Divergent breast cancer incidence trends by hormone receptor status in the state of Sarawak, Malaysia

Trends in breast cancer incidence by estrogen receptor status in the United States, 2004-2020

Divergent trends of breast cancer incidence by subtype have been reported in the United States and elsewhere; however, it remains unknown whether this trend has continued until the era of the COVID-19 pandemic. Using high-quality population-based cancer registry data, representing 83% of the US population, this study examined breast cancer incidence rates by estrogen receptor (ER) status in women aged 20-84 years from 2004 to 2020. The incidence rate of ER-positive cancer increased by 1.75% per year from 2004 to 2009 (95% confidence interval [CI] = 1.26%-3.15%) and has slowed to a 0.87% annual increase (95% CI = 0.41%-1.03%) from 2009 to 2019, followed by a 10.2% reduction from 2019 to 2020. Trends were generally similar across race and ethnicity, although young women (20-49 years), Asian or Pacific Islander, and Hispanic women experienced steady increases until 2019. The incidence rate of ER-negative cancer decreased by 3.13% annually (95% CI = -4.2% to -2.55%) from 2004 to 2012, and the decrease stabilized from 2012 to 2019 (annual percent change: 0.55%; 95% CI = -1.30% to 0.92%), followed by a 6.0% reduction from 2019 to 2020, with trends generally consistent by age and across racial and ethnic groups. The stabilization of the steep decline in ER-negative cancer suggests a departure from the encouraging trajectories projected in earlier studies. Coupled with the deceleration in the rise of ER-positive cancer, the latest trend signals a potential stabilization in the previous rise of the proportional burden of ER-positive cancer. Understanding the impact of the pandemic on each subtype of breast cancer individually may provide a more comprehensive insight into its long-term sequelae on survival and mortality.

Intercontinental Comparison of Immunohistochemical Subtypes Among Individuals With Breast Cancer in South-East Asia and South America: A Scoping Systematic Review and Meta-Analysis of Observational Studies

Background

Breast cancer (BC) remains a significant global concern, particularly among developing countries in South-East Asia (SEA) and South America (SA). The socioeconomic burdens of oncologic care in those countries were often originated from limited accessibility on attainable therapeutic options and reliability on identifying essential information of cancer cells, i.e., immunohistochemical (IHC) subtyping to determine suitable approaches. The triple-negative breast cancer (TNBC) is among the most aggressive category in breast malignancy, therefore, requiring more specific molecular pathway blocking to exhaust the cells. However, large-scale epidemiological investigation on its rate among BC remains unavailable to date. This study aimed to describe the prevalence of TNBC in the SEA and SA continents since it may guide the future direction of oncologic research and trials.

Methods

This review focuses on observational studies from the SEA and SA continents from the last decade. Each study represents its country or cities, period of observation, population size, and the TNBC-BC rate as the main outcomes. Therefore, we may also limit the reporting bias originated from same-patient data on the specific occasions. The analysis will be derived to SEA-SA comparison, plus SEA/SA-specific session as processed in Comprehensive Meta-Analysis (CMA) version 3.0. The statistical analysis will be performed in random effects model (REM) within 95% confidence interval (CI).

Results

From 46 studies included in the final analysis with a total enlisted population of 34,346 unique individuals with BC, the TNBC rate was higher in the SEA compared to the SA region (19.3% vs. 15.7%; P < 0.05 in 95% CI), with the highest prevalence observed in Vietnam (22.4%) and Peru (17.8%), if it was restricted on countries with two or more studies. Interestingly, both Laos and Argentina possessed significant differences compared to other countries within their respective continents, with the highest and lowest TNBC rates (P < 0.05).

Conclusions

The IHC characteristics in SEA differ from those in the SA continent as mainly represented by TNBC prevalence, possibly shaping the course of future trials in the respective region based on IHC expressivity status.

Epidemiology of Uterine Cancer in Sarawak, Borneo, A 20-Year Review

OBJECTIVE

This study aimed to determine the epidemiology of uterine cancer in Sarawak, Malaysia, using data from a population-based cancer registry.

METHODS

The study population included all women diagnosed with uterine cancer in Sarawak, Malaysia between January 1996 and December 2015. Data on demographic and clinical characteristics were obtained from the Sarawak Cancer Registry. The crude incidence rate, age-standardized incidence rate (ASR), and incidence risk ratios (IRR) were calculated. Joinpoint regression analyses were performed to assess trends in incidence rates.

RESULTS

A total of 811 women were diagnosed with primary uterine cancer during the study period. The overall crude incidence rate for uterine cancer in Sarawak for the period 1996-2015 was 3.7 per 100,000. The ASR was 4.4 per 100,000 with a 95% CI (4.1-4.8). The ASR in 2011-2015 is 1.6 times higher than the ASR of uterine cancer in 1996-2000. Higher incidence rates were observed in women aged 40-59 years and those aged 60 years and above. Chinese women had the highest ASR, followed by Malay and Iban women. Joinpoint regression analyses showed a significant increase in cases of uterine cancer among all ethnic groups and age groups.

CONCLUSION

The incidence of primary uterine cancer in Sarawak, Malaysia, has increased over the past 20 years, with higher incidence rates observed in older age groups and among Chinese women. The findings suggest the need for continued efforts to improve the prevention, early detection, and treatment of uterine cancer in Sarawak.

Mechanisms of Traditional Chinese medicine/natural medicine in HR-positive Breast Cancer: A comprehensive Literature Review

ETHNOPHARMACOLOGICAL RELEVANCE

With the emergence of endocrine resistance, the survival and good prognosis of HR-positive breast cancer (HR + BC) patients are threatened. As a common complementary and alternative therapy in cancer treatment, traditional Chinese medicine (TCM) has been widely used, and its internal mechanisms have been increasingly explored.

AIM OF THE REVIEW

In this review, the development status and achievements in understanding of the mechanisms related to the anti-invasion and anti-metastasis effects of TCM against HR + BC and the reversal of endocrine drug resistance by TCM in recent years have been summarized to provide ideas for antitumour research on the active components of TCM/natural medicine.

METHODS

We searched the electronic databases PubMed, Web of Science, and China National Knowledge Infrastructure database (CNKI) (from inception to July 2023) with the key words "HR-positive breast cancer" or "HR-positive breast carcinoma", "HR + BC" and "traditional Chinese medicine", "TCM", or "natural plant", "herb", etc., with the aim of elucidating the intrinsic mechanisms of traditional Chinese medicine and natural medicine in the treatment of HR + BC.

RESULTS

TCM/natural medicine monomers and formulas can regulate the expression of related genes and proteins through the PI3K/AKT, JAK2/STAT3, MAPK, Wnt and other signalling pathways, inhibit the proliferation and metastasis of HR + BC tumours, play a synergistic role in combination with endocrine drugs, and reverse endocrine drug resistance.

CONCLUSION

The wide variety of TCM/natural medicine components makes the research and development of new methods of TCM for BC treatments more selective and innovative. Although progress has been made on research on TCM/natural medicine, there are still many problems in clinical and basic experimental designs, and more in-depth scientific explorations and research are still needed.

Association of reproductive risk factors and breast cancer molecular subtypes: a systematic review and meta-analysis

BACKGROUND

Associations between reproductive factors and breast cancer (BC) risk vary by molecular subtype (i.e., luminal A, luminal B, HER2, and triple negative/basal-like [TNBC]). In this systematic review and meta-analysis, we summarized the associations between reproductive factors and BC subtypes.

METHODS

Studies from 2000 to 2021 were included if BC subtype was examined in relation to one of 11 reproductive risk factors: age at menarche, age at menopause, age at first birth, menopausal status, parity, breastfeeding, oral contraceptive (OC) use, hormone replacement therapy (HRT), pregnancy, years since last birth and abortion. For each reproductive risk factor, BC subtype, and study design (case-control/cohort or case-case), random-effects models were used to estimate pooled relative risks and 95% confidence intervals.

RESULTS

A total of 75 studies met the inclusion criteria for systematic review. Among the case-control/cohort studies, later age at menarche and breastfeeding were consistently associated with decreased risk of BC across all subtypes, while later age at menopause, later age of first childbirth, and nulliparity/low parity were associated with increased risk of luminal A, luminal B, and HER2 subtypes. In the case-only analysis, compared to luminal A, postmenopausal status increased the risk of HER2 and TNBC. Associations were less consistent across subtypes for OC and HRT use.

CONCLUSION

Identifying common risk factors across BC subtypes can enhance the tailoring of prevention strategies, and risk stratification models can benefit from subtype specificity. Adding breastfeeding status to current BC risk prediction models can enhance predictive ability, given the consistency of the associations across subtypes.

A rapid rise in hormone receptor-positive and HER2-positive breast cancer subtypes in Southern Thai women: A population-based study in Songkhla

The incidence of breast cancer is increasing in low- and middle-income countries, including Thailand. However, its molecular immunohistochemical (M-IHC) subtypes have not been summarized in a population-based cancer registry. Thus, we aimed to estimate the breast cancer incidence and trends based on the hormone receptor and human epidermal growth factor receptor 2 (HER2) status. This cross-sectional study included 2,883 women diagnosed with primary invasive breast cancer between 2009 and 2018 from the Songkhla Cancer Registry. After imputing the missing values of estrogen receptor (ER), progesterone receptor (PR), and HER2 status, the cases were classified into four subtypes: HR+/HER2-, HR+/HER2+, HR-/HER2-, and HR-/HER2+. The age-specific incidence rate of 5-year age groups and age-standardized incidence rate (ASR) were calculated. An age-period-cohort (APC) model was used to describe the effects of age, birth cohort, and period of diagnosis. Finally, the incidence trends were extrapolated to 2030 based on the APC and joinpoint models. The results showed, HR+/HER2- had the highest ASR in breast cancer. The incidence trends of HR+/HER2- and HR+/HER2+ increased with an annual percent change of 5.4% (95%CI: 2.5% to 8.3%) and 10.1% (95%CI: 4.9% to 15.5%), respectively. The rate ratio was high in the younger generation and recent period of diagnosis. The joinpoint and APC model projections showed that the ASR of HR+/HER2- would reach 30.0 and 29.2 cases per 100,000 women, while ASR of the HR+/HER2+ would reach 8.8 and 10.4 cases per 100,000 women in 2030. On the other hand, the incidence trends of the HR-/HER2- and HR-/HER2+ subtypes were stable. The rising trends of HR-positive and a part of HER2-positive breast cancer forecast a dynamicity of the future health care budgeting, resource allocation, and provision of facilities.

Circular RNA circPRMT5 is upregulated in breast cancer and is required for cell proliferation and migration

BACKGROUND

To evaluate the role of cyclic protein arginine methyltransferase 5 (circPRMT5) in the occurrence and development of breast cancer (BC).

METHODS

A total of 90 BC patients who underwent radical mastectomy and 40 age-matched healthy female controls were recruited in the Second People's Hospital of China Three Gorges University, Yichang Second People's Hospital from 2017 to 2020. Quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to detect the expression levels of circPRMT5 in BC tissues, serum, normal breast cell line (MCF-10A), and BC cell line (T47D, MCF-7, BT549, Hs-578T, and MDA-MB-231, MDAMB-468). The associations between circPRMT5 expression level and age, tumor size, degree of differentiation, TNM stage, distant metastasis, estrogen receptor (ER) or progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status were analyzed. BC cell lines with circPRMT5 knockdown or overexpression were subject to CCK-8 cell proliferation assay, and transwell cell invasion/migration assay.

RESULTS

CircPRMT5 expression in BC tissue was higher than that in adjacent normal breast tissue. Consistently, the expression level of circPRMT5 was also elevated in serum samples collected from BC patients when compared with healthy controls. And in multiple breast cancer cell lines, circPRMT5 was upregulated as compared to normal breast epithelial MCF-10A cells. CircPRMT5 expression level was correlated with tumor size, TNM stage, lymph node metastasis distant metastasis, but no correlation was observed with ER, PR, HER2 status. Overexpression of circPRMT5 promoted the proliferation, invasion, and migration of MCF7 cells; while the knockdown of circPRMT5 inhibited cell proliferation, invasion, and migration.

DISCUSSION

CircPRMT5 seems to act as an oncogene in the progression of BC. Our data suggest that CircPRMT5 may be used as a biomarker for the diagnosis, prognosis evaluation, and targeted therapy of breast cancer.

Anticancer Activity of Ω-6 Fatty Acids through Increased 4-HNE in Breast Cancer Cells

Simple Summary

Epidemiological evidence suggests that breast cancer risk is lowered by Ω-3 and increased by Ω-6 polyunsaturated fatty acids (PUFAs). Paradoxically, the Ω-6 PUFA metabolite 4-hydroxynonenal (4-HNE) inhibits cancer cell growth. This duality prompted us to study whether arachidonic acid (AA) would enhance doxorubicin (dox) cytotoxicity towards breast cancer cells. We found that supplementing AA or inhibiting 4-HNE metabolism potentiated doxorubicin (dox) toxicity toward Her2-dependent breast cancer but spared myocardial cells. Our results suggest that Ω-6 PUFAs could improve outcomes of dox chemotherapy in Her2-overexpressing breast cancer.

Abstract

Her2-amplified breast cancers resistant to available Her2-targeted therapeutics continue to be a challenge in breast cancer therapy. Dox is the mainstay of chemotherapy of all types of breast cancer, but its usefulness is limited by cumulative cardiotoxicity. Because oxidative stress caused by dox generates the pro-apoptotic Ω-6 PUFA metabolite 4-hydroxynonenal (4-HNE), we surmised that Ω-6 PUFAs would increase the effectiveness of dox chemotherapy. Since the mercapturic acid pathway enzyme RALBP1 (also known as RLIP76 or Rlip) that limits cellular accumulation of 4-HNE also mediates dox resistance, the combination of Ω-6 PUFAs and Rlip depletion could synergistically improve the efficacy of dox. Thus, we studied the effects of the Ω-6 PUFA arachidonic acid (AA) and Rlip knockdown on the antineoplastic activity of dox towards Her2-amplified breast cancer cell lines SK-BR-3, which is sensitive to Her2 inhibitors, and AU565, which is resistant. AA increased lipid peroxidation, 4-HNE generation, apoptosis, cellular dox concentration and dox cytotoxicity in both cell lines while sparing cultured immortalized cardiomyocyte cells. The known functions of Rlip including clathrin-dependent endocytosis and dox efflux were inhibited by AA. Our results support a model in which 4-HNE generated by AA overwhelms the capacity of Rlip to defend against apoptosis caused by dox or 4-HNE. We propose that Ω-6 PUFA supplementation could improve the efficacy of dox or Rlip inhibitors for treating Her2-amplified breast cancer.