Current Status of Breast Cancer Management in India

Sexual Health in Pre-menopausal Breast Cancer Survivors

Sexual health is often a neglected issue and affects the quality of life after treatment completion in breast cancer patients. The aim of the study was to find the incidence of sexual dysfunction and impact of mastectomy, breast conservation surgery (BCS), and hormone therapy in eligible patients on female sexuality in breast cancer survivors. It is a prospective study of 150 non-metastatic pre-menopausal BC survivors. Each participant answered the Female Sexual Function Index (FSFI) questionnaire at 4 weeks and at 3 months after completion of all therapy. Scores were compared between mastectomy and BCS patients and on hormonal therapy versus non-hormonal therapy. Chemotherapy was given to all patients and > 90% received adjuvant radiotherapy. Patients underwent both mastectomy (n = 104; 70%) and BCS (n = 46), based on imaging, staging, and patients' choice. Of the patients, 82.6% (n = 124) had sexual dysfunction at 3 months post-treatment (cutoff of 26.55). BCS survivors had significantly better scores in comparison to mastectomy survivors at 3-month interval evaluation (median 22.85 ± 2.19 versus 21.75 ± 2.09, p = 0.002). There was statistically non-significant reduction in arousal, lubrication, orgasm, pain in mastectomy survivors, and in desire, arousal, and pain in hormonal group survivors, at 3 months follow-up. Overall sexual dysfunction is high in breast cancer survivors irrespective of therapy (82.6%); however, it is more in patients undergoing mastectomy in comparison to patients undergoing conservative surgery in short-term follow-up. Sexual dysfunction issues needs to be addressed during survivorship programs, and longer follow-up is necessary to assess effect of various treatment modalities.

Leveraging nanostructured lipid carriers to enhance targeted delivery and efficacy in breast cancer therapy: a comprehensive review

Cancer, characterized by uncontrolled cell growth and proliferation, continues to be a major global health concern. Breast cancer, the most commonly diagnosed cancer among women, remains a leading cause of cancer-related deaths worldwide. Conventional treatment modalities such as surgery, radiation, and chemotherapy have made significant strides in improving patient outcomes. However, these approaches often face challenges such as limited efficacy, systemic toxicity, and multidrug resistance. Nanotechnology has emerged as a promising avenue for revolutionizing cancer therapy, offering targeted drug delivery, enhanced efficacy, and reduced side effects. Among the various nanocarrier systems, nanostructured lipid carriers (NLCs) have gained considerable attention for their unique advantages. Comprising a blend of solid and liquid lipids, NLCs offer improved drug loading capacity, enhanced stability, sustained release, and biocompatibility. This manuscript provides a comprehensive overview of the role of NLCs in breast cancer management, covering their formulation, methods of preparation, advantages, and disadvantages. Additionally, several studies are presented to illustrate the efficacy of NLCs in delivering anticancer drugs to breast tumors. These studies demonstrate the ability of NLCs to enhance drug cytotoxicity, improve tumor suppression, and minimize systemic toxicity. This manuscript aims to contribute to the existing literature by consolidating current knowledge and providing insights into the future directions of NLC-based therapeutics in breast cancer management.

Endophytic fungi: A future prospect for breast cancer therapeutics and drug development

Globally, breast cancer is a primary contributor to cancer-related fatalities and illnesses among women. Consequently, there is a pressing need for safe and effective treatments for breast cancer. Bioactive compounds from endophytic fungi that live in symbiosis with medicinal plants have garnered significant interest in pharmaceutical research due to their extensive chemical composition and prospective medicinal attributes. This review underscores the potentiality of fungal endophytes as a promising resource for the development of innovative anticancer agents specifically tailored for breast cancer therapy. The diversity of endophytic fungi residing in medicinal plants, success stories of key endophytic bioactive metabolites tested against breast cancer and the current progress with regards to in vivo studies and clinical trials on endophytic fungal metabolites in breast cancer research forms the underlying theme of this article. A thorough compilation of putative anticancer compounds sourced from endophytic fungi that have demonstrated therapeutic potential against breast cancer, spanning the period from 1990 to 2022, has been presented. This review article also outlines the latest trends in endophyte-based drug discovery, including the use of artificial intelligence, machine learning, multi-omics approaches, and high-throughput strategies. The challenges and future prospects associated with fungal endophytes as substitutive sources for developing anticancer drugs targeting breast cancer are also being highlighted.

Rates of Compliance in South Indian American Communities of Southern California Regarding Cancer Screening

BACKGROUND

Studies have shown lower rates of cancer screening and high mortality rates among all Asian Americans than among non-Hispanic White populations. However, most of these studies often confound diverse Asian American subgroups with limited data on cancer screening for Indian Americans, with this group being particularly interesting because of their counterintuitive socioeconomic status. For this reason, the objective of this study is to evaluate knowledge of the United States Preventive Services Task Force (USPSTF) cancer screening guidelines and compliance among South Indian Americans residing in Southern California.

METHODS

This was a cross-sectional study gathering community responses through an electronic survey. The survey reports knowledge of USPSTF screening guidelines and participant compliance rates. Rates were further compared to non-Hispanic White populations from official sources.

RESULTS

South Indian Americans residing in California had lower rates of compliance for colorectal, lung, and breast cancer screening when compared to that of non-Hispanic White populations in the same region, with the exception of cervical cancer screening rates.

CONCLUSION

Understanding the cultural characteristics of special populations, such as Indian Americans, can help communities adhere to more effective screening practices that can improve outcomes.

Chebulinic Acid: An Incipient Anticancer Agent

BACKGROUND

Terminalia chebula (T. chebula) comprising chebulinic acid as its principle active constituent is used to cure various diseases. T. chebula and chebulinic acid are used as antimicrobial, antioxidant, antidiabetic, anti-inflammatory, hepatoprotective, antimutagenic, radioprotective, cardioprotective, antiproliferative, antiarthritic, anticaries, and so on.

OBJECTIVE

The objective of this current study is to give an overview of the recent literature and patents of T. chebula and chebulinic acid including methods of its isolation/extraction and their application in the prevention of various cancers and other diseases.

METHODS

Present research and patents highlighting the anti-cancer potential of T. chebula and chebulinic acid have been studied and discussed keeping in view the scientific novelty and impact.

RESULTS

Both T. chebula and chebulinic acid are currently being explored for their anticancer potential in vitro and in vivo. They are either incorporated alone or in combination with other plants or drugs to show their activity and many clinical trials are also going on various potentials of the plant and chebulinic acid. Novel extraction techniques are also explored and patented. Efforts are being made to improve the bioavailability by developing Novel herbal drug delivery systems of the plant extract or chebulinic acid itself.

CONCLUSION

Anti-cancer potential of T. chebula and chebulinic acid may be well established by promising clinical trials and may open new interventions in various tumors. Clinical trials in conjunction with standard therapies are required to explore and validate the actual potential of T. chebula and chebulinic acid respectively.

Lived experiences of post-mastectomy women: A qualitative study of Western Rajasthan

BACKGROUND

Women's breasts have biological functions to lactate, socially and culturally seen as sensual, and the essence of her femininity. In the world, breast cancer is the most constantly occurring non-cutaneous cancer among women. The qualitative phenomenological study aimed to explore the lived experiences of post-mastectomy women.

MATERIAL AND METHODS

A total of 14 post-mastectomy women were recruited through non-probability convenience sampling based on data saturation, at the radiation unit of a tertiary care hospital, in Basni, Jodhpur, Rajasthan, from September to November 2020. The data was collected using an in-depth interview schedule. It was firstly audio-recorded and transcribed, and then themes and subthemes were extracted. Experiences of women were recorded and analyzed using Colaizzi"s framework (1978) and ATLAS ti. 9 scientific software.

RESULT

This revealed five main themes and their subthemes: Body image changes, physical impacts, emotional impacts, treatment impacts, and coping and support sources.

CONCLUSION

In India, the lack of exploration regarding this topic is due to the stigmatization of very private parts, i.e., breast involvement and people rarely discuss it. Thus, there is a need for more such studies to be done, and more attention is required on the role of nurses to assist post-mastectomy women psychologically, spiritually, and physically to cope with their conditions. Findings highlight that mastectomy as a surgical treatment may negatively affect a woman's body image. It's highly recommended to address individual women's psychosocial needs and preferences before undergoing mastectomy in educational sessions by physicians involving nurses with them. Also, proper knowledge about reconstructive procedures should be provided to improve their body image. The counseling sessions can be conducted pre and post-mastectomy by a professional counselor.

Association of RAD51, XRCC1, XRCC2, and XRCC3 Polymorphisms with Risk of Breast Cancer

Background: DNA repair genes are among the low-penetrance genes implicated in breast cancer. However variants of DNA repair genes may alter their protein function thus leading to carcinogenesis. Breast cancer is the most common cancer among women in India. The aim of the present study was to identify association, if any, of single nucleotide polymorphisms (SNP's) in four genes involved in DNA repair pathways including, RAD51 rs1801320, XRCC1 rs25487, XRCC2 rs3218536, and XRCC3 rs861539 with the risk of breast cancer. Materials and Methods: In this case-control study 611 female subjects (311 breast cancer patients and 300 healthy controls) were screened for four SNPs using polymerase chain reaction-restriction fragment length polymorphism analyses. Multifactor dimensionality reduction (MDR) analysis was performed to estimate the gene-gene interaction. Protein-protein interaction network analysis were studied using the STRING database. Results: The GC genotype (p = 0.018) and the combined GC+CC (p = 0.03) genotypes of RAD51 rs1801320 were significantly associated with reduced risk of breast cancer. The CT genotype (p = 0.0001), the combined CT+TT genotypes (p = 0.0002), and the T allele (p = 0.0019) of XRCC3 rs861539 polymorphism were associated with reduced risk of the breast cancer. No association of XRCC1 rs25487 and XRCC2 rs3218536 polymorphisms with breast cancer was observed. MDR analysis indicated a positive interaction between XRCC3 and XRCC2. String network analysis showed that the RAD51, XRCC1, XRCC2, and XRCC3 proteins are in strong interaction with each other and other breast cancer-related proteins such as BRCA2. Conclusion: RAD51 rs1801320 and XRCC3 rs861539 polymorphisms were associated with reduced risk of breast cancer. There is evidence of positive interactions among XRCC1, XRCC2, XRCC3, and RAD51.

Association of hormonal and reproductive risk factors with breast cancer in Indian women: A systematic review of case-control studies

The incidence of breast cancer in India has seen a rapid increase in recent years. Hormonal and reproductive risk factors for breast cancer have been affected by socioeconomic development. Studies on breast cancer risk factors in India are limited by the small sample size and specific geographical area. The current systematic review was carried out to assess the association of hormonal and reproductive risk factors with breast cancer in Indian women. A systematic review of MEDLINE, Embase, Scopus, and Cochrane database of systematic reviews were done. Relevant case-control studies published in peer-reviewed indexed journals were analyzed for hormonal risk factors such as age at menarche, menopause, and first childbirth; breastfeeding; abortion; and oral contraceptive pills use. Younger age (<13 years) at menarche was associated with high risk (odds ratio 1.23-3.72). Other hormonal risk factors with strong association were age at first childbirth and menopause, parity, and duration of breastfeeding. Abortion and the use of contraceptive pills did not have a clear association with breast cancer. Hormonal risk factors have a higher association in premenopausal disease and estrogen receptor-positive tumors. There is a strong association between hormonal and reproductive risk factors and breast cancer in Indian women. The protective effect of breastfeeding is related to the cumulative duration of breastfeeding.

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.

Global Increase in Breast Cancer Incidence: Risk Factors and Preventive Measures

Breast cancer is a global cause for concern owing to its high incidence around the world. The alarming increase in breast cancer cases emphasizes the management of disease at multiple levels. The management should start from the beginning that includes stringent cancer screening or cancer registry to effective diagnostic and treatment strategies. Breast cancer is highly heterogeneous at morphology as well as molecular levels and needs different therapeutic regimens based on the molecular subtype. Breast cancer patients with respective subtype have different clinical outcome prognoses. Breast cancer heterogeneity emphasizes the advanced molecular testing that will help on-time diagnosis and improved survival. Emerging fields such as liquid biopsy and artificial intelligence would help to under the complexity of breast cancer disease and decide the therapeutic regimen that helps in breast cancer management. In this review, we have discussed various risk factors and advanced technology available for breast cancer diagnosis to combat the worst breast cancer status and areas that need to be focused for the better management of breast cancer.

Breast cancer in India: Present scenario and the challenges ahead

Breast cancer is the commonest malignancy among women globally. From being fourth in the list of most common cancers in India during the 1990s, it has now become the first. In this review, we examine the available literature to understand the factors that contributed to the high burden of breast cancer in the country. We also provide the landscape of changes in the field of early diagnosis and the treatment modalities as well as the limitations of the Indian healthcare delivery systems (e.g., delayed diagnosis, human resources and funding for treatment). This review also sheds light on the newer interventions and the future of breast cancer management keeping in mind the coronavirus disease 2019 imposed limitations.

The Discovery of New Drug-Target Interactions for Breast Cancer Treatment

Drug–target interaction (DTIs) prediction plays a vital role in probing new targets for breast cancer research. Considering the multifaceted challenges associated with experimental methods identifying DTIs, the in silico prediction of such interactions merits exploration. In this study, we develop a feature-based method to infer unknown DTIs, called PsePDC-DTIs, which fuses information regarding protein sequences extracted by pseudo-position specific scoring matrix (PsePSSM), detrended cross-correlation analysis coefficient (DCCA coefficient), and an FP2 format molecular fingerprint descriptor of drug compounds. In addition, the synthetic minority oversampling technique (SMOTE) is employed for dealing with the imbalanced data after Lasso dimensionality reduction. Then, the processed feature vectors are put into a random forest classifier to perform DTIs predictions on four gold standard datasets, including nuclear receptors (NR), G-protein-coupled receptors (GPCR), ion channels (IC), and enzymes (E). Furthermore, we explore new targets for breast cancer treatment using its risk genes identified from large-scale genome-wide genetic studies using PsePDC-DTIs. Through five-fold cross-validation, the average values of accuracy in NR, GPCR, IC, and E datasets are 95.28%, 96.19%, 96.74%, and 98.22%, respectively. The PsePDC-DTIs model provides us with 10 potential DTIs for breast cancer treatment, among which erlotinib (DB00530) and FGFR2 (hsa2263), caffeine (DB00201) and KCNN4 (hsa3783), as well as afatinib (DB08916) and FGFR2 (hsa2263) are found with direct or inferred evidence. The PsePDC-DTIs model has achieved good prediction results, establishing the validity and superiority of the proposed method.

Mediating Role of Affective Experiences in the Relationship between Perceived Social Support and Life Satisfaction among Breast Cancer Patients

Aim:

The role of social support network in managing psychological symptoms in cancer patients is widely acknowledged. The purpose of this study was to investigate the potential mediating role of Affective experiences in the relationship between perceived social support (PSS) and life satisfaction (LS) among breast cancer patients in India.

Methods:

A total of 100 breast cancer patients from S. S. Hospital, Banaras Hindu University participated in the study. They were tested using the PGI Social Support questionnaire, Satisfaction with Life Scale and Scale of Positive and Negative Experiences.

Results:

Co-relational results indicated that PSS was positively associated with positive affect and LS, while inversely related to negative affect. Affect was also associated with LS. Results showed that the mediation of affective experiences in the relationship between PSS and LS was significant (P <.01 level).

Conclusion:

Both PSS played a big role in LS among breast cancer patients. Besides focusing on improvement of the social support network, the psychologists and counsellors should adopt an integrated approach for evidence-based intervention strategies to enhance their ability to effectively balance their positive and negative emotions to promote LS among cancer patients.

Thermoresponsive Pluronic based microgels for controlled release of curcumin against breast cancer cell line

We developed here stimuli responsive curcumin loaded microgels based on Pluronic F-127. These microgels were prepared using coupling reaction between the amine modified Pluronic and EDTA. The microgel exhibited the affinity for hydrophobic drug, curcumin and showed pH as well as temperature-dependent release. Furthermore, the cytotoxicity study demonstrated dose-dependent inhibition of MDA-MB-231 cell growth with the most effective IC₅₀ value (3.8 ± 0.2 μg mL^-1 after 24 h). Based on these findings, the fabricated curcumin loaded microgels offered additional advantages over conventional drug therapies for treatment of cancer.

Comparison of Dosimetric Parameters of Three- Dimensional Conformal Radiotherapy and Intensity- Modulated Radiotherapy in Breast Cancer Patients Undergoing Adjuvant Radiotherapy after Modified Radical Mastectomy

Introduction Adjuvant radiotherapy has an important role in preventing locoregional recurrences. But radiation-induced late sequelae have become an important area of concern. The ideal postmastectomy radiotherapy technique is an area of controversy. The present study was designed to compare two widely practiced conformal techniques, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), in terms of dosimetry.

Material and Methods A total of 50 postmodified radical mastectomy patients were selected and were randomized to treatment either by 3DCRT or IMRT technique. Two opposing tangential beams were used in 3DCRT plans whereas five to seven tangential beams were used for IMRT plans. The prescribed dose was 50 Gy in 25 fractions over 5 weeks. The dosimetric parameters were compared for planning target volume (PTV), lungs, heart, and left ventricle, opposite breast and esophagus.

Results The dosimetric parameters of PTV in terms of D95%, D90%, D50%, and Dmean showed no significant difference among both techniques. The IMRT technique had significantly better mean values of Dnear-min/D98% (45.56 vs. 37.92 Gy; p = 0.01) and Dnear-max/D2% (51.47 vs. 53.65 Gy; p < 0.001). Also, conformity index (1.07 vs. 1.29; p = 0.004) and homogeneity index (0.22 vs. 0.46; p = 0.003) were significantly better in IMRT arm.

The dosimetric parameters of ipsilateral lung were significantly higher in IMRT arm in terms of mean dose (19.92 vs. 14.69 Gy; p < 0.001) and low/medium dose regions (V5, V10, V13, V15, V20; p < 0.05). However, high-dose regions (V40) were significantly higher in 3DCRT arm (15.57 vs. 19.89 Gy; p = 0.02). In contralateral lung also, mean dose was significantly higher in IMRT technique (3.63 vs. 0.53 Gy; p < 0.0001) along with low-dose regions (V5, V10, V13, V15; p < 0.05) while V20 was comparable between both the arms.

In left-sided patients, the heart dose favored 3DCRT technique in terms of mean dose (17.33 vs. 8.51 Gy; p = 0.003), low/medium dose regions (V5, V10, V20; p < 0.05), and doses to partial/whole volumes (D33, D67, D100). But the high-dose regions (V25, V30, V40) were comparable between both the arms. The dosimetry of left ventricle also showed significantly lesser values of mean dose and V5 in 3DCRT technique (p < 0.0001).

The opposite breast also showed higher mean dose with IMRT technique (2.60 vs. 1.47 Gy; p = 0.009) along with higher V5 (11.60 vs. 3.83 Gy; p = 0.001). The dosimetric parameters of esophagus showed higher mean dose in IMRT technique (10.04 vs. 3.24 Gy; p < 0.0001) but the high-dose regions V35 and V50 were comparable between both the arms.

Conclusion A clear advantage could not be demonstrated with any of the techniques. The IMRT technique led to more conformal and homogenous dose distribution with reduction in high-dose regions in ipsilateral lung while the 3DCRT technique showed lesser mean dose to organs at risk (OARs). The exposure of large volumes of OARs to low doses in IMRT technique may translate to increased long-term radiation-induced complications. The shortcomings of 3DCRT technique can be overcome by using multiple subfields within tangential fields.