Breast cancer statistics, 2017, racial disparity in mortality by state

Trends in breast cancer mortality by race/ethnicity, age, and US census region, United States─1999-2020

BACKGROUND

Breast cancer remains a leading cause of morbidity and mortality among women in the United States. Previous analyses show that breast cancer incidence increased from 1999 to 2018. The purpose of this article is to examine trends in breast cancer mortality.

METHODS

Analysis of 1999 to 2020 mortality data from the Centers for Disease Control and Prevention, National Center for Health Statistics, among women by race/ethnicity, age, and US Census region.

RESULTS

It was found that overall breast cancer mortality is decreasing but varies by race/ethnicity, age group, and US Census region. The largest decrease in mortality was observed among non-Hispanic White women, women aged 45 to 64 years of age, and women living in the Northeast; whereas the smallest decrease in mortality was observed among non-Hispanic Asian or Pacific Islander women, women aged 65 years or older, and women living in the South.

CONCLUSION

This report provides national estimates of breast cancer mortality from 1999 to 2020 by race/ethnicity, age group, and US Census region. The decline in breast cancer mortality varies by demographic group. Disparities in breast cancer mortality have remained consistent over the past two decades. Using high-quality cancer surveillance data to estimate trends in breast cancer mortality may help health care professionals and public health prevention programs tailor screening and diagnostic interventions to address these disparities.

miRNA-1260b Promotes Breast Cancer Cell Migration and Invasion by Downregulating CCDC134

BACKGROUND

Breast cancer (BRCA) is the most common type of cancer among women worldwide. MiR-1260b has been widely demonstrated to participate in multiple crucial biological functions of cancer tumorigenesis, but its functional effect and mechanism in human breast cancer have not been fully understood.

METHODS

qRT-PCR was used to detect miR-1260b expression in 29 pairs of breast cancer tissues and normal adjacent tissues. Besides, the expression level of miR-1260b in BRCA cells was also further validated by qRT-PCR. miR-1260b played its role in the prognostic process by using Kaplan-Meier curves. In addition, miR-1260b knockdown and target gene CCDC134 overexpression model was constructed in cell line MDA-MB-231. Transwell migration and invasion assay was performed to analyze the effect of miR-1260b and CCDC134 on the biological function of BRCA cells. TargetScan and miRNAWalk were used to find possible target mRNAs. The relationship between CCDC134 and immune cell surface markers was analyzed using TIMER and database and the XIANTAO platform. GSEA analysis was used to identify possible CCDC134-associated molecular mechanisms and pathways.

RESULTS

In the present study, miR-1260b expression was significantly upregulated in human breast cancer tissue and a panel of human breast cancer cell lines, while the secretory protein coiled-coil domain containing 134 (CCDC134) exhibited lower mRNA expression. High expression of miR-1260b was associated with poor overall survival among the patients by KM plot. Knockdown of miR-1260b significantly suppressed breast cancer cell migration and invasion and yielded the opposite result. In addition, overexpression of CCDC134 could inhibit breast cancer migration and invasion, and knockdown yielded the opposite result. There were significant positive correlations of CCDC134 with CD25 (IL2RA), CD80 and CD86. GSEA showed that miR-1260b could function through the MAPK pathway by downregulating CCDC134.

CONCLUSION

Collectively, these results suggested that miR-1260b might be an oncogene of breast cancer and might promote the migration and invasion of BRCA cells by down-regulating its target gene CCDC134 and activating MAPK signaling pathway as well as inhibiting immune function and causing immune escape in human breast cancer.

Gene expression signatures in older patients with breast cancer: A systematic review

BACKGROUND

Gene expression signatures have emerged to predict prognosis and guide the use of adjuvant therapy in patients with hormone receptor-positive breast cancer. The objective of this systematic review was to evaluate the prognostic and predictive value of commercially available gene expression signatures as a tool in adjuvant treatment decision-making in older patients with breast cancer.

METHODS

PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, and Emcare were reviewed for relevant articles published before December 2021. Eligible studies were randomised trials and cohort studies that externally validated commercially available gene expression signatures in patients aged 65 years and older, including studies that presented subanalyses of this age group. Data extraction and risk of bias assessment was performed independently by two investigators.

RESULTS

Fifteen studies were included. Most studies investigated Oncotype DX, while results from other gene expression signatures were limited. Several studies underlined the prognostic performance of Oncotype DX and Prosigna Risk of Recurrence in older patients. Moreover, Oncotype DX was predictive for older patients with an intermediate-risk recurrence score; chemotherapy could be spared in both lymph node-positive and lymph node-negative disease.

CONCLUSIONS

Prognostic performance has been demonstrated in older patients for several gene expression signatures. However, additional validation in patients with high-risk tumours is needed before gene expression signatures can be implemented in clinical practice as a prediction tool for adjuvant chemotherapy decision-making in the older age group.

Pluronic® triblock copolymer-based nanoformulations for cancer therapy: A 10-year overview

This paper provides a review of the literature on the use of Pluronic® triblock copolymers for drug encapsulation over the last 10 years. A special focus is given to the progress of drug delivery systems (e.g., micelles, liposomes, micro/nanoemulsions, hydrogels and nanogels, and polymersomes and niosomes); the beneficial aspects of Pluronic® triblock copolymers as biological response modifiers and as pharmaceutical additives, adjuvants, and stabilizers, are also discussed. The advantages and limitations encountered in developing site-specific targeting approaches based on Pluronic-based nanostructures in cancer treatment are highlighted, in addition to innovative examples for improving tumor cytotoxicity while reducing side effects.

EA, Udupa KS, Gota V, Mallayasamy S. Factors Influencing Pharmacokinetics of Tamoxifen in Breast Cancer Patients: A Systematic Review of Population Pharmacokinetic Models

BACKGROUND

Tamoxifen is useful in managing breast cancer and it is reported to have significant variability in its pharmacokinetics. This review aimed to summarize reported population pharmacokinetics studies of tamoxifen and to identify the factors affecting the pharmacokinetics of tamoxifen in adult breast cancer patients.

METHOD

A systematic search was undertaken in Scopus, Web of Science, and PubMed for papers published in the English language from inception to 20 August 2022. Studies were included in the review if the population pharmacokinetic modeling was based on non-linear mixed-effects modeling with a parametric approach for tamoxifen in breast cancer patients.

RESULTS

After initial selection, 671 records were taken for screening. A total of five studies were selected from Scopus, Web of Science, PubMed, and by manual searching. The majority of the studies were two-compartment models with first-order absorption and elimination to describe tamoxifen and its metabolites' disposition. The CYP2D6 phenotype and CYP3A4 genotype were the main covariates that affected the metabolism of tamoxifen and its metabolites. Other factors influencing the drug's pharmacokinetics included age, co-medication, BMI, medication adherence, CYP2B6, and CYP2C19 genotype.

CONCLUSION

The disposition of tamoxifen and its metabolites varies primarily due to the CYP2D6 phenotype and CYP3A4 genotype. However, other factors, such as anthropometric characteristics and menopausal status, should also be addressed when accounting for this variability. All these studies should be externally evaluated to assess their applicability in different populations and to use model-informed dosing in the clinical setting.

Case report: 18F-FES PET/CT predicted treatment responses of second-line and third-line CDK4/6 inhibitors after disease progression on first-line CDK4/6 inhibitor in a HR+/HER2- metastatic breast cancer patient

Background

Cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) has become the commonest first-line treatment of hormonal receptor positive and human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer (MBC). However, therapy is quite individualized after progression of disease (PD) when CDK4/6i fails. Estrogen receptor (ER) status of metastatic lesions of bone, lung or liver might be different from the primary tumor and biopsy of metastatic lesions was invasive and not always available. Prediction of treatment response after PD of CDK4/6i remains unsolved. ¹⁸F-fluoroestradiol (FES) PET/CT could non-invasively reveal ER expression both in primary and metastatic breast cancer and recognize heterogeneity of ER status.

Case presentation

A 70-year-old woman with Parkinson's disease, osteoporosis and cardiovascular co-morbidity was diagnosed with HR+/HER2- breast cancer (pT2N2M0, stage IIIa). Three years later, she developed metastases in right lung and pleura with pleural effusion and received palbociclib + letrozole. After 8 months the disease progressed, and ¹⁸F-FES PET/CT revealed multiple ER-positive pleural lesions and ER-negative pulmonary nodules after PD and the progression-free survival (PFS) of first-line CDK4/6i was 8 months. Since most of the metastatic lesions were ER-positive, abemaciclib + fulvestrant were chosen as the second-line CDK4/6i treatment and the PFS was 15 months. Another ¹⁸F-FES PET/CT showed a new ER-positive pleural mass with multiple ER-negative pulmonary nodules. Since ¹⁸F-FES PET/CT revealed that the dominant lesions were still ER-positive, dalpiciclib + exemestane + fulvestrant were prescribed as the third-line CDK4/6i treatment. Currently the patient's disease had been stable for 2 months.

Conclusion

This case demonstrated that ¹⁸F-FES PET/CT could show ER heterogeneity non-invasively and reveal the treatment responses a predictive imaging tool of serial second- and third-line of CDK4/6i treatments when first-line CDK4/6i failed in HR+/HER2- MBC. So long as the dominant or newly-developed metastatic lesion was ER-positive on ¹⁸F-FES PET after first-line CDK4/6i, the patient might show certain therapeutic response towards endocrine-based treatment including second- and third-line of CDK4/6i, and thus increased the time to chemotherapy (TTC).

Identifying the predictors of adherence to oral endocrine therapy in racial/ethnic minority patients with low socioeconomic status

Background Adherence to oral endocrine therapy (OET) is crucial in ensuring its maximum benefit in prevention and treatment of hormone receptor-positive (HR+) breast cancer (BC) in patients. Medication use behavior is suboptimal especially in racial/ethnic minorities of lower socioeconomic status (SES). We aimed to assess the OET adherence and its predictors in racial/ethnic minority patients of lower SES. Aim We aimed to assess the OET adherence and determine the predictors of OET nonadherence in racial/ethnic minority patients of lower SES. Method A retrospective study was conducted at the Harris Health System in Houston, Texas. Since the study period included the COVID-19 pandemic, data was collected during the 6 months prior and 6 months after the start of the pandemic. The adherence was assessed using the prescription refill data using the proportion of days covered. Multivariable logistic regression model was used to identify predictors of nonadherence. Eighteen years or older patients on appropriate doses of OET for prevention or treatment of BC were included. Result In 258 patients, the adherence was significantly lower during the pandemic (44%) compared to before the pandemic (57%). The predictors of OET nonadherence before the pandemic were Black/African American, obesity/extreme obesity, prevention setting, tamoxifen therapy, and 4 or more years on OET. During the pandemic, prevention setting and those not using home delivery were more likely to be nonadherent. Conclusion Racial/ethnic minority patients of lower SES, especially African Americans and those using OET for prevention of BC, require individualized interventions to improve adherence.

Breast cancer diagnosis in Inner-City African American and Hispanic women: The importance of early screening

PURPOSE

To evaluate the diagnosis of breast cancer in inner-city African-American and Hispanic women under age 50 to support the importance of screening in this population.

METHODS

This retrospective chart review included women newly diagnosed with breast cancer from 1/1/2015 to 1/1/2019 in a city hospital mainly serving minority patients. Chi-square and Fisher's exact tests were used for analysis.

RESULTS

In this cohort of 108 newly diagnosed African-American (63%) and Hispanic (31%) women, 60/108 (56%) presented with a site of palpable concern for diagnostic workup, and the remaining were diagnosed via asymptomatic screening. Women ages 30-49 were significantly more likely to present with a site of palpable concern when compared to women ages 50-69 (68% vs. 44%, p = 0.045). Additionally, women ages 30-49 were more likely to have triple-negative breast cancer (TNBC) than women ages 50-69 (20% vs. 10%, p = 0.222). However, women ages 30-49 were less likely to have prior mammogram than women ages 50-69 (24% vs. 46%, p = 0.062).

CONCLUSION

African-American and Hispanic women ages 30-49 were more likely to present with a site of palpable concern and TNBC than those ages 50-69. However, these young minority women ages 30-49 were less likely to have prior screening mammograms when compared to those ages 50-69. Our data highlights the importance of starting screening mammography no later than age 40 in African-American and Hispanic women. In addition, these women should have risk assessment for breast cancer no later than age 30 and be screened appropriately.

The College of American Pathologists Foundation's See, Test & Treat Program®: an Evaluation of a One-Day Cancer Screening Program Implemented in Mississippi

Women in Mississippi experience significant barriers to healthcare that results in high incidence rates of late-stage breast, cervical, and oropharyngeal cancer. We implemented See, Test, & Treat, a cancer screening and education program, that was aimed at increasing access to cancer screening for underserved women in the Jackson Metropolitan Area. During the event, 103 women between the ages of 21 and 69 years old received breast, cervical, and/or oral cancer screenings. Quantitative and qualitative data were collected to evaluate the effect of the program on the participants' cancer screening knowledge, self-efficacy to obtain medical check-ups, and intentions to engage in health-enhancing behaviors. Of the 57 women who received a mammogram, 18 had abnormal results that required follow-up care. None of the women who received a Pap test had abnormal results, but 8 women were diagnosed with trichomoniasis. One woman was diagnosed with stage 4 oral cancer. The evaluation data indicated that participants found that free cancer screenings and receipt of results on the same day were primary benefits of the program.

Organoids from patient biopsy samples can predict the response of BC patients to neoadjuvant chemotherapy

PROPOSE

Neoadjuvant chemotherapy has been widely used in locally advanced and inflammatory breast cancer. Generally, complete pathological response after neoadjuvant chemotherapy treatment predicts survival. Studies have shown that patient-derived organoids can be used in cancer research and drug development. Therefore, we aimed to generate a living organoid biobank from biopsy samples to predict the response of patients to neoadjuvant chemotherapy.

METHOD

We generated a living organoid biobank from locally advanced breast cancer patients receiving neoadjuvant chemotherapy. When the patient received neoadjuvant chemotherapy, the organoids were treated with similar drugs, thereby simulating the situation of the patient receiving treatment.

RESULT

We successfully constructed organoids from breast cancer biopsies, demonstrating that organoids can be generated from a small sample of tissue. The phenotype of breast cancer organoid often agreed with the original breast cancer according to the blinded histopathological analysis of H&E stain tissue and organoid sections. In addition, our data confirm that the patient's response to chemotherapy closely matches the organoids' response to drugs.

CONCLUSION

Our data indicate that patient-derived organoids can be used to predict the clinical response of breast cancer patients to neoadjuvant chemotherapy in vitro and to screen drugs that have different effects on different patients. Key messageComplete pathological response (pCR) after adjuvant chemotherapy can predict, survival, therefore, predicting patient response to neoadjuvant chemotherapy is critical.Patient-derived organoids (PDOs) matched the original tumour in terms of histopathology, hormone receptor levels and HER2 receptor status.Patient-derived organoids can predict the responsiveness of patient to neoadjuvant chemotherapy.

Endo/exo-genous dual-stimuli responsive gold nanotetrapod-based nanoprobe for magnetic resonance imaging and enhanced multimodal therapeutics by amplifying·OH generation

Tumor microenvironment (TME) responsive chemodynamic therapy (CDT) can produce high-toxic hydroxyl radicals (·OH) to kill cancer cells, but the limited concentration of endogenous hydrogen peroxide (H₂O₂) seriously restricted its application. Herein, using endo/exo-genous dual-stimuli, a novel nanoprobe with enhanced ·OH generation was developed for magnetic resonance (MR) imaging and multimodal therapeutics, in which gold nanotetrapod (AuNTP) with photothermal therapy (PTT) performance was coated with mesoporous silica (mSiO₂) and loaded with cisplatin (CDDP), then a thin layer of manganese dioxide (MnO₂) was deposited to construct AuNTP@mSiO₂@CDDP@MnO₂ nanoprobes. In TME, endogenous H₂O₂, CDDP-triggered self-supplying H₂O₂ produced via cascade reaction and the exogenous photothermal effect of AuNTPs together enhanced the ·OH generation of Mn²⁺ induced by glutathione (GSH) responsive degradation of MnO₂. The prepared AuNTP@mSiO₂@CDDP@MnO₂ nanoprobes possessed perfect core@shell structure, good biocompatibility and GSH-dependent MR performance, in which the relaxation rates increased from 0.717 mM^-1·s^-1 to 8.12 mM^-1·s^-1. Under the multimodal therapeutics of CDT/PTT/chemotherapy, the developed AuNTP@mSiO₂@CDDP@MnO₂ nanoprobes demonstrated good antitumor efficacy. Our work provided a promising strategy for constructing TME-responsive nanoprobes with endo/exo-genous stimuli, achieving enhanced visualized theranostics of tumors. STATEMENT OF SIGNIFICANCE: Tumor microenvironment (TME) responsive chemodynamic therapy (CDT) can produce high-toxic hydroxyl radicals (·OH) to kill cancer cells, but the limited concentration of endogenous hydrogen peroxide (H₂O₂) seriously restricted its application. Using endo/exo-genous dual-stimuli, AuNTP@mSiO₂@CDDP@MnO₂ (AMCM) nanoprobe was constructed, in which endogenous H₂O₂, CDDP-triggered self-supplying H₂O₂ and the exogenous photothermal effect of AuNTPs together enhanced the ·OH generation. Under the multimodal therapeutics of CDT/PTT/chemotherapy, the developed AuNTP@mSiO₂@CDDP@MnO₂ nanoprobe demonstrated good antitumor efficacy, and provided a promising strategy for constructing TME-responsive nanoprobes with endo/exo-genous stimuli, achieving enhanced CDT of tumors.

Suicide risk among female breast cancer survivors: A population-based study

Background

Breast cancer is the most common cancer type for females and has the highest relative number of suicide cases among female-specific cancers. This study aimed to demonstrate suicide rates and changing trends and to identify risk factors for suicide among female breast cancer survivors.

Methods

Data were derived from the surveillance, epidemiology, and end results database for women diagnosed with breast cancer from 2000 to 2017. Mortality rate and standardized mortality ratios (SMRs) were calculated to describe the incidence rate and trend of suicide among female breast cancer survivors. Gray's test and cumulative incidence function (CIF) curves were used to assess difference of cumulative suicide incidence in subgroups. Multivariate Fine-Gray competing risk model was used to identify risk factors for individual survivors and nomogram model was used to estimate the probability of suicide.

Result

There were 414 suicide cases among 638,547 female breast cancer survivors observed for 5,079,194 person-years, and the suicide rate and SMRs gradually increased with the year of diagnosis. Female breast cancer survivors had a higher risk of suicide than the general population (SMR = 1.19; 95% CI (1.08-1.31)). Based on the result of Fine-Gray competing risk models, age group (50-70 vs <50: HR=0.65, 95% CI:0.52-0.80; >70 vs <50: HR=0.22, 95% CI:0.15-0.32), race/ethnicity (black vs white: HR= 0.20, 95% CI: 0.11-0.36; other race vs white: HR= 0.67, 95% CI: 0.46-0.97), marital status (separated vs married: HR= 1.50, 95% CI: 1.16-1.94; single vs married: HR= 1.70, 95% CI: 1.31-2.20), stage (distant vs regional: HR= 0.30, 95% CI: 0.14-0.63), radiotherapy (Yes vs No/Unknown: HR= 0.62, 95% CI: 0.49-0.77), and molecular subtypes (HER-2 vs Luminal B (HR= 2.53, 95% CI: 1.10-5.82), TNBC vs Luminal B (HR= 2.11, 95% CI: 1.01-4.42)) were independent predictors of suicide among female breast cancer patients. A nomogram was constructed to predict the suicide probability for individual survivors with a C-index of 0.62 (95%CI: 0.59-0.66).

Conclusion

Female breast cancer survivors with younger age (less than 50 years old), white race, unmarried status, regional stage, HER-2 or TNBC subtype, and no radiotherapy performed were more likely to commit suicide. The clinicians and family members should pay more attention to patients with high risk factors of suicide to decrease the mortality rate.

HMGB3 Targeted by miR-145-5p Impacts Proliferation, Migration, Invasion, and Apoptosis of Breast Cancer Cells

This study focused on the investigation into how HMGB3 works in breast cancer (BC) progression. Firstly, we analyzed the relationship between HMGB3 and BC patients through the TCGA database. We performed qRT-PCR for determining the HMGB3 mRNA level and Western blot for detecting the protein level of HMGB3 in BC cell lines. CCK-8, flow cytometry, transwell, and wound healing assays were utilized to detect the effect of HMGB3 on BC cell phenotypes. Next, the prediction of the binding site shared by miR-145-5p and HMGB3 was performed by the bioinformatics method. The targeting relationship between miR-145-5p and HMGB3 was validated by using dual-luciferase assay. Finally, rescue experiments were employed for assessing the effect of the miR-145-5p/HMGB3 axis on BC cells. HMGB3 was demonstrated to have a high-level expression in BC cell lines and facilitated BC progression. On the contrary, miR-145-5p was shown a low-level expression in BC cell lines, which could target HMGB3. miR-145-5p restrained the proliferation, migration, and invasion of BC cells via inhibiting HMGB3.

The efficacy of cognitive behavioral therapy for cancer: A scientometric analysis

Cognitive behavioral therapy (CBT) is one of the most recognized psychological interventions to improve the overall quality of life of cancer survivors. To analyze current research trends in the field of the link between CBT and cancer and to provide potential future research directions, we conducted the scientometric analysis. The study was conducted on all documents in this field from 2012 to 2022 retrieved from Web of Science. Then Biblioshiny, VOSviewer software, and CiteSpace software were used for getting the information of article postings and citations, countries, institutions, journals, authors, and keywords. The number of documents about the link between CBT and cancer from 2012 to 19 July 2022, was 619, with 476 of articles and 143 of reviews. The number of annual publications has been fluctuating, with the highest number of publications in 2020. The country with the maximum number of publications and citations was the US. The University of Houston was the organization with the highest quantity of publications and total link strength (TLS). Psycho-Oncology was the most active journal in the field and has the highest h-index. Zvolensky MJ was the author with the highest quantity of publications. The most cited keywords were "Quality-of-life," "Cognitive-behavioral therapy," "Depression," "Cognitive therapy" and "Breast-cancer." And as evidenced by the keyword citations, the focus of this research area has gradually shifted to the mental health of patients and the underlying pathogenesis. The impact of CBT in cancer treatment is now well established and has gradually evolved toward symptom-specific treatment. However, the relationship between CBT and cancer has not been further developed. Future research is needed to be further developed in the identification of a generic formula for CBT in cancer and the exploration of mechanisms of CBT and cancer.

Light at night and the risk of breast cancer: Findings from the Sister study

BACKGROUND

Light at night (LAN) may alter estrogen regulation through circadian disruption. High levels of outdoor LAN may increase breast cancer risk, but studies have largely not considered possible residual confounding from correlated environmental exposures. We evaluated the association between indoor and outdoor LAN and incident breast cancer.

METHODS

In 47,145 participants in the prospective Sister Study cohort living in the contiguous U.S., exposure to outdoor LAN was determined using satellite-measured residential data and indoor LAN was self-reported (light/TV on, light from outside the room, nightlight, no light). We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between outdoor and indoor LAN and breast cancer risk. Models were adjusted for age, race/ethnicity, educational attainment, annual household income, neighborhood disadvantage, latitude, and population density as a proxy for urbanicity. To evaluate the potential for residual confounding of the outdoor LAN and breast cancer relationship by factors associated with urbanicity, we considered further adjustment for exposures correlated with outdoor LAN including NO2 [Spearman correlation coefficient, rho (ρ) = 0.78], PM2.5 (ρ = 0.36), green space (ρ =  - 0.41), and noise (ρ = 0.81).

RESULTS

During 11 years of follow-up, 3,734 breast cancer cases were identified. Outdoor LAN was modestly, but non-monotonically, associated with a higher risk of breast cancer (Quintile 4 vs 1: HR = 1.10, 95% CI: 0.99-1.22; Quintile 5 vs 1: HR = 1.04, 95% CI: 0.93-1.16); however, no association was evident after adjustment for correlated ambient exposures (Quintile 4 vs 1: HR = 0.99, 95% CI: 0.86-1.14; Quintile 5 vs 1: HR = 0.89, 95% CI: 0.74-1.06). Compared to those with no indoor LAN exposure, sleeping with a light or TV on was associated with a HR = 1.09 (95% CI: 0.97-1.23) in the adjusted model.

CONCLUSIONS

Outdoor LAN does not appear to increase the risk of breast cancer after adjustment for correlated environmental exposures.

The relationship between Mediterranean-DASH diet intervention for the neurodegenerative delay (MIND) Diet and risk of breast Cancer: a case-control study among iranian adult women

BACKGROUND

choosing a healthier lifestyle and modifying dietary habits could prevent four million new people from developing cancer. Recently, a new index called the Mediterranean-dietary approach to stop hypertension (DASH) diet intervention for the neurodegenerative delay (MIND) diet has been developed. In the current study, we aimed to assess the relationship between the MIND diet and the risk of breast cancer (BC) among Tehranian adult women.

METHOD

In this hospital-based, case-control study, 134 Tehranian women ≥ 30 years old with recently (< 6 months) diagnosed BC, confirmed histologically and 272 women of the same age as control were included. Dietary intakes were assessed in a personal interview using a valid and reliable semi-quantitative 168-item food frequency questionnaire. The odds ratio (OR) and 95% confidence intervals (CI) of breast cancer across tertiles of the MIND diet were determined using multivariable-adjusted logistic regression analysis.

RESULTS

In the crude model, participants in the highest tertiles had lower odds of BC [(OR = 0.57; 95% CI,0.34-0.95), P for trend = 0.020)] than those with the lowest scores on the MIND diet. After controlling for potential confounding variables, individuals in the highest tertile of the MIND diet had a 45% lower risk of BC [(OR = 0.55; 95% CI, 0.32-0.96), P for trend = 0.021)] compared with those in the lowest tertile. Also, in women with an abortion history, higher adherence to the MIND diet was associated with a lower risk of BC [(OR = 0.15; 95% CI, 0.04-0.52, P for trend = 0.002)].

CONCLUSION

Our findings revealed that higher adherence to the MIND diet was associated with decreased BC risk, which was strongly observed among women with a history of abortion.

Integrin regulation by tissue factor promotes cancer stemness and metastatic dissemination in breast cancer

Tissue Factor (TF) is the initiator of blood coagulation but also functions as a signal transduction receptor. TF expression in breast cancer is associated with higher tumor grade, metastasis and poor survival. The role of TF signaling on the early phases of metastasis has never been addressed. Here, we show an association between TF expression and metastasis as well as cancer stemness in 574 breast cancer patients. In preclinical models, blockade of TF signaling inhibited metastasis tenfold independent of primary tumor growth. TF blockade caused a reduction in epithelial-to-mesenchymal-transition, cancer stemness and expression of the pro-metastatic markers Slug and SOX9 in several breast cancer cell lines and in ex vivo cultured tumor cells. Mechanistically, TF forms a complex with β1-integrin leading to inactivation of β1-integrin. Inhibition of TF signaling induces a shift in TF-binding from α3β1-integrin to α6β4 and dictates FAK recruitment, leading to reduced epithelial-to-mesenchymal-transition and tumor cell differentiation. In conclusion, TF signaling inhibition leads to reduced pro-metastatic transcriptional programs, and a subsequent integrin β1 and β4-dependent reduction in metastasic dissemination.

Spatial Analysis of Breast Cancer Mortality Rates in a Rural State

Introduction

Breast cancer affects 1 in 8 women in the US and is the most frequently diagnosed cancer in women. In South Dakota, 102 women die from breast cancer each year. We assessed which sociodemographic factors contributed to mortality rates in South Dakota and used spatial analysis to investigate how counties’ observed age-adjusted mortality rates compared with expected rates.

Methods

We computed standardized incidence ratios (SIRs) of all counties in South Dakota by using the age-adjusted mortality rates, the 2000 US standard population, and the South Dakota estimated population. We used a linear regression model to identify sociodemographic factors associated with breast cancer mortality rates and to compute a new SIR value, after controlling for relevant factors.

Results

Educational level and breast cancer incidence rates were significantly associated with breast cancer mortality rates at the county level. The SIR values based on age-adjusted counts showed which counties had more deaths due to breast cancer than what might be expected using South Dakota as the reference population. After controlling for sociodemographic factors, the range of SIR values decreased and had lower variability.

Conclusion

The regression model helped identify factors associated with mortality and provided insights into which risk factors are at play in South Dakota. This information, in combination with the spatial distribution of mortality by county, can be used to help allocate resources to the counties in South Dakota that need them most.

Targeting Both Autophagy and Immunotherapy in Breast Cancer Treatment

As clinical efforts towards breast-conserving therapy and prolonging survival of those with metastatic breast cancer increase, innovative approaches with the use of biologics are on the rise. Two areas of current focus are cancer immunotherapy and autophagy, both of which have been well-studied independently but have recently been shown to have intertwining roles in cancer. An increased understanding of their interactions could provide new insights that result in novel diagnostic, prognostic, and therapeutic strategies. In this breast cancer-focused review, we explore the interactions between autophagy and two clinically relevant immune checkpoint pathways; the programmed cell death-1 receptor with its ligand (PD-L1)/PD-1 and the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4)/CD80 and CD86 (B7-1 and B7-2). Furthermore, we discuss emerging preclinical and clinical data supporting targeting both immunotherapy and autophagy pathway manipulation as a promising approach in the treatment of breast cancer.

LINC00467: an oncogenic long noncoding RNA

Long non-coding RNAs (lncRNAs) have been found to play essential roles in the cell proliferation, fission and differentiation, involving various processes in humans. Recently, there is more and more interest in exploring the relationship between lncRNAs and tumors. Many latest evidences revealed that LINC00467, an oncogenic lncRNA, is highly expressed in lung cancer, gastric cancer, colorectal cancer, hepatocellular carcinoma, breast cancer, glioblastoma, head and neck squamous cell carcinoma, osteosarcoma, and other malignant tumors. Besides, LINC00467 expression was linked with proliferation, migration, invasion and apoptosis via the regulation of target genes and multiple potential pathways. We reviewed the existing data on the expression, downstream targets, molecular mechanisms, functions, relevant signaling pathways, and clinical implications of LINC00467 in various cancers. LINC00467 may serve as a novel biomarker or therapeutic target for the diagnosis and prognosis of various human tumors.

Construction and validation of a nomogram to predict overall survival in patients with breast sarcoma

Background

This study aimed to construct a nomogram for Breast sarcoma (BS) to predict the prognosis of patients with BS accurately and provide a theoretical basis for individualized treatment.

Methods

Patients selected from the Surveillance, Epidemiology and End Results (SEER) database from 2000 to 2018 were assigned to a training group (TG, n = 696) and an internal validation group (IVG, n = 299) at a 7:3 ratio. Cox regression analysis was performed on the TG, and statistically significant factors were used to establish a nomogram to predict 3-, 5-, and 10-year overall survival (OS). The nomogram’s predictive power was validated using data from patients who attended our institution as the external validation group (EVG, n =79).

Results

Cox regression analysis identified five factors, which were used to construct the nomogram. Good prediction accuracy was demonstrated using calibration curves. The concordance (C) indices for TG = 0.804 (95% confidence interval (CI) 0.777–0.831) and IVG = 0.761 (0.716–0.806) were higher than those based on 8th American Joint Committee on Cancer (AJCC8) stage: TG = 0.695 (0.660–0.730), IVG = 0.637 (0.584–0.690). The EVG also had a high C-index: 0.844 (0.768–0.920). Decision curve analysis showed that nomogram has larger net benefits than the AJCC8. The Kaplan–Meier curves of the nomogram-based risk groups showed significant differences (p &lt; 0.001).

Conclusions

The nomogram could accurately predict 3-, 5-, and 10-year OS and provided nomogram-based risk stratification, which could help physicians to personalize treatment plans for patients with BS.

Breast cancer mortality of older patients with and without recurrence analysed by novel multi-state models

INTRODUCTION

In older patients with breast cancer, the risk of dying from other causes than breast cancer strongly increases after the age of 70. The aim of this study was to assess contributions of breast cancer mortality versus other-cause mortality after locoregional or distant recurrence in a population-based cohort of older patients analysed by multi-state models.

METHODS

Surgically treated patients ≥70 years diagnosed with stage I-III breast cancer in 2003-2009 were selected from the Netherlands Cancer Registry. A novel multi-state model with locoregional and distant recurrence that incorporates relative survival was fitted. Other-cause and breast cancer mortality were indicated as population and excess mortality.

RESULTS

Overall, 18,419 patients were included. Ten-year cumulative incidences of locoregional and distant recurrence were 2.8% (95%CI 2.6-3.1%) and 12.5% (95%CI 11.9-13.1%). Other-cause mortality increased from 23.9% (95%CI 23.7-24.2%) in patients 70-74 years to 73.8% (95%CI 72.2-75.4%) in those ≥80 years. Ten-year probabilities of locoregional or distant recurrence with subsequent breast cancer death were 0.4-1.3% and 10.2-14.6%, respectively. For patients with a distant recurrence in the first two years after diagnosis, breast cancer death probabilities were 95.3% (95%CI 94.2-96.4%), 93.1% (95%CI 91.6-94.6%), and 88.6% (95%CI 86.5-90.8%) in patients 70-74, 75-79, and ≥80 years.

CONCLUSION

In older patients without recurrence, prognosis is driven by other-cause mortality. Although locoregional recurrence is a predictor for worse outcome, given its low incidence it contributes little to breast cancer mortality after diagnosis. For patients who develop a distant recurrence, breast cancer remains the dominant cause of death, even at old age.

Baicalein Loaded Crown Ether-mPEG-PLGA Micelle Drug Delivery System for Increased Breast Cancer Treatment: Preparation, Characterization, In-Vitro and In-Vivo Evaluations

Due to low aqueous solubility and poor bioavailability of the flavone baicalein (BIC), a nano-micelle of delivery system was developed. Preparation of BIC-loaded crown ether-mPEG-PLGA micelle (BCPP-M) was performed via thin-film hydration method. Characterization of micellar excipients was accomplished with 1H NMR, while evaluation of the optimal BCPP-M formulation was appropriately carried out through zeta potential (ZP), size of particles (PS), efficiency of encapsulation (EE) and capacity of drug loading (DL). We evaluated BIC release In-Vitro and profile of In-Vivo pharmacokinetics. Evaluation of the anti-breast cancer property of BCPP-M using MCP-7 cells cytotoxicity and mice model was performed. Particles of BCPP-M were homogenously and spherically shaped with smaller average PS, coupled with higher EE and DL, good stability and polydispersity index (PDI). The accumulative release of BCPP-M was obviously higher than free-BIC. Significantly, oral biological availability of BCPP-M was improved comparable to free BIC. Besides, half maximum inhibitory concentration (IC50) of BCPP-M in MCP-7 cells was lower than free-BIC. Animal experiments also showed targeting, long circulation and antitumor potential of BCPP-M. Successful incorporation of BIC into long-acting and targeting micellar system could have enhanced solubility in aqueous media, oral In-Vivo availability and antitumor property of BIC.

Stakeholder Engagement in Adoption, Implementation, and Sustainment of an Evidence-Based Intervention to Increase Mammography Adherence Among Low-Income Women

Multi-level organizational stakeholder engagement plays an important role across the research process in a clinical setting. Stakeholders provide organizational specific adaptions in evidence-based interventions to ensure effective adoption, implementation, and sustainability. Stakeholder engagement strategies involve building mutual trust, providing clear communication, and seeking feedback. Using constructs from the Consolidated Framework for Implementation Research and The International Association for Public Participation spectrum, a conceptual framework was created to guide stakeholder engagement in an evidence-based intervention to increase mammography appointment adherence in underserved and low-income women. A document review was used to explore the alignment of the conceptual framework with intervention activities and stakeholder engagement strategies. The results indicate an alignment with the conceptual framework constructs and a real-world application of stakeholder engagement in a mammography evidence-based intervention. The conceptual framework and stakeholder engagement strategies can be applied across a range of community-based cancer programs and interventions, organizations, and clinical settings.

Can Radiotherapy After Breast-Conserving Surgery be Omitted in Elderly Patients with Early-Stage, Hormone-Receptor Negative Breast Cancer? A Population-Based Study and Proposed Nomogram

INTRODUCTION

We aimed to evaluate whether radiotherapy (RT) after breast-conserving surgery (BCS) can be omitted in elderly patients with early-stage, hormone receptor-negative breast cancer.

METHODS

Patients aged 65 years and older with T1-2N0-1, hormone receptor-negative breast cancer in 2010-2015 were extracted from the Surveillance, Epidemiology, and End Results program. Propensity score matching was used to balance the baseline of different groups. Survival analysis was performed using Kaplan-Meier plot and log-rank test. Independent risk factors were identified by multivariate Cox analysis. A nomogram predicting breast cancer-specific survival (BCSS) and a risk stratification model were constructed and validated.

RESULTS

A total of 4465 patients were included and 27.7% (1237/4465) patients did not receive postoperative RT. RT was significantly associated with improved overall survival (OS) (HR = 0.552 P < 0.001) and BCSS (HR = 0.559, P < 0.001) in the matched cohort. The same results were found after adjusting independent risk factors by multivariate analysis. On the basis of the nomogram predicting BCSS of patients without RT by incorporating independent risk factors (age, race, HER2 status, T stage, and N stage), we built a risk stratification model which indicated that RT improved OS (HR = 0.511, P < 0.001) and BCSS (HR = 0.517, P < 0.001) in the high-risk group (total score > 150), but not in the low-risk group (total score ≤ 120). The C-index and all calibration curves demonstrated sufficient accuracies and good predictive capabilities.

CONCLUSIONS

RT is indeed beneficial for the whole cohort in this study. However, it may be omitted in the low-risk subgroup without significantly sacrificing survival. For patients in the high-risk group, RT following BCS remained beneficial. This study highlights the need for prospective randomized trials to study RT de-escalation strategies.

Meme manyetik rezonans görüntülemede malign ve benign lezyonların ayrımında histogram analizi: ön çalışma

Purpose: The present study assesses whether malignant and benign lesions can be distinguished through histogram analysis of non-fat-suppressed T1-weighted and fat-suppressed T2-weighted breast magnetic resonance images (MRIs). Materials and Methods: MRIs of 20 malignant and 20 benign breast lesions were reviewed retrospectively by histogram analysis performed using Osirix V.4.9 software. The regions of interest (ROIs) were drawn manually to include almost the entire lesion, and values from these ROIs were used to calculate gray-level intensity mean, standard deviation, entropy, uniformity, skewness, kurtosis, and percentile values. Results: In non-fat-suppressed T1-weighted images, the minimum, 1st, 3rd, 5th, 10th and 25th percentile values were significantly lower in the malignant lesions than in the benign lesions. The minimum value had sensitivity of 70% and specificity of 63.2%. On the fat-suppressed T2-weighted images, skewness was significantly higher while uniformity was significantly lower in malignant lesions than benign lesions. Skewness had 68.4% sensitivity and 60% specificity, and uniformity had 65% sensitivity and 68.4% specificity. Conclusion: The results of this study demonstrated that histogram analysis of non-fat-suppressed T1-weighted and fat-suppressed T2-weighted images can be used to differentiate malignant and benign lesions in breast MRI.

Clonal evolution characteristics and reduced dimension prognostic model for non-metastatic metachronous bilateral breast cancer

Background

How to evaluate the prognosis and develop overall treatment strategies of metachronous bilateral breast cancer (MBBC) remains confused in clinical. Here, we investigated the correlation between clonal evolution and clinical characteristics of MBBC; we aim to establish a novel prognostic model in these patients.

Methods

The data from Surveillance, Epidemiology, and End Results (SEER) database and the First Hospital of Jilin University were analyzed for breast cancer–specific cumulative mortality (BCCM) by competing risk model. Meanwhile, whole-exome sequencing was applied for 10 lesions acquired at spatial–temporal distinct regions of five patients from our own hospital to reconstruct clonal evolutionary characteristics of MBBC. Then, dimensional-reduction (DR) cumulative incidence function (CIF) curves of MBBC features were established on different point in diagnostic interval time, to build a novel DR nomogram.

Results

Significant heterogeneity in genome and clinical features of MBBC was widespread. The mutational diversity of contralateral BC (CBC) was significantly higher than that in primary BC (PBC), and the most effective prognostic MATH ratio was significantly correlated with interval time (R2 = 0.85, p&lt; 0.05). In SEER cohort study (n = 13,304), the interval time was not only significantly affected the BCCM by multivariate analysis (p&lt; 0.000) but determined the weight of clinical features (T/N stage, grade and ER status) on PBC and CBC in prognostic evaluation. Thus, clinical parameters after DR based on interval time were incorporated into the nomogram for prognostic predicting BCCM. Concordance index was 0.773 (95% CI, 0.769–0.776) in training cohort (n = 8,869), and 0.819 (95% CI, 0.813–0.826) in validation cohort (n = 4,435).

Conclusions

Bilateral heterogeneous characteristics and interval time were determinant prognostic factors of MBBC. The DR prognostic nomogram may help clinicians in prognostic evaluation and decision making.

Cuproptosis Combined with lncRNAs Predicts the Prognosis and Immune Microenvironment of Breast Cancer

Breast cancer (BC), the most common cancer in women, is caused by the uncontrolled proliferation of mammary epithelial cells under the action of a variety of carcinogenic factors. Cuproptosis-related targets have been found to be closely associated with breast cancer development. TCGA obtained 1226 tumor samples, 1073 clinical data, and 37 lncRNAs during univariate Cox multivariate analysis. We used nonnegative matrix factoring (NMF) agglomeration to spot thirty-three potential molecular subsets with totally different cuproptosis-related lncRNA expression patterns. The least absolute shrinkage and selection operator (LASSO) formula and variable Cox multivariate analysis were not used to construct the best prognostic model. The variations in neoplasm mutation burden and factor gene ontology (GO) and gene set enrichment analysis (GSEA) within the high- and low-risk teams were analyzed, and therefore, the potential mechanism of the development of carcinoma was analyzed. We created a prognostic profile consisting of nineteen cuproptosis-related genes (NFE2L2, LIPT1, LIPT2, DLD, etc.) and their connected targets. The correlation between tumor mutational burden (TMB) and clinical manifestations of tumors demonstrates the importance of high- and low-expression bunch data on the incidence of clinical manifestations of tumors. The area under the curve (AUC) shows moderate prophetic power for copper mortality. GO enrichment analysis showed that immunorelated responses were enriched. Correlation analysis of immune cells showed that pathology could play an important role in the prevalence and prognosis of tumors, and there were variations in immune cells between the probable and low-risk groups. Our study suggests that the prognostic characteristic genes associated with cuproptosis can be used as new biomarkers to predict the prognosis of breast cancer patients. In addition, we found that immunotherapy may play a key role in breast cancer treatment regimens. Levels of immune-associated cells and pathways vary significantly among risk groups of breast cancer patients.

Barriers to breast cancer screening in Atlanta, GA: results from the Pink Panel survey at faith-based institutions

Purpose

Our research sought to describe barriers to mammography screening among a sample of predominantly Black women in metropolitan Atlanta, Georgia.

Methods

The Pink Panel project convened community leaders from faith-based institutions to administer an offline survey to women via convenience sampling at fourteen churches in Atlanta in late 2019 and early 2020. With the COVID-19 pandemic, the research team switched to an online survey. The survey included seven questions about breast cancer awareness, barriers to breast cancer screening, and screening status. We used residence information to attain the 9-digit zip code to link to the Area Deprivation Index at the Census Block Group neighborhood level. We report results as descriptive statistics of the barriers to mammography screening.

Results

The 643 women represented 21 counties in Georgia, predominantly from metropolitan Atlanta, and 86% identified as Black. Among women aged 40 and older, 90% have ever had a mammogram. Among all women, 79% have ever had a mammogram, and 86% indicated that they would get a mammogram if offered in their neighborhood. The top barriers to mammography screening were lack of health insurance and high cost. Barriers to mammography screening did not differ substantially by Area Deprivation Index.

Conclusion

Among metropolitan Atlanta women aged 40+ , nearly all reported ever having a mammogram. However, addressing the barriers, including lack of health insurance and high cost, that women reported may further improve mammography screening rates.

Racial Disparity in Quadruple Negative Breast Cancer: Aggressive Biology and Potential Therapeutic Targeting and Prevention

Simple Summary

Quadruple negative breast cancer (QNBC), a subgroup of triple negative BC, has emerged as a highly aggressive BC subtype that disproportionately afflicts and impacts Black/African-American (AA) women. In this article, we review molecular distinctions in Black/AA and White/European-American (EA) QNBC biology as well as address potential non-genetic risk factors that could be underlying this racially disparate burden. We aim to provide deeper insight and provide a framework for novel discovery of actionable therapeutic targets and identify lifestyle changes to improve outcomes for Black/AA QNBC patients.

Abstract

Black/African-American (AA) women, relative to their White/European-American (EA) counterparts, experience disproportionately high breast cancer mortality. Central to this survival disparity, Black/AA women have an unequal burden of aggressive breast cancer subtypes, such as triple-negative breast cancer (ER/PR-, HER2-wild type; TNBC). While TNBC has been well characterized, recent studies have identified a highly aggressive androgen receptor (AR)-negative subtype of TNBC, quadruple-negative breast cancer (ER/PR-, HER2-wildtype, AR-; QNBC). Similar to TNBC, QNBC disproportionately impacts Black/AA women and likely plays an important role in the breast cancer survival disparities experienced by Black/AA women. Here, we discuss the racial disparities of QNBC and molecular signaling pathways that may contribute to the aggressive biology of QNBC in Black/AA women. Our immediate goal is to spotlight potential prevention and therapeutic targets for Black/AA QNBC; ultimately our goal is to provide greater insight into reducing the breast cancer survival burden experienced by Black/AA women.

Breast cancer microenvironment and obesity: challenges for therapy

Women with obesity who develop breast cancer have a worsened prognosis with diminished survival rates and increased rates of metastasis. Obesity is also associated with decreased breast cancer response to endocrine and chemotherapeutic treatments. Studies utilizing multiple in vivo models of obesity as well as human breast tumors have enhanced our understanding of how obesity alters the breast tumor microenvironment. Changes in the complement and function of adipocytes, adipose-derived stromal cells, immune cells, and endothelial cells and remodeling of the extracellular matrix all contribute to the rapid growth of breast tumors in the context of obesity. Interactions of these cells enhance secretion of cytokines and adipokines as well as local levels of estrogen within the breast tumor microenvironment that promote resistance to multiple therapies. In this review, we will discuss our current understanding of the impact of obesity on the breast tumor microenvironment, how obesity-induced changes in cellular interactions promote resistance to breast cancer treatments, and areas for development of treatment interventions for breast cancer patients with obesity.

Characterization of the Metabolome of Breast Tissues from Non-Hispanic Black and Non-Hispanic White Women Reveals Correlations between Microbial Dysbiosis and Enhanced Lipid Metabolism Pathways in Triple-Negative Breast Tumors

Simple Summary

We previously showed that breast tumor tissues from women display an imbalance in abundance and composition of microbiota compared to normal healthy breast tissues. It is unknown whether these differences in breast tumor microbiota may be driven by alterations in microbial metabolites, leading to potentially protective or pathogenic consequences. The aim of our study was to conduct global metabolic profiling on normal and breast tumor tissues to identify differences in metabolite profiles and to determine whether breast microbial dysbiosis may be associated with enrichment of microbial metabolites in triple-negative breast cancer (TNBC) which disproportionately affects women of African ancestry. We observed significant correlations between elevated lipid metabolism pathways and microbial dysbiosis in TNBC tissues from both non-Hispanic black and white women. This is the first study to report an association between breast microbial dysbiosis and alterations in host metabolic pathways in breast tumors, including TNBC, of non-Hispanic black and non-Hispanic white women.

Abstract

Triple-negative breast cancer (TNBC) is an aggressive form of breast cancer that is non-responsive to hormonal therapies and disproportionately impact women of African ancestry. We previously showed that TN breast tumors have a distinct microbial signature that differs from less aggressive breast tumor subtypes and normal breast tissues. However, it is unknown whether these differences in breast tumor microbiota may be driven by alterations in microbial metabolites, leading to potentially protective or pathogenic consequences. The goal of this global metabolomic profiling study was to investigate alterations in microbial metabolism pathways in normal and breast tumor tissues, including TNBC, of non-Hispanic black (NHB) and non-Hispanic white (NHW) women. In this study, we profiled the microbiome (16S rRNA) from breast tumor tissues and analyzed 984 metabolites from a total of 51 NHB and NHW women. Breast tumor tissues were collected from 15 patients with TNBC, 12 patients with less aggressive luminal A-type (Luminal) breast cancer, and 24 healthy controls for comparison using UHPLC-tandem mass spectrometry. Principal component analysis and hierarchical clustering of the global metabolomic profiling data revealed separation between metabolic signatures of normal and breast tumor tissues. Random forest analysis revealed a unique biochemical signature associated with elevated lipid metabolites and lower levels of microbial-derived metabolites important in controlling inflammation and immune responses in breast tumor tissues. Significant relationships between the breast microbiome and the metabolome, particularly lipid metabolism, were observed in TNBC tissues. Further investigations to determine whether alterations in sphingolipid, phospholipid, ceramide, amino acid, and energy metabolism pathways modulate Fusobacterium and Tenericutes abundance and composition to alter host metabolism in TNBC are necessary to help us understand the risk and underlying mechanisms and to identify potential microbial-based targets.

Shamsabadi F, Maleki Z, Nasirikenari M, Shahbazi M. In vivo assessment of simultaneous G1 cyclins silencing by a tumor-specific bidirectional promoter on the mammary tumor in nude mice

Dysregulation of G1 cyclins (cyclins D1 A and E) expression contributes to the loss of standard cell cycle control during tumorigenesis. This study aims to evaluate the inhibitory effect of G1 cyclins in nude mice. The human breast cancer MDA-MB-231 cells were subcutaneously transplanted into the supra-femoral right side of female Balb/c-nude mice. The dual shRNA vector harboring G1 cyclins shRNAs (bipSUR) was intratumorally injected by the in vivo jetPEI transfection reagent for 2 weeks. We have evaluated tumor growth and tumor weight as parameters of tumor progression. Finally, necropsy, histopathological analysis, and immunodetection of G1 cyclins were assessed. Also, apoptosis induction in tumor tissues was evaluated by TUNEL assay. No toxicity and metastasis was observed in the tumor-bearing mice treated by the bipSUR. Tumor weight and volume were significantly lower in the bipSUR treated mice than untreated tumor-bearing mice and control. Histopathological observations revealed more apoptotic foci and lower mitotic cells in tumor sections in the treated mice than in control groups. A significant reduction of G1 cyclins at the protein level was indicated in the bipSUR treated mice than in other groups. Apoptosis in tumor tissues was remarkably induced in response to the bipSUR (42.53%). The bipSUR reduced the protein expression of G1 cyclins and exhibited an inhibitory effect on MDA-MB-231 xenograft mice through apoptosis induction. Further research is demanded to identify the protein partners of G1 cyclins involved in the cancer pathways. These may offer new insight into the biomedical function of G1 cyclins in breast cancer progression.

Efficacy and safety of controlled ovarian hyperstimulation with or without letrozole for fertility preservation in breast cancer patients: A multicenter retrospective study

INTRODUCTION

Fertility preservation (FP) is recommended in young breast cancer (BC) patients before (neo)adjuvant treatment. Letrozole-associated controlled ovarian hyperstimulation (LetCOH) is used worldwide to collect mature oocytes for FP, but its efficacy and safety compared to conventional protocols (cCOH) are still debated.

AIMS

To compare efficacy and safety of FP procedure using LetCOH or cCOH in BC patients in terms of oocyte maturation rate and disease-free survival rates after at least two years of follow-up.

METHODS

This multicenter retrospective study compared outcomes of 107 cycles in 97 non-metastatic BC patients aged ≤40 years who underwent cCOH (n = 56) or LetCOH (n = 41) for FP in CHU-Lille and Erasme Hospital, respectively, between December 2012 and January 2017.

RESULTS

Patients and oncological characteristics were similar except for tumor size and HER2 status which were less favorable in the LetCOH group. Patients underwent adjuvant chemotherapy in 96.4% and 48.8% of the cases in cCOH and LetCOH groups, respectively. Hence, 51.2% of LetCOH patients underwent neoadjuvant chemotherapy (p < 0.001). Estradiol peak at ovulation trigger was lower in LetCOH compared to cCOH group while oocyte maturation rates were significantly higher (p < 0.001), without impacting the final number of mature oocytes collected. Seven and four patients relapsed in LetCOH and cCOH groups, respectively, and one patient died in each group after a median follow-up of four years.

CONCLUSION

LetCOH is as effective as cCOH for FP. At this time point, there were no safety concerns regarding cCOH in the adjuvant setting but a longer follow-up is warranted.

A tumor microenvironment-related risk model for predicting the prognosis and tumor immunity of breast cancer patients

Background

This study aimed to construct a tumor microenvironment (TME)-related risk model to predict the overall survival (OS) of patients with breast cancer.

Methods

Gene expression data from The Cancer Genome Atlas was used as the training set. Differentially expressed gene analysis, prognosis analysis, weighted gene co-expression network analysis, Least Absolute Shrinkage and Selection Operator regression analysis, and Wald stepwise Cox regression were performed to screen for the TME-related risk model. Three Gene Expression Omnibus databases were used to validate the predictive efficiency of the prognostic model. The TME-risk-related biological function was investigated using the gene set enrichment analysis (GSEA) method. Tumor immune and mutation signatures were analyzed between low- and high-TME-risk groups. The patients’ response to chemotherapy and immunotherapy were evaluated by the tumor immune dysfunction and exclusion (TIDE) score and immunophenscore (IPS).

Results

Five TME-related genes were screened for constructing a prognostic signature. Higher TME risk scores were significantly associated with worse clinical outcomes in the training set and the validation set. Correlation and stratification analyses also confirmed the predictive efficiency of the TME risk model in different subtypes and stages of breast cancer. Furthermore, immune checkpoint expression and immune cell infiltration were found to be upregulated in the low-TME-risk group. Biological processes related to immune response functions were proved to be enriched in the low-TME-risk group through GSEA analysis. Tumor mutation analysis and TIDE and IPS analyses showed that the high-TME-risk group had more tumor mutation burden and responded better to immunotherapy.

Conclusion

The novel and robust TME-related risk model had a strong implication for breast cancer patients in OS, immune response, and therapeutic efficiency.

Expression of KIF2A, NDC80, CDK1, and CCNB1 in breast cancer patients: Their interaction and linkage with tumor features and prognosis

Background

Kinesin family member 2A (KIF2A), nuclear division cycle 80 (NDC80), cyclin‐dependent kinase 1 (CDK1), and cyclin B1 (CCNB1) exhibit a complex interrelation, which promote cancer progression via multiple ways, whereas their interaction and clinical implications in breast cancer are obscure. Hence, this study aimed to evaluate the correlation among KIF2A, NDC80, CDK1, CCNB1, and their linkage with clinicopathological features and prognosis in breast cancer patients.

Methods

195 breast cancer patients underwent surgical resection were analyzed. KIF2A, NDC80, CDK1, and CCNB1 expressions were determined by immunohistochemical (IHC) assay and scored by a semiquantitative IHC score or positive cell percentage.

Results

KIF2A expression positively associated with NDC80, CDK1, and CCNB1 expressions (all p < 0.01). In terms of tumor features: KIF2A high expression linked with increased T stage (p = 0.011), N stage (p = 0.014), and TNM stage (p = 0.009) but not tumor differentiation (p = 0.651). NDC80 high expression only related to higher N stage (p = 0.010); CDK1 high expression only connected with elevated N stage (p = 0.035) and TNM stage (p = 0.023). In aspect of prognosis, high expression of KIF2A was correlated with worse disease‐free survival (DFS) (p = 0.031), while NDC80 high (p = 0.329), CDK1 high (p = 0.276), and CCNB1 positive (p = 0.063) expressions only showed trends to link with poor DFS (without statistical significance). Furthermore, high expression of KIF2A (p = 0.063), NDC80 (p = 0.939), CDK1 (p = 0.413) and positive expression of CCNB1 (p = 0.296) did not relate to overall survival.

Conclusion

KIF2A correlates with NDC80, CDK1, CCNB1, and may link with advanced tumor stages and poor prognosis in breast cancer patients.

Social relationships and their associations with affective symptoms of women with breast cancer: A scoping review

BACKGROUND

Problems in affective and cognitive functioning are among the most common concurrent symptoms that breast cancer patients report. Social relationships may provide some explanations of the clinical variability in affective-cognitive symptoms. Evidence suggests that social relationships (functional and structural aspects) can be associated with patients' affective-cognitive symptoms; however, such an association has not been well studied in the context of breast cancer.

PURPOSE

The purpose of this scoping review was to address the following question: What social relationships are associated with affective-cognitive symptoms of women with breast cancer?

METHODS

This scoping review used the framework proposed by Arksey and O'Malley and PRISMA-Sc. Studies published by February 2022 were searched using four databases: MEDLINE (PubMed), Embase (Elsevier), PsycINFO (EBSCOhost), and Web of Science (Clarivate). All retrieved citations were independently screened and eligibility for inclusion was determined by study team members. Extracted data included research aims, design, sample, type and measures of social relationships (functional and structural), and the association between social relationships and affective-cognitive symptoms.

RESULTS

A total of 70 studies were included. Affective symptoms were positively associated with social support, family functioning, quality of relationships, social networks, and social integration, whereas the negative association was found with social constraints.

CONCLUSION

Our findings suggest positive social relationships may mitigate affective symptoms of women with breast cancer. Thus, health care providers need to educate patients about the importance of building solid social relationships and encourage them to participate in a supportive network of friends and family members.

Potential utility of miRNAs for liquid biopsy in breast cancer

Breast cancer (BC) remains the most prevalent malignancy due to its incidence rate, recurrence, and metastasis in women. Conventional strategies of cancer detection– mammography and tissue biopsy lack the capacity to detect the complete cancer genomic landscape. Besides, they often give false- positive or negative results. The presence of this and other disadvantages such as invasiveness, high-cost, and side effects necessitates developing new strategies to overcome the BC burden. Liquid biopsy (LB) has been brought to the fore owing to its early detection, screening, prognosis, simplicity of the technique, and efficient monitoring. Remarkably, microRNAs (miRNAs)– gene expression regulators seem to play a major role as biomarkers detected in the samples of LB. Particularly, miR-21 and miR-155 among other possible candidates seem to serve as favorable biomarkers in the diagnosis and prognosis of BC. Hence, this review will assess the potential utility of miRNAs as biomarkers and will highlight certain promising candidates for the LB approach in the diagnosis and management of BC that may optimize the patient outcome.

Hispanic Ethnicity and Breast Cancer: Disaggregating Surgical Management and Mortality by Race

OBJECTIVE

Breast cancer is the leading cause of cancer death among Hispanic women. Unfortunately, few studies disaggregate Hispanic patients by race to understand its implications on treatment and clinical outcomes such as mortality. The aim of this study is to examine surgical management and overall mortality among different subgroups of women who self-identify as Hispanic.

METHODS

Hispanic female patients, ages 18-90, stages I-III, diagnosed with breast cancer between 2010 and 2015 from the National Cancer Data Base were identified. The study cohort was divided into three ethnoracial categories: (1) Hispanic White (HW), 2) Hispanic Black (HB), and 3) Hispanic Other (HO). Descriptive statistics and multivariate models were constructed to determine the relationship between sociodemographic factors, clinical variables, surgical management, and mortality when disaggregated by race.

RESULTS

There were 56,675 Hispanic women who met the study criteria. Most where HW (n=50,599, 89.3%) and the rest were HB (n=1,334, 2.4%) and HO (n=4,742, 8.3%). There was no difference between the three groups on receipt of breast conservation therapy (P=0.12). HB (48.5%) and HO (46.6%) women were more likely to undergo reconstruction than those who identified as HW (38.7%) (P<0.001). Additionally, HB (38.3%) women were more likely to undergo tissue-based reconstruction than HW (29.0%) and HO women (30%) (P=0.0008). There was no difference between the groups in the utilization of contralateral prophylactic mastectomy (CPM) (P=0.078). On multivariable analysis, there was no difference in mortality between HB and HW patients (HR 1.18, 95%CI 0.92-1.51; Ref HW). However, HO women had a 24% relative risk reduction in mortality (HR 0.76, 95% CI 0.63-0.92; HW ref).

CONCLUSION

Findings from this study suggest there are ethnoracial disparities in reconstruction utilization and mortality among Hispanic women. Future studies should examine how culture, language, healthcare access, and patient preferences contribute to these disparities.

Patients with Lung Cancer of Different Racial Backgrounds Harbor Distinct Immune Cell Profiles

Tumors accumulated with infiltrated immune cells (hot tumors) have a higher response rate to immune checkpoint blockade, when compared with those with minimal T-cell infiltration (cold tumors). We report here that patients with lung cancer with different racial backgrounds harbored distinct immune cell profiles in the tumor microenvironment. Compared with African Americans (AA), Caucasian Americans (CA) exhibited increased immune cell infiltration and vasculature, and increased survival. Changes of survival and immune profile were most pronounced among active smokers and nonsmokers, compared with former smokers and total patients. Neighborhood analysis showed that immune cells accumulated around cancer cells in CAs but not AAs. Our findings reveal intrinsic biological differences between AA and CA patients with lung cancer, suggesting that treatment plans should be tailored for patients with different racial backgrounds.

Significance

We report biological racial differences among patients with lung cancer where Caucasians present a hot tumor microenvironment compared with cold tumor in AAs. Treatment plans should be customized to maximize therapeutic outcomes.

A Scoping Review on the Status of Female Breast Cancer in Asia with a Special Focus on Nepal

This study aimed to provide updated evidence on the status of female breast cancer and cancer treatment facilities in Asia, with a special focus on Nepal. This review used search phrases that included, breast neoplasm or cancer, health status, epidemiology, breast cancer survivors, cancer care facilities, Asia, Nepal. Researchers examined databases from January 2011 to December 2020 (PubMed, PMC, Google Scholar, and the reference lists of included papers). Studies of any design and reviews, were included in the study, except for qualitative studies. The study findings are presented in a narrative synthesis format using Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews. An initial search resulted in 974 papers, and 896 were reviewed after being checked for duplication using the Zotero software. Accordingly, utilizing the inclusion and exclusion criteria, 188 publications were selected, and after review of titles and abstracts, an additional 98 papers were removed for different reasons. Finally, the study looked at 90 female breast cancer papers. Results showed that the number of cases of breast cancer is growing all around the world, including in Asia and Nepal. Age, early menarche, late menopause, nulliparity, positive family history, excessive fat consumption, alcohol, and smoking are all frequent risk factors for breast cancer found in Asian women. Breast self-examination, clinical breast examination, and mammography screening are common methods for detecting breast carcinoma. Chemotherapy, radiation, and modified mastectomy are commonly used options for treatment. The number of breast cancer survivors is growing throughout the world, indicating better clinical care. There is a paucity of survival data in many Asian countries, including Nepal. There is also a scarcity of health workforce specialized in cancer care and treatment, as well as a few health facilities that are available to treat cancer cases in many Asian countries, including Nepal.

Cardiovascular Magnetic Resonance Imaging in the Early Detection of Cardiotoxicity Induced by Cancer Therapies

The significant progress in cancer treatment, including chemotherapy, immunotherapy, radiotherapy, and combination therapies, has led to higher long-term survival rates in cancer patients, while the cardiotoxicity caused by cancer treatment has become increasingly prominent. Cardiovascular magnetic resonance (CMR) is a non-invasive comprehensive imaging modality that provides not only anatomical information, but also tissue characteristics and cardiometabolic and energetic assessment, leading to its increased use in the early identification of cardiotoxicity, and is of major importance in improving the survival rate of cancer patients. This review focused on CMR techniques, including myocardial strain analysis, T1 mapping, T2 mapping, and extracellular volume fraction (ECV) calculation in the detection of early myocardial injury induced by cancer therapies. We summarized the existing studies and ongoing clinical trials using CMR for the assessment of subclinical ventricular dysfunction and myocardial changes at the tissue level. The main focus was to explore the potential of clinical and preclinical CMR techniques for continuous non-invasive monitoring of myocardial toxicity associated with cancer therapy.

Emerging Roles of Circ-ZNF609 in Multiple Human Diseases

Circular RNAs (circRNAs) are a special type of endogenous RNAs with extensive roles in multiple human diseases. They are formed by back-splicing of partial sequences of the parental precursor mRNAs. Unlike linear RNAs, their covalently closed loop structure without a 5′ cap and a 3′ polyadenylated tail confers on them high stability and they are difficult to be digested by RNase R. Increasing evidence has proved that aberrant expressions of many circRNAs are detected and that circRNAs exert essential biological functions in disease development and progression via acting as a molecular sponge of microRNA, interacting with proteins as decoys or scaffolds, or self-encoding small peptides. Circular RNA zinc finger protein 609 (circ-ZNF609) originates from exon2 of ZNF609, which is located at chromosome 15q22.31, and it has recently been proved that it can translate into a protein. Being aberrantly upregulated in various diseases, it could promote malignant progression of human tumors, as well as tumor cell proliferation, migration, and invasion. Here in this review, we concluded the biological functions and potential mechanisms of circ-ZNF609 in multiple diseases, which could be further explored as a targetable molecule in future accurate diagnosis and prognosis.

The Clinical Application of Combined Ultrasound, Mammography, and Tumor Markers in Screening Breast Cancer among High-Risk Women

In order to explore the clinical application value of color Doppler ultrasound (CDUS), mammography (MAM), and serum tumor marker carbohydrate antigen 153 (CA153) in screening breast cancer (BC) for high-risk women, a total of 38,241 women were surveyed by epidemiological questionnaire on BC high-risk factors. A total of 10,821 cases were screened, accounting for 28.30%. They were randomly divided into US, MAM, and CA153 and combined examination group which has no significant difference in high-risk factors. Breast cancer in high-risk population was screened by CDUS, MAM, and CA153 and combined examination. CA153 was detected by electroluminescence method. The positive detection rate of BC was 360.41/100,000 (39/10,821). The overall difference in the positive detection rate of BC among 10,821 cases in all age groups was statistically significant. The sensitivity and negative predictive value of combined examination were significantly improved compared with each single examination. Combined examination for BC screening can significantly improve the sensitivity of BC early diagnosis and reduce the missed diagnosis rate.

Multimodal Dimension Reduction and Subtype Classification of Head and Neck Squamous Cell Tumors

Traditional analysis of genomic data from bulk sequencing experiments seek to group and compare sample cohorts into biologically meaningful groups. To accomplish this task, large scale databases of patient-derived samples, like that of TCGA, have been established, giving the ability to interrogate multiple data modalities per tumor. We have developed a computational strategy employing multimodal integration paired with spectral clustering and modern dimension reduction techniques such as PHATE to provide a more robust method for cancer sub-type classification. Using this integrated approach, we have examined 514 Head and Neck Squamous Carcinoma (HNSC) tumor samples from TCGA across gene-expression, DNA-methylation, and microbiome data modalities. We show that these approaches, primarily developed for single-cell sequencing can be efficiently applied to bulk tumor sequencing data. Our multimodal analysis captures the dynamic heterogeneity, identifies new and refines subtypes of HNSC, and orders tumor samples along well-defined cellular trajectories. Collectively, these results showcase the inherent molecular complexity of tumors and offer insights into carcinogenesis and importance of targeted therapy. Computational techniques as highlighted in our study provide an organic and powerful approach to identify granular patterns in large and noisy datasets that may otherwise be overlooked.

Health Disparities in Cancer Among American Indians and Alaska Natives

American Indians and Alaska Natives (AI/AN) are underserved populations who suffer from several health disparities, 1 of which is cancer. Malignancies, especially cancers of the breast, liver, and lung, are common causes of death in this population. Health care disparities in this population include more limited access to diagnostic radiology because of geographic and/or health system limitations. Early detection of these cancers may be enabled by improving patient and physician access to medical imaging. Awareness by the radiology community of the cancer disparities among this population is needed to support research targeted to this specific ethnic group and to support outreach efforts to provide more imaging opportunities. Providing greater access to imaging facilities will also improve patient compliance with screening recommendations, ultimately improving mortality in these populations.

Patient and Clinician Decision Support to Increase Genetic Counseling for Hereditary Breast and Ovarian Cancer Syndrome in Primary Care: A Cluster Randomized Clinical Trial

IMPORTANCE

To promote the identification of women carrying BRCA1/2 variants, the US Preventive Services Task Force recommends that primary care clinicians screen asymptomatic women for an increased risk of carrying a BRCA1/2 variant risk.

OBJECTIVE

To examine the effects of patient and clinician decision support about BRCA1/2 genetic testing compared with standard education alone.

DESIGN, SETTING, AND PARTICIPANTS

This clustered randomized clinical trial was conducted at an academic medical center including 67 clinicians (unit of randomization) and 187 patients. Patient eligibility criteria included women aged 21 to 75 years with no history of breast or ovarian cancer, no prior genetic counseling or testing for hereditary breast and ovarian cancer syndrome (HBOC), and meeting family history criteria for BRCA1/2 genetic testing.

INTERVENTIONS

RealRisks decision aid for patients and the Breast Cancer Risk Navigation Tool decision support for clinicians. Patients scheduled a visit with their clinician within 6 months of enrollment.

MAIN OUTCOMES AND MEASURES

The primary end point was genetic counseling uptake at 6 months. Secondary outcomes were genetic testing uptake at 6 and 24 months, decision-making measures (perceived breast cancer risk, breast cancer worry, genetic testing knowledge, decision conflict) based upon patient surveys administered at baseline, 1 month, postclinic visit, and 6 months.

RESULTS

From December 2018 to February 2020, 187 evaluable patients (101 in the intervention group, 86 in the control group) were enrolled (mean [SD] age: 40.7 [13.2] years; 88 Hispanic patients [46.6%]; 15 non-Hispanic Black patients [8.1%]; 72 non-Hispanic White patients [38.9%]; 35 patients [18.9%] with high school education or less) and 164 (87.8%) completed the trial. There was no significant difference in genetic counseling uptake at 6 months between the intervention group (20 patients [19.8%]) and control group (10 patients [11.6%]; difference, 8.2 percentage points; OR, 1.88 [95% CI, 0.82-4.30]; P = .14). Genetic testing uptake within 6 months was also statistically nonsignificant (13 patients [12.9%] in the intervention group vs 7 patients [8.1%] in the control group; P = .31). At 24 months, genetic testing uptake was 31 patients (30.7%) in intervention vs 18 patients (20.9%) in control (P = .14). Comparing decision-making measures between groups at baseline to 6 months, there were significant decreases in perceived breast cancer risk and in breast cancer worry (standard mean differences = -0.48 and -0.40, respectively).

CONCLUSIONS AND RELEVANCE

This randomized clinical trial did not find a significant increase in genetic counseling uptake among patients who received patient and clinician decision support vs those who received standard education, although more than one-third of the ethnically diverse women enrolled in the intervention underwent genetic counseling. These findings suggest that the main advantage for these high-risk women is the ability to opt for screening and preventive services to decrease their cancer risk.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03470402.