across various malignancies. This review delves into the mechanisms of action, clinical applications, and emerging therapeutic strategies surrounding PD-1/PD-L1 blockade. We explore the intricate interactions between PD-1/PD-L1 and other immune checkpoints, shedding light on combinatorial approaches to enhance treatment outcomes and overcome resistance mechanisms. Furthermore, we discuss the expanding landscape of immune checkpoint inhibitors beyond PD-1/PD-L1, including novel targets such as CTLA-4, LAG-3, TIM-3, and TIGIT. Through a comprehensive analysis of preclinical and clinical studies, we highlight the promise and challenges of immune checkpoint blockade in cancer immunotherapy, paving the way for future advancements in the field.

The evolving role of B cells in malignancies

B cells play diverse roles in different pathological circumstances, such as neoplastic diseases, autoimmune disorders, and neurological maladies. B cells, which are essential elements of the adaptive immune system, demonstrate exceptional functional variety, including the generation of antibodies, the presentation of antigens, and the secretion of cytokines. Within the field of oncology, B cells display a multifaceted nature in the tumor microenvironment, simultaneously manifesting both tumor-promoting and tumor-suppressing characteristics. Studies have found that the existence of tertiary lymphoid structures, which consist of B cells, is linked to better survival rates in different types of cancers. This article examines the involvement of B cells in different types of malignancies, emphasizing their importance in the development of the diseases and their potential as biomarkers. Additionally, the review also examines the crucial role of B cells in autoimmune illnesses and their potential as targets for therapy. The article also analyses the role of B cells in immunization and exploring their potential uses in cancer immunotherapy. This analysis highlights the intricate and occasionally contradictory roles of B cells, underlining the necessity for additional research to clarify their varied actions in various illness scenarios.

Evaluation and Comparison of Prognostic Multigene Tests in Early-Stage Breast Cancer: Which Is the Most Effective? A Literature Review Exploring Clinical Utility to Enhance Therapeutic Management in Luminal Patients

Breast cancer is the most common malignancy affecting women, marked by significant complexity and heterogeneity. This disease includes multiple subtypes, each with unique biological features and treatment responses. Despite significant advancements in detection and therapy, challenges remain, particularly in managing aggressive forms like triple-negative breast cancer and overcoming drug resistance. Breast cancer classification and subtype determination are typically performed by immunohistochemistry (IHC) method, which assesses four key markers (ER, PR, HER2, KI67); however, due to the recognized issues with this approach-especially regarding the evaluation of Ki67-there is a risk of misclassification. Patients who may be suitable for chemotherapy could miss possible advantages and only experience needless toxicity as a result of improper treatment decisions. Molecular profiling has improved breast cancer management, enabling the creation of multigene prognostic tests (MPTs) like Oncotype Dx, MammaPrint, Prosigna, Endopredict, and Breast Cancer Index which assess gene expression profiles to more accurately predict recurrence risks. These tools help personalize treatment, identifying patients who can avoid chemotherapy and/or extended endocrine therapy. While many MPTs are available, only Oncotype Dx and MammaPrint have prospective validation, with Prosigna providing additional prognostic insights by incorporating clinical variables. Molecular tests are especially usefull in the "gray zone," which includes tumors measuring between 1 and 3 cm with 0-3 positive lymph nodes and an intermediate proliferation index. However, their clinical utility has not been definitively established, and significant differences exist between them. This article provides an in-depth analysis of established genomic assays, including testing procedures, clinical validity, utility, diagnostic frameworks, and methodologies. Our comparison aims to improve early breast cancer management by guiding pathologists and oncologists in optimizing the use of genomic assays in clinical practice. By presenting this information, we aim to enhance understanding of the clinical utility and effectiveness of these assays, supporting the development of personalized treatment strategies for early breast cancer patients. Genomic assays offer important insights that can support treatment decisions in early-stage breast cancer, especially when used alongside other clinical evaluations, predictive tools, and management guidelines. While multiple gene expression profiling tests are available, they classify patients differently and are not interchangeable; therefore, their application should be at the clinician's discretion during the decision-making process. It is essential that these tests are not the sole factor in determining the best treatment plan: other clinical considerations and patient preferences should also play a significant role in guiding treatment decisions.

Linguistic difference in the effect of organized programs on socioeconomic inequalities in breast cancer screening: ecological study in Switzerland

OBJECTIVE

The objective of this study is to examine how the effect of organized mammography screening programs on breast cancer screening participation differ between socioeconomic strata and how this relationship may be modified by the context of linguistic differences. Switzerland, marked by its diverse linguistic landscape, reflects cultural variations alongside differences in public health strategies. The goal of this study was to assess potential socioeconomic differences in regional mammography screening programs effectiveness to improve breast cancer screening participation.

METHODS

Data on 14 173 women in the regionally adapted breast cancer screening age range was drawn from five cross-sectional waves of the nationally representative Swiss Health Interview Survey (1997-2017). Socioeconomic indicators included education, household income, and employment status. Poisson regression was used to estimate the adjusted prevalence ratios of up-to-date (last 2 years) mammography uptake. Inequality was assessed using relative index of inequality and the slope index of inequality.

RESULTS

Organized screening programs were generally effective and increased up-to-date mammography uptake by close to 20 percentage points in both regions. While in the Latin cantons, screening programs had no impact on socioeconomic inequalities in screening, it reduced inequalities for women with lower education in the German cantons. This modification effect of screening programs was not seen for income and employment-related inequalities and did not differ across linguistic regions.

CONCLUSIONS

Public health agencies should consider the different cultural reception of programs as addressing these differences could help ensure that breast cancer screening initiatives are not only effective, but also culturally equitable across different socioeconomic groups.

Microtubule associated serine/threonine kinase-3 inhibits the malignant phenotype of breast cancer by promoting phosphorylation-mediated ubiquitination degradation of yes-associated protein

BACKGROUND

Microtubule associated series/threonine kinase-3 (MAST3) is a member of microtubule associated serine/threonine kinase family (MAST1-4, MAST-like), and the expression and underlying molecular mechanism of MAST3 in human tumors, including breast cancer, is not yet elucidated.

METHODS

We employed immunohistochemistry to assess the significant expression of MAST3 in breast cancer tissue samples. Additionally, we utilized an overexpression vector and shRNA to bi-directionally regulate MAST3 expression, aiming to observe the impact of MAST3 on the proliferation, migration, and invasion capabilities of breast cancer cells. Furthermore, we employed immunoprecipitation, immunoblotting, luciferase reporter genes and real-time quantitative PCR to investigate the interaction between MAST3 and YAP, as well as the regulatory effects on the expression of Hippo pathway-related target genes.

RESULTS

Low MAST3 expression was observed both in breast cancer cells and tissues, which was significantly associated with advanced tumor T stage, lymph node metastasis, and poor patient prognosis. Functional experiments found that overexpression of MAST3 can gradually inhibit the proliferation and invasion of breast cancer cells, knocking-out MAST3 showed the opposite functional effect. Immunoprecipitation showed that MAST3 interacts with the key effector factor, yes-associated protein (YAP), in the Hippo pathway. The combination of MAST3-YAP promoted the phosphorylation of YAP, which led to its degradation through the ubiquitin-proteasome pathway and reduced nuclear translocation.

CONCLUSIONS

MAST3 was identified as a novel tumor suppressor protein in breast cancer, which directly regulates the expression of YAP through the non-dependent mammalian sterile-20-like (MST)-large tumor suppressor (LATS) classical signaling pathway, providing a theoretical and experimental basis for the development of small-molecule tumor inhibitors in breast cancer.

Risk and survival of third primary cancers in a population-based cohort of patients with a cervical, endometrial, or ovarian cancer

PURPOSE

Multiple primary cancers are relevant outcomes among survivors of gynecological cancers, contributing to the overall cancer burden and having a potential impact on the management of each primary cancer. This study aimed to estimate the risk and survival of third primary cancers (TPCs) among females with a cervical, endometrial, or ovarian first primary cancer (FPC).

METHODS

Patients with a cervical, endometrial, or ovarian FPC from the Portuguese North Region Cancer Registry, diagnosed between 2000 and 2010 (n = 5846), were followed for a TPC (December 31, 2015) and death from any cause (December 31, 2023). The cumulative incidence of TPCs and mortality was estimated. Patients with a TPC were matched (1:1) to patients without a TPC (FPC + second primary cancer [SPC] only) to compare survival.

RESULTS

Overall, 29 (0.5% of FPCs and 5.4% of SPCs) TPCs were diagnosed. The most common sites were digestive organs (n = 9) followed by breast and urinary tract cancers (n = 4 each). Among all FPCs, the 10-year cumulative incidence (95% confidence interval [CI]) of a TPC was 0.5% (0.3%-0.7%) and among SPCs, it was 5.8% (3.3%-8.2%). For TPCs, compared to matched patients, the age-adjusted hazard ratio (95% CI) for death was 3.0 (1.39-6.50). The 10-year cumulative mortality of TPCs and matched patients was 75.7% and 42.0%, respectively.

CONCLUSIONS

In Northern Portugal, TPCs occurred mainly in digestive organs, followed by the breast and urinary tract, with a 10-year cumulative incidence of 0.5% among all FPCs. TPCs had a worse long-term survival compared to patients with an SPC only.

A combination of fat grafting with inferior dermal flap in breast reconstruction following prophylactic mastectomy: A cohort study

BACKGROUND

Breast reconstruction following prophylactic mastectomy in women with ptotic or hypertrophic breasts often poses challenges. We describe a combined technique of large-volume fat grafting (>100 mL) and an inferior dermal flap, aiming to improve aesthetic outcomes and patient satisfaction.

METHODS

We conducted a retrospective analysis of 21 patients undergoing immediate breast reconstruction with the described technique. All patients were asked to complete the BREAST-Q questionnaire preoperatively and at least 12 months postoperatively (median interval: 20 months). Statistical analysis (Wilcoxon signed-rank test) was used to assess changes in satisfaction and well-being; aesthetic outcomes were scored by an independent, multidisciplinary team.

RESULTS

Among 13 patients with complete BREAST-Q data, satisfaction with the breasts increased significantly from a median score of 38-85 (p = 0.002), psychosocial well-being from 57-70 (p = 0.045), and physical well-being (chest) from 68 to 81 (p = 0.045). Sexual well-being rose from 47-63 (p = 0.023). Aesthetic evaluation by an independent panel showed notable improvements in breast symmetry, shape, and overall appearance. Minimal and asymptomatic fat necroses or oil liponecrotic pseudocysts were observed.

CONCLUSIONS

Combining large-volume fat grafting with an inferior dermal flap appears promising for women with ptotic breasts, yielding high satisfaction and low complication rates. Despite requiring multiple operative stages, this autologous reconstruction technique may offer a less invasive alternative for high-risk patients seeking natural outcomes without implants.

Fluorine in the Pharmaceutical Industry: FDA-Approved Fluorine-Containing Drugs in 2024

Fluorine has become an essential element in the development of modern pharmaceuticals, due to its unique chemical properties that can significantly enhance the biological activity, metabolic stability, and lipophilicity of drug molecules. This review explores recent advancements in the synthesis and application of fluorine-containing drugs approved by the US Food and Drug Administration (FDA) in 2024. These novel drugs demonstrate improved efficacy and safety profiles, addressing a range of therapeutic areas including oncology, infectious diseases, metabolic disorders and genetic disorders that affect the adrenal glands. The incorporation of fluorine atoms into drug candidates has facilitated the development of molecules with optimized pharmacokinetic and pharmacodynamic properties, leading to better patient outcomes. The review further discusses the synthetic methodologies employed, the structural characteristics of these drugs, and their clinical implications, providing insights into the ongoing innovation within the pharmaceutical industry driven by fluorine chemistry.

Interaction between redox regulation, immune activation, and response to treatment in HER2+ breast cancer

In HER2+ breast cancer (BC), neoadjuvant therapy represents an ideal scenario for translational research, considering pathological complete response (pCR) as an endpoint. In these patients, achieving pCR after neoadjuvant therapy is associated with a better prognosis. However, biomarkers are needed to tailor optimal treatment for each patient. Evaluating tumour-infiltrating lymphocytes (TILs) has gained attention in predicting pCR. In the context of metastatic disease, TILs also appear to play a role in predicting outcomes. The interaction between the presence of TILs and reactive oxygen species (ROS) remains an area to be explored. ROS are critical for tumour cell homeostasis, and different levels can trigger differential biological responses in cancer cells and their microenvironment. Nevertheless, the influence of ROS on treatment efficacy and prognosis in patients with HER2+ BC remains to be elucidated. In this article, we reviewed the interplay between treatment response, immune system activation, and ROS production in HER2+ BC and suggested novel areas of intervention and research. We also present a bioinformatic analysis demonstrating that the altered expression of several redox-related genes could be associated with the prevalence of immune cell populations in the tumour microenvironment and with patient survival. New biomarkers are thus suggested and should be further explored to tailor the best treatment to each patient.

Impact of postmastectomy radiotherapy on locoregional recurrence and survival in patients with ypN0 breast cancer after neoadjuvant chemotherapy: A comprehensive meta-analysis and systematic review

BACKGROUND

The necessity of postmastectomy radiotherapy (PMRT) following neoadjuvant chemotherapy (NAC) in patients with ypN0 breast cancer remains a controversial clinical issue. To elucidate this issue, the present study performed a systematic review and meta-analysis, focusing on studies of clinically lymph node-negative patients exhibiting a favorable pathologic response to NAC.

MATERIALS AND METHODS

After a comprehensive literature search of PubMed and major oncology congress abstracts, 16 studies that met the inclusion criteria were included. A fixed or random effects model was used to assess the impact of PMRT on the local recurrence rate (LRR) and survival outcomes, where appropriate.

RESULTS

The pooled data from ten studies indicated that PMRT significantly reduced the LRR in patients with ypN0 breast cancer (risk ratio [RR], 0.52; 95% confidence interval [CI], 0.41-0.67, P < 0.00001). Moreover, a marginal increase in the overall survival (OS) rates was observed in nine studies (RR, 1.01; 95% CI, 1.00-1.02, P = 0.006), whereas no significant effect on disease-free survival (DFS) was found in six studies (RR, 1.01; 95% CI, 0.95-1.08, P = 0.72).

CONCLUSIONS

Our findings suggest that PMRT is associated with reduced LRR and slightly improved OS in patients with ypN0 breast cancer. However, prospective studies are needed to provide more evidence and inform clinical decision-making.

Body mass index and clinical outcomes in breast cancer patients undergoing endocrine therapy: A meta-analysis and Mendelian randomization study

OBJECTIVE

The relationship between breast cancer prognosis, Body Mass Index (BMI), and endocrine therapy outcomes remains inconclusive. This study examines BMI's impact on survival outcomes in breast cancer patients receiving endocrine therapy through Mendelian randomization (MR) and a comprehensive clinical data review.

METHODS

A meta-analysis of clinical studies up to January 2024 investigated the association between obesity and the efficacy and safety of endocrine therapy. Additionally, a two-sample MR approach using genetic variants evaluated the causal effect of BMI on survival in breast cancer patients undergoing endocrine therapy.

RESULTS

Meta-analysis of eight studies (n = 12,673) found that BMI generally does not affect therapy outcomes. However, subgroup analysis showed that overweight patients on anastrozole had shorter disease-free survival (DFS) than normal-weight patients (Hazard Ratio (HR) = 1.21, P = 0.03), increased fatigue (Risk Ratio (RR) = 0.91, P = 0.03), and higher nausea with cyclin-dependent kinase 4/6(CDK4/6)inhibitors (Risk Ratio, RR = 0.69, P < 0.0001). Normal-weight patients on tamoxifen had a greater risk of bone pain (RR = 1.25, P = 0.03). Further MR analysis revealed no causal link between BMI and 5-year or 15-year survival rates in endocrine-treated patients (5-year HR = 0.7923, 95 % Confidence Interval (CI)[0.2053, 3.0581], P = 0.7355; 15-year HR = 0.9793, 95 % CI [0.7121, 1.3469], P = 0.898).

CONCLUSION

Current meta-analysis and MR findings suggest no significant link between BMI and the overall efficacy of endocrine therapy in breast cancer. However, BMI should be considered in anastrozole therapy due to differential effects on DFS and adverse events.

Low-dose aspirin and non-aspirin non-steroidal anti-inflammatory drugs and epithelial ovarian cancer survival: a registry-based cohort study in Norway

BACKGROUND

Aspirin and non-aspirin non-steroidal anti-inflammatory drugs (NA-NSAID) have been associated with improved survival in individuals with epithelial ovarian cancer (EOC); however, findings to date are inconsistent.

METHODS

We conducted a registry-based cohort study evaluating survival following an incident invasive EOC diagnosis including individuals diagnosed between 2004-2018 (n = 4325; n = 2206 deaths; n = 1973 EOC deaths). Evaluated exposures were low-dose aspirin and NA-NSAIDs. Two primary post-diagnosis exposure windows were evaluated: fixed post-diagnostic baseline exposure ≤ 305 days after diagnosis (use, non-use) and updated "time-varying" exposure (never, past, current use; cumulative defined daily dose (DDD)). Pre-diagnostic exposure (use, non-use) was further evaluated. Multivariable Cox-proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals [95% CIs]. The primary outcome was cause-specific survival. Restricted mean survival time (RMST) in exposure groups was estimated at 5 years following start of follow-up.

RESULTS

Baseline post-diagnosis aspirin use was not associated with survival following an EOC diagnosis (e.g., use vs. no use: aspirin, HR = 1.02 [95% CI = 0.84-1.24]). Inverse associations were observed between current aspirin use post-diagnosis and survival in the time-varying exposure models (HR 0.68 [0.57-0.81]), and with higher post-diagnosis cumulative DDD of aspirin. Findings for NA-NSAIDs were less consistent. No associations were observed for pre-diagnostic use. Results for overall survival were similar to those for cause-specific survival. Compared to never use, post-diagnosis low-dose aspirin use was associated with a longer RMST (e.g., ever vs. never use, difference in RMST = 2.67 months).

CONCLUSIONS

This study provides further evidence of a potential beneficial effect of post-diagnosis low-dose aspirin use for ovarian cancer survival.

Imaging Evaluation and Management of Breast Symptoms in the Pediatric Population

The clinical approach, differential diagnosis, diagnostic imaging, and management of breast masses differs between adult and pediatric patients. Breast symptoms in pediatric populations are likely to be normal, variants of normal development, or classically benign. When evaluating pediatric patients, a thorough history and physical examination is key and may include US imaging if clinically indicated. Currently, there are no consensus guidelines from professional societies specific to the imaging evaluation, reporting, or management of the pediatric breast. Inappropriate utilization of additional imaging or biopsy recommendations can cause stress to patients and caregivers, added financial costs, and potential damage to the developing breast. As such, it is increasingly important for radiologists to have a clear understanding of the expected physical and imaging findings for developing breast tissue, developmental abnormalities, benign conditions, and rare malignancies. This review summarizes the expected normal developmental breast changes in the pediatric population as well as common anatomic variants. Both benign and rare malignant breast pathologies are reviewed with a discussion about clinical presentation and management to guide breast imaging trainees and practicing radiologists.

Gene expression profiling, prognosis, and immune microenvironment of KLF4 in malignancies

Gene expression profiling plays a crucial role in understanding the role of Krüppel-like factor 4 (KLF4) in the prognosis and tumor immune microenvironment of various malignancies. The transcription factor KLF4 plays a crucial role in various cellular processes, including cell differentiation, proliferation, and apoptosis. Genetic alterations and aberrant KLF4 expression have been observed in many malignancies, thus suggesting a potential role as a prognostic marker and therapeutic target. Herein, a systematic analysis of KLF4 genetic alterations revealed the mutation, amplification, and deletion frequencies across different cancer types. The genetic alteration patterns varied across malignancies, thus highlighting the diverse roles of KLF4 in different tumor contexts. Secondly, the prognostic significance of KLF4 expression was assessed in multiple cancers. High expression levels of KLF4 were associated with better clinical outcomes in kidney renal clear cell carcinoma, while low KLF4 expression correlated with a favorable prognosis in certain malignancies. In conclusion, the genetic alterations, dysregulated RNA expression, and prognostic implications of KLF4 in malignancies underscore its significance in cancer biology. The present findings will aid in understanding the role of KLF4 in tumor biology and its association with immune responses. Future investigations should focus on elucidating the functional roles and regulatory mechanisms of KLF4 to further assess its potential as a therapeutic target and predictive biomarker in cancer management.

Advances and challenges in cancer immunotherapy: Strategies for personalized treatment

Cancer immunotherapy has transformed oncology by harnessing the immune system to specifically target cancer cells, offering reduced systemic toxicity compared to traditional therapies. This review highlights key strategies, including adoptive cell transfer (ACT), immune checkpoint inhibitors, oncolytic viral (OV) therapy, monoclonal antibodies (mAbs), and mRNA-based vaccines. ACT reinfuses enhanced immune cells like tumor-infiltrating lymphocytes (TILs) to combat refractory cancers, while checkpoint inhibitors (eg, PD-1 and CTLA-4 blockers) restore T-cell activity. OV therapy uses engineered viruses (eg, T-VEC) to selectively lyse cancer cells, and advanced mAbs improve targeting precision. mRNA vaccines introduce tumor-specific antigens to trigger robust immune responses. Despite significant progress, challenges like immune-related side effects, high costs, and immunosuppressive tumor microenvironments persist. This review underscores the need for combination strategies and precision medicine to overcome these barriers and maximize the potential of immunotherapy in personalized cancer treatment.

Multifunctional Bioactive Dual-Layered Nanofibrous Matrix for Effective Breast Cancer Therapy and Enhanced Wound Healing

Surgical resection is the primary treatment for triple-negative breast cancer (TNBC). Post-operative complications, including tumor recurrence and bacterial infections, hinder complete remission and long-term recovery. To address these challenges, a multifunctional bioactive dual-layered nanofibrous matrix (MBDL-NanoMat) featuring adaptive shape control, excellent wound adherence, tunable drug release profiles, and superior biocompatibility for post-surgical applications is developed. The MBDL-NanoMat comprises a hydrophilic (HyPhil) layer and a hydrophobic (HyPhob) layer, offering distinct functionalities. The HyPhil layer, electrospun with gelatin and copper peroxide nanoparticles (Cu NPs), rapidly releases Cu NPs to induce anticancer effects through chemodynamic therapy (CDT), ferroptosis, and cuproptosis along with antibacterial action. Near-infrared laser irradiation enhances therapeutic efficacy through photothermal therapy (PTT). The HyPhob layer ensures prolonged therapeutic effects by releasing therapeutic molecules, such as rapamycin, enabling sustained chemotherapy (CT) and antibacterial activity. This synergistic therapeutic system integrates multiple mechanisms-CT, CDT, PTT, ferroptosis, and cuproptosis-suppressing tumor recurrence and accelerating wound healing. Preclinical results demonstrated enhanced angiogenesis, collagen deposition, and dermal regeneration without systemic safety. In short, the MBDL-NanoMat platform offers a unique advantage in post-surgical TNBC care by simultaneously targeting tumor recurrence and facilitating wound healing. Further investigation of this platform can significantly improve oncological and regenerative medicine strategies.

HbA1c levels and breast cancer prognosis in women without diabetes

BACKGROUND

Diabetes is associated with impaired breast cancer prognosis; however, the effectiveness of glycosylated hemoglobin (HbA1c) as a prognostic biomarker in breast cancer remains uncertain, especially for patients without diabetes. We aimed to determine whether elevated HbA1c is associated with a worse prognosis in breast cancer patients without known diabetes.

METHODS

The study population comprised women with primary invasive stage I-III breast cancer between 2010 and 2020 surgically treated at Aarhus University Hospital, Denmark, without a diabetes diagnosis at baseline. We assessed HbA1c at breast cancer diagnosis as a categorical (quartiles; HbA1c-Q1 = 21-33 mmol/mol, HbA1c-Q2 = 34-36 mmol/mol, HbA1c-Q3 = 37-38 mmol/mol, HbA1c-Q4 = ≥ 39 mmol/mol) and log2-transformed continuous variable. Follow-up began at the date of primary breast cancer surgery and continued until the first occurrence of either a new breast cancer event (loco-regional or distant recurrence, or contralateral breast cancer), new primary cancer other than breast cancer, death, emigration, or end-of-follow-up (November 15th, 2021). Cox regression models estimated crude and adjusted hazard ratios and associated 95% confidence intervals (95% CIs) of a new breast cancer event and all-cause mortality, adjusting for patient characteristics based on a directed acyclic graph. The lowest HbA1c quartile (HbA1c-Q1) was used as reference.

RESULTS

In total, 2514 women (median age 62 years) were included. During median 5.6 years follow-up for new breast cancer events, 230 (9.1%) events occurred. An escalating risk of new breast cancer events was observed with increasing HbA1c quartiles (adjusted hazard ratios, HbA1c-Q2: 1.09 [95% CI = 0.75-1.60]; HbA1c-Q3: 1.35 [95% CI = 0.88-2.07]; HbA1c-Q4: 1.69 [95% CI = 1.13-2.54]) compared to HbA1c-Q1. During median 6.0 years follow-up for all-cause mortality, 267 deaths (10.6%) occurred. No apparent association was evident between increasing HbA1c quartiles and all-cause mortality (adjusted hazard ratios, HbA1c-Q2: 0.75 [95% CI = 0.52-1.07]; HbA1c-Q3: 0.82 [95% CI = 0.55-1.21]; HbA1c-Q4: 1.06 [95% CI = 0.74-1.53]). Similarly, a log2(HbA1c) increase was associated with an increased risk of new breast cancer events, but not all-cause mortality.

CONCLUSIONS

For women with primary breast cancer and no known diagnosis of diabetes, higher levels of HbA1c were associated with an increased risk of new breast cancer events, but not all-cause mortality. HbA1c may serve as a prognostic metabolic biomarker for breast cancer patients without diabetes.

Prognostic and recurrence risk predictive values of tumor infiltrating lymphocytes in HER2-low breast cancer

BACKGROUND

With the emergence of novel anti-HER2 antibody drug conjugates, patients with HER2-low breast cancer have received increased attention. Tumor-infiltrating lymphocytes (TILs) are significantly associated with survival benefits in cancers. However, their prognostic value in patients with low her2 breast cancer is unknown. Therefore, we aimed to determine the relationship between TILs and recurrence in patients with HER2-low breast cancer.

METHODS

Clinicopathological data were retrospectively collected from patients with human epidermal growth factor receptor 2 (HER2) low-expression breast cancer who underwent consultations at Qingdao University Affiliated Hospital. We determined the correlation between TILs and disease-free survival (DFS) followed by the threshold value of TILs using X-tile software. Survival was assessed using Kaplan-Meier analysis, and cox regression analysis was performed for recurrence risk modeling.

RESULTS

Our study showed a 15% TIL level was the optimal cutoff for DFS. The low and high TILs survival curves showed significant differences in the log-rank test (p = 0.009). Cox regression analyses found that lymph node stage, histologic grading, TILs, and Ki-67 were independent variables influencing the prognosis (p < 0.05). On this basis, we developed a risk prediction model to accurately predict the 3- and 5-year disease-free survival rates of patients with HER2-low breast cancer, the model demonstrated good overall performance.

CONCLUSION

TILs are associated with recurrence in patients with breast cancer and low HER2 levels. TILs > 0.15 is a reliable indicator of DFS. For patients with low TILs (≤ 0.15), extensive follow-up is required. These findings provide a basis for targeted, individualized treatment.

Exploring the impact of breast cancer support groups on survivorship and treatment decision-making in eastern Ethiopia: a qualitative study

PURPOSE

This study explores the psychosocial impact of breast cancer (BC) support groups on survivorship and treatment decision-making among women in Harar, Ethiopia. It examines the influence of cultural, social, and economic factors on treatment decisions and assesses the effectiveness of support groups in addressing these challenges.

METHODS

A community-based case study used semi-structured, in-depth interviews and focus group discussions. Participants included women attending BC support groups and key informants, including healthcare providers, caregivers, and spiritual leaders. Data were collected at the Hiwot Fana Cancer Treatment Center and were analyzed thematically using an inductive approach to identify key themes.

RESULTS

The study highlighted significant barriers to timely BC treatment, including cultural stigma, financial constraints, reliance on alternative medicine, and limited healthcare infrastructure. Support groups were pivotal in improving emotional and psychological well-being, fostering a sense of community, and influencing treatment decision-making. Participants reported increased awareness, reduced stigma, and enhanced community advocacy.

CONCLUSIONS

BC support groups in Harar address critical gaps in cancer care by providing psychosocial support and mitigating barriers to treatment. These groups also serve as platforms for community education and advocacy, promoting early detection and modern treatment practices.

IMPLICATIONS FOR CANCER SURVIVORS

Support groups empower BC survivors by improving emotional resilience, facilitating informed treatment decisions, and fostering a sense of belonging. They also help reduce stigma and build supportive community networks essential for long-term survivorship in low-resource settings. Expanding access to such groups could significantly enhance cancer care outcomes in Ethiopia and similar contexts.

Population-based analysis of breast cancer incidence and mortality: overall and age-specific temporal trends over 40-year period in Girona, Spain

PURPOSE

Breast cancer (BC) incidence and mortality in women have changed over time. This study aims to analyze population-level incidence and mortality trends over 40 years of observation.

METHODS

Population-based study of BC conducted by Girona Cancer Registry covering the period 1980-2019. Age-standardized incidence and mortality rates were calculated. Poisson change-point regression models were used to analyze trends, calculating the annual percentage change (APC).

RESULTS

A total of 12,283 diagnoses of invasive BC between 1980 and 2019. The overall age-standardized incidence rate was 109.9 (95% confidence intervals (CI) 104.4; 115.4) cases per 100,000 women-years. Trend analyses showed a statistically significant incidence increase of 4.2% per year from 1980 to 1994 (95%CI 3.3; 5.1), and a stabilization between 1994 and 2019, with an APC of 0.28% (95%CI - 0.04; 0.56). These trends were similar for the age groups 0-49 years and 50-69 years. In women over 69 years of age, an increase in incidence of 4.4% (95%CI 2.8; 6.0) per year was observed between 1980 and 1995 followed by a non-statistically significant decrease of - 0.35% (95%CI - 0.86; 0.15) between 1995 and 2019. The overall age-standardized mortality rate was 30.3 (95%CI 29.3; 31.3) cases per 100,000 women-years. Mortality rate trends showed a statistically significant decrease of - 1.87% (95%CI - 2.38; - 1.37) per year since 1992.

CONCLUSION

There has been a stabilization in the incidence of BC and a gradual decline in BC mortality in women. The introduction of mammography in the mid-1990s, alongside early detection and treatment due to screening programs may play a significant role in the reduction of BC burden in women of all ages.

Association of Gene Variant Type and Location with Breast Cancer Risk in the General Population

BACKGROUND

Pathogenic variants (PVs) in ATM, BRCA1, BRCA2, CHEK2, and PALB2 are associated with increased breast cancer risk. However, it is unknown whether this risk differs by PV type or location in carriers ascertained from the general population.

PATIENTS AND METHODS

To evaluate breast cancer risks associated with PV type and location in ATM, BRCA1, BRCA2, CHEK2, and PALB2, we performed age adjusted case-control association analysis in 32,247 women with and 32,544 age-matched women without breast cancer from the CARRIERS Consortium. PVs were grouped by type and location within genes and assessed for risks of breast cancer (odds ratios (OR), 95% confidence intervals (CI), and P-values) using logistic regression.

RESULTS

Compared to women carrying BRCA2 exon 11 protein truncating variants (PTVs) in the CARRIERS population-based study, women with BRCA2 ex1-10 PTVs (OR=13.5, 95%CI 6.0-38.7, P<0.001) and ex13-27 PTVs (OR=9.0, 95%CI 4.9-18.5, P<0.001) had higher breast cancer risks, lower rates of ER-negative breast cancer (ex13-27 OR=0.5, 95%CI 0.2-0.9, P=0.035; ex1-10 OR=0.5, 95%CI 0.1-1.0, P=0.065), and earlier age at breast cancer diagnosis (ex13-27 5.5 years, P<0.001; ex1-10 2.4 years, P=0.169). These associations with ER-negative breast cancer and age replicated in a high-risk clinical cohort from Ambry Genetics and the population-based UK Biobank cohort. No differences in risk by gene region were observed for PTVs in other predisposition genes.

CONCLUSION

Population-based and clinical high-risk cohorts establish that PTVs in exon 11 of BRCA2 are associated with reduced breast cancer risk, later age at diagnosis, and greater risk of ER-negative disease. These differential risks may improve individualized risk prediction and clinical management for women carrying BRCA2 PTVs.