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Martín Cameán M, Jaunarena I, Sánchez-Méndez JI, Martín C, Boria F, Martín E, Spagnolo E, Zapardiel I, Hernández Gutiérrez A. Survival in pregnancy-associated breast cancer patients compared to non-pregnant controls. Reprod Biol Endocrinol 2024; 22:34. [PMID: 38532462 PMCID: PMC10964548 DOI: 10.1186/s12958-024-01206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Pregnancy-associated breast cancer (PABC) is a rare entity whose prognosis has previously been studied and is subject to controversy. METHODS Survival of patients with PABC diagnosed between 2009 and 2021 with breast cancer during pregnancy or until 1 year after childbirth was compared with non-pregnant patients with breast cancer from the same period at La Paz University Hospital. Cox proportional hazards regression was used to compare disease-free (DFS) and overall (OS) survival between the groups, adjusting for grade and pathologic stage. RESULTS Among the 89 included patients with breast cancer, 34 were diagnosed during pregnancy, and 55 were not pregnant. The pregnant patients were more likely to have grade 3 tumors (61.3% vs 37%, p = 0.023) and an advanced stage (pathologic stage III-IV: 44.1% vs 17.6%, p = 0.008). Median follow-up was 47 months for the pregnant group and 46 months for the control group. After adjustments for tumor grade and pathologic stage, OS was comparable between the groups (HR 2.03; 95% CI 0.61 to 6.79; P = 0.25). CONCLUSIONS The outcome of women diagnosed with PABC is comparable to young non-pregnant controls. However, it should be taken into account that PABC has a more aggressive phenotype.
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Grants
- PI20/01368 Instituto de Salud Carlos III (ISCIII), PI20/01368, co-founded by the European Union.
- PI20/01368 Instituto de Salud Carlos III (ISCIII), PI20/01368, co-founded by the European Union.
- PI20/01368 Instituto de Salud Carlos III (ISCIII), PI20/01368, co-founded by the European Union.
- PI20/01368 Instituto de Salud Carlos III (ISCIII), PI20/01368, co-founded by the European Union.
- PI20/01368 Instituto de Salud Carlos III (ISCIII), PI20/01368, co-founded by the European Union.
- PI20/01368 Instituto de Salud Carlos III (ISCIII), PI20/01368, co-founded by the European Union.
- PI20/01368 Instituto de Salud Carlos III (ISCIII), PI20/01368, co-founded by the European Union.
- PI20/01368 Instituto de Salud Carlos III (ISCIII), PI20/01368, co-founded by the European Union.
- PI20/01368 Instituto de Salud Carlos III (ISCIII), PI20/01368, co-founded by the European Union.
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Affiliation(s)
- María Martín Cameán
- Department of Gynecology and Obstetrics, La Paz University Hospital, Madrid, 28046, Spain.
| | - Ibon Jaunarena
- Gynecologic Oncology Unit, Department of Gynecology and Obstetrics, Donostia University Hospital, San Sebastian, 20014, Spain
| | | | - Covadonga Martín
- Department of Gynecology and Obstetrics, La Paz University Hospital, Madrid, 28046, Spain
| | - Félix Boria
- Clínica Universidad de Navarra, Madrid, 28027, Spain
| | - Elena Martín
- Department of Gynecology and Obstetrics, La Paz University Hospital, Madrid, 28046, Spain
| | - Emanuela Spagnolo
- Department of Gynecology and Obstetrics, La Paz University Hospital, Madrid, 28046, Spain
| | - Ignacio Zapardiel
- Department of Gynecology and Obstetrics, La Paz University Hospital, Madrid, 28046, Spain
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Patel A, Dewani D, Jaiswal A, Reddy LS, Yadav P, Sethi N. Unveiling the Role of Pregnancy-Associated Plasma Protein A (PAPP-A) in Pregnancy-Associated Breast Cancer: A Comprehensive Review. Cureus 2024; 16:e56269. [PMID: 38623138 PMCID: PMC11017795 DOI: 10.7759/cureus.56269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/16/2024] [Indexed: 04/17/2024] Open
Abstract
Pregnancy-associated breast cancer (PABC) presents unique challenges due to its occurrence during or shortly after pregnancy. Pregnancy-associated plasma protein A (PAPP-A) has emerged as a potential biomarker and regulator in PABC. This comprehensive review examines the role of PAPP-A in PABC, highlighting its involvement in tissue remodeling and cancer progression. Molecular mechanisms linking PAPP-A to breast cancer, including signaling pathways and interactions with other molecules, are explored. The review also discusses the diagnostic and therapeutic implications of PAPP-A dysregulation in PABC, emphasizing the need for further research to elucidate underlying mechanisms and develop targeted therapies. Collaborative efforts among researchers, clinicians, and industry stakeholders are essential for translating findings into clinically relevant interventions to improve outcomes for PABC patients.
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Affiliation(s)
- Archan Patel
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepika Dewani
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lucky Srivani Reddy
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Yadav
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha Sethi
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Dou H, Jia S, Ba Y, Luo D, Yu P, Li F, Wang Y, Chen X, Xiao M. Clinical characteristics and pathologic complete response (pCR) rate after neoadjuvant chemotherapy in postpartum women with breast cancer. J Cancer Res Clin Oncol 2023; 149:14185-14204. [PMID: 37555951 PMCID: PMC10590317 DOI: 10.1007/s00432-023-05194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Breast cancer (BC) is currently the leading cause of death in women worldwide. Studies have confirmed that pregnancy is an independent factor affecting the survival of BC patients. BC found during pregnancy, lactation, or shortly after delivery is what we used to think of as pregnancy-associated breast cancer (PABC). The current expert definition of this concept is not uniform; however, there is growing evidence that postpartum breast cancer (PPBC) differs from other types of BC in terms of both biological features and prognosis, with a slightly different focus on diagnosis and treatment. With the increase of female reproductive age population and changes in fertility policies in China, patients with PPBC are receiving increasing attention. Here, we systematically analyzed the clinicopathological characteristics and chemotherapeutic response of patients with PPBC. We retrospectively analyzed the clinicopathological data, molecular subtypes, chemotherapy regimens, and pathological complete remission (pCR) rates of 1343 patients with non-metastatic BC at Harbin Medical University Cancer Hospital from January 1, 2012 to May 31, 2023. The categorical data were compared by chi-square test and Fisher exact test using logistic regression model. Predictor variables with P < 0.05 in the univariate analysis were included in the multivariate regression analysis to investigate the relationship between different age groups and pCR. RESULTS A total of 714 patients were eligible for analysis in this study, and 667 patients had a history of pregnancy, 40 (5.6%) of whom were PPBC patients. When diagnosed with BC, patients with PPBC were younger, more likely to undergo breast-conserving surgery (BCS), and more likely to achieve pCR (P < 0.05). In molecular typing, human epidermal growth factor receptor 2 (HER-2)-positive and triple-negative breast cancer (TNBC) were more frequent. In the entire cohort, HER-2 expression and delivery status were independent predictors of pCR rates in BC patients after neoadjuvant chemotherapy (NAC). CONCLUSION Our findings suggest that postpartum status is an independent predictor of pCR attainment in BC patients. PPBC is more sensitive to chemotherapy than other patients.We need to pay more attention to this group and achieve individualized treatment, which will help us treat BC better and provide new targets and blueprints for our clinical therapy.
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Affiliation(s)
- He Dou
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, No.150, Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Siyuan Jia
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, No.150, Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Yuling Ba
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, No.150, Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Danli Luo
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, No.150, Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Pingyang Yu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, No.150, Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Fucheng Li
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, No.150, Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Youyu Wang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, No.150, Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Xingyan Chen
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, No.150, Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Min Xiao
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, No.150, Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China.
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Zou S, Lin Y, Yu X, Eriksson M, Lin M, Fu F, Yang H. Genetic and lifestyle factors for breast cancer risk assessment in Southeast China. Cancer Med 2023; 12:15504-15514. [PMID: 37264741 PMCID: PMC10417168 DOI: 10.1002/cam4.6198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/01/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Despite the rising incidence and mortality of breast cancer among women in China, there are currently few predictive models for breast cancer in the Chinese population and with low accuracy. This study aimed to identify major genetic and life-style risk factors in a Chinese population for potential application in risk assessment models. METHODS A case-control study in southeast China was conducted including 1321 breast cancer patients and 2045 controls during 2013-2016, in which the data were randomly divided into a training set and a test set on a 7:3 scale. The association between genetic and life-style factors and breast cancer was examined using logistic regression models. Using AUC curves, we also compared the performance of the logistic model to machine learning models, namely LASSO regression model and support vector machine (SVM), and the scores calculated from CKB, Gail and Tyrer-Cuzick models in the test set. RESULTS Among all factors considered, the best model was achieved when polygenetic risk score, lifestyle, and reproductive factors were considered jointly in the logistic regression model (AUC = 0.73; 95% CI: 0.70-0.77). The models created in this study performed better than those using scores calculated from the CKB, Gail, and Tyrer-Cuzick models. However, the logistic model and machine learning models did not significantly differ from one another. CONCLUSION In summary, we have found genetic and lifestyle risk predictors for breast cancer with moderate discrimination, which might provide reference for breast cancer screening in southeast China. Further population-based studies are needed to validate the model for future applications in personalized breast cancer screening programs.
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Affiliation(s)
- Shuqing Zou
- Department of Epidemiology and Health Statistics, School of Public HealthFujian Medical UniversityFuzhouChina
| | - Yuxiang Lin
- Department of Breast SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Breast Cancer Institute, Fujian Medical UniversityFuzhouChina
| | - Xingxing Yu
- Department of Epidemiology and Health Statistics, School of Public HealthFujian Medical UniversityFuzhouChina
| | - Mikael Eriksson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | | | - Fangmeng Fu
- Department of Breast SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Breast Cancer Institute, Fujian Medical UniversityFuzhouChina
| | - Haomin Yang
- Department of Epidemiology and Health Statistics, School of Public HealthFujian Medical UniversityFuzhouChina
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
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5
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Heeling E, van de Kamer JB, Methorst M, Bruining A, van de Meent M, Vrancken Peeters MJTFD, Lok CAR, van der Ploeg IMC. The Safe Use of 125I-Seeds as a Localization Technique in Breast Cancer during Pregnancy. Cancers (Basel) 2023; 15:3229. [PMID: 37370839 DOI: 10.3390/cancers15123229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Some aspects of the treatment protocol for breast cancer during pregnancy (PrBC) have not been thoroughly studied. This study provides clarity regarding the safety of the use of 125I-seeds as a localization technique for breast-conserving surgery in patients with PrBC. METHODS To calculate the exposure to the fetus of one 125I-seed implanted in a breast tumor, we developed a model accounting for the decaying 125I-source, time to surgery, and the declining distance between the 125I-seed and the fetus. The primary outcome was the maximum cumulative fetal dose of radiation at consecutive gestational ages (GA). RESULTS The cumulative fetal dose remains below 1 mSv if a single 125I-seed is implanted at a GA of 26 weeks. After a GA of 26 weeks, the fetal dose can be at a maximum of 11.6 mSv. If surgery takes place within two weeks of implantation from a GA of 26 weeks, and one week above a GA of 32 weeks, the dose remains below 1 mSv. CONCLUSION The use of 125I-seeds is safe in PrBC. The maximum fetal exposure remains well below the threshold of 100 mSv, and therefore, does not lead to an increased risk of fetal tissue damage. Still, we propose keeping the fetal dose as low as possible, preferably below 1 mSv.
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Affiliation(s)
- Eva Heeling
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Michelle Methorst
- Department of Gynaecologic Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Annemarie Bruining
- Department of Radiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Mette van de Meent
- Department of Obstetrics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - Christianne A R Lok
- Department of Gynaecologic Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Iris M C van der Ploeg
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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6
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Veisi P, Nikouei M, Cheraghi M, Shahgheibi S, Moradi Y. The association between the multiple birth and breast cancer incidence: an update of a systematic review and meta-analysis from 1983 to 2022. Arch Public Health 2023; 81:76. [PMID: 37106433 PMCID: PMC10142199 DOI: 10.1186/s13690-023-01089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND It has been assumed that perinatal factors such as multiple pregnancies may affect subsequent breast cancer risk in the mother. Considering the inconsistencies in the results of case-control and cohort studies published in the world, this meta-analysis was conducted in order to determine the exact association between multiple pregnancies (twins or more) and the breast cancer incidence. METHODS This study was performed as a meta-analysis based on PRISMA guidelines by searching the international databases of PubMed (Medline), Scopus, and Web of Science as well as by screening selected articles based on their subject, abstract and full text. The search time was from January 1983 to November 2022. Then the NOS checklist was used to evaluate the quality of the final selected articles. The indicators considered for the meta-analysis included the odds ratio (OR) and the risk ratio (RR) along with the confidence interval reported in the selected primary studies. The desired analyzes were performed with STATA software version 17 to be reported. RESULTS In this meta-analysis, 19 studies were finally selected for analysis, which fully met the inclusion criteria. Of these, 11 were case-control studies and 8 were cohort ones. Their sample size was 263,956 women (48,696 with breast cancer and 215,260 healthy) and 1,658,378 (63,328 twin or multiple pregnancies and 1,595,050 singleton pregnancies), respectively. After combining the results of cohort and case-control studies, the effect of multiple pregnancies on the breast cancer incidence was equal to 1.01 (95% CI: 0.89-1.14; I2: 44.88%, P: 0.06) and 0.89 (95% CI: 0.83-0.95; I2: 41.73%, P: 0.07), respectively. CONCLUSION The present meta-analysis results showed, in general, multiple pregnancies were one of the preventive factors of breast cancer.
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Affiliation(s)
- Pedram Veisi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maziar Nikouei
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mojtaba Cheraghi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Sholeh Shahgheibi
- Department of Obstetrics and Gynecology, School of Medicine, Besat Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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7
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Updates in the pathology of Pregnancy Associated Breast Cancer (PABC). Pathol Res Pract 2023; 244:154413. [PMID: 36921545 DOI: 10.1016/j.prp.2023.154413] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
Pregnancy associated breast cancer (PABC) is defined as a breast cancer diagnosed during gestation, lactation or within 5 years postpartum. While the development of malignancy during pregnancy is rare, the incidence is increasing. Breast cancer is one of the most common cancers diagnosed during pregnancy, affecting up to 1 in 3000 deliveries. New understanding of the pathophysiology of PABC recently resulted in updated definitions distinguishing breast cancer diagnosed during pregnancy (PrBC) from cancer diagnosed during the postpartum period (PPBC) due to distinct biology and prognosis. Pregnancy has a dual effect on breast cancer development- both protective against cancer and promoting tumor growth. While several hypotheses have been proposed over the years to explain these effects, the most likely hypothesis for the development of PABC is the involution hypothesis, proposing that remodeling programs activated in the immediate postpartum period are similar to wound healing and inflammation that may be associated with tumor development and progression. Although PABCs reflect all subtypes of breast carcinomas, they are most commonly invasive ductal carcinomas of high tumor grade and large tumor size, with more advanced stage at presentation and higher rates of lymph node involvement. Most PABCs are hormone negative tumors (triple negative or HER2 amplified tumors) with high Ki-67 proliferation rates. Several studies have shown that PABCs have different genomic signatures than non-PABC tumors, showing increased expression of immune response mediators. Better understanding of the molecular pathways of tumor initiation and progression, along with prompt diagnosis and novel treatment protocols in the care of PrBC and PPBC are needed to improve outcomes for these young, high-risk breast cancer patients.
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8
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Margioula-Siarkou G, Margioula-Siarkou C, Petousis S, Vavoulidis E, Margaritis K, Almperis A, Haitoglou C, Mavromatidis G, Dinas K. Breast Carcinogenesis during Pregnancy: Molecular Mechanisms, Maternal and Fetal Adverse Outcomes. BIOLOGY 2023; 12:biology12030408. [PMID: 36979100 PMCID: PMC10045536 DOI: 10.3390/biology12030408] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Abstract
Breast cancer is a common type of cancer diagnosed during pregnancy, with increasing incidence over the last years, as more women choose to delay childbearing. Compared to breast cancer in general population, pregnancy-associated breast cancer (PABC) is significantly different in its terms of epidemiology, diagnostic and therapeutic management, while it exhibits particularly aggressive behavior, deriving from its unique molecular and biological profile. Although not fully elucidated, the pathophysiological basis of PABC can be traced back to a combination of hormonal and immune changes during pregnancy, breast involution and altered gene expression. There is considerable controversy in the existing literature about the influence of PABC on pregnancy outcomes, regarding both short- and long-term effects on maternal and fetal/neonatal health. The majority of PABC patients have advanced-stage disease at initial diagnosis and face a significantly poorer prognosis, with decreased survival rates. The most commonly reported adverse obstetrical–fetal events are preterm delivery and prematurity-associated neonatal morbidity, while other neonatal treatment-associated complications might also occur, even when safe therapeutic options are applied during pregnancy. The objective of the present comprehensive review was to summarize current knowledge and up-to-date evidence about the pathophysiological, molecular and biological basis of PABC, as well as its association with adverse maternal, obstetrical, fetal and neonatal outcomes.
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Affiliation(s)
- Georgia Margioula-Siarkou
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence:
| | - Chrysoula Margioula-Siarkou
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Eleftherios Vavoulidis
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Kosmas Margaritis
- 2nd Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Aristarchos Almperis
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Costas Haitoglou
- Laboratory of Biochemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - George Mavromatidis
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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9
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Fazeli S, Sakala M, Rakow-Penner R, Ojeda-Fournier H. Cancer in pregnancy: breast cancer. Abdom Radiol (NY) 2023; 48:1645-1662. [PMID: 36750478 DOI: 10.1007/s00261-023-03824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/09/2023]
Abstract
Breast cancer is the most common malignancy in women, and for women under 40, it is the leading cause of cancer-related deaths. A specific type of breast cancer is pregnancy-associated breast cancer, which is diagnosed during pregnancy, the first-year postpartum, or during lactation. Pregnancy-associated breast cancer is seen in 3/1000 pregnancies and is increasing in incidence as women delay pregnancy. This type of breast cancer is more aggressive, and not infrequently, there is a delay in diagnosis attributed to physiologic changes that occur during pregnancy and a lack of awareness among physicians. In this review, we discuss the demographics of pregnancy-associated breast cancer, provide differential considerations, and illustrate the multimodality imaging features to bring attention to the radiologist about this aggressive form of breast cancer.
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Affiliation(s)
- Soudabeh Fazeli
- Department of Radiology, Division of Breast Imaging, UC San Diego Health, 9400 Campus Point Dr., La Jolla, CA, 92037, USA
| | | | - Rebecca Rakow-Penner
- Department of Radiology, Division of Breast Imaging and Body Imaging, UC San Diego Health, 9400 Campus Point Dr., La Jolla, CA, USA
| | - Haydee Ojeda-Fournier
- Department of Radiology, Division of Breast Imaging, UC San Diego Health, 9400 Campus Point Dr., La Jolla, CA, 92037, USA.
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Furth PA, Wang W, Kang K, Rooney BL, Keegan G, Muralidaran V, Zou X, Flaws JA. Esr1 but Not CYP19A1 Overexpression in Mammary Epithelial Cells during Reproductive Senescence Induces Pregnancy-Like Proliferative Mammary Disease Responsive to Anti-Hormonals. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:84-102. [PMID: 36464512 PMCID: PMC9768685 DOI: 10.1016/j.ajpath.2022.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 12/04/2022]
Abstract
Molecular-level analyses of breast carcinogenesis benefit from vivo disease models. Estrogen receptor 1 (Esr1) and cytochrome P450 family 19 subfamily A member 1 (CYP19A1) overexpression targeted to mammary epithelial cells in genetically engineered mouse models induces largely similar rates of proliferative mammary disease in prereproductive senescent mice. Herein, with natural reproductive senescence, Esr1 overexpression compared with CYP19A1 overexpression resulted in significantly higher rates of preneoplasia and cancer. Before reproductive senescence, Esr1, but not CYP19A1, overexpressing mice are tamoxifen resistant. However, during reproductive senescence, Esr1 mice exhibited responsiveness. Both Esr1 and CYP19A1 are responsive to letrozole before and after reproductive senescence. Gene Set Enrichment Analyses of RNA-sequencing data sets showed that higher disease rates in Esr1 mice were accompanied by significantly higher expression of cell proliferation genes, including members of prognostic platforms for women with early-stage hormone receptor-positive disease. Tamoxifen and letrozole exposure induced down-regulation of these genes and resolved differences between the two models. Both Esr1 and CYP19A1 overexpression induced abnormal developmental patterns of pregnancy-like gene expression. This resolved with progression through reproductive senescence in CYP19A1 mice, but was more persistent in Esr1 mice, resolving only with tamoxifen and letrozole exposure. In summary, genetically engineered mouse models of Esr1 and CYP19A1 overexpression revealed a diversion of disease processes resulting from the two distinct molecular pathophysiological mammary gland-targeted intrusions into estrogen signaling during reproductive senescence.
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Affiliation(s)
- Priscilla A Furth
- Department of Oncology, Georgetown University, Washington, District of Columbia; Department of Medicine, Georgetown University, Washington, District of Columbia.
| | - Weisheng Wang
- Department of Oncology, Georgetown University, Washington, District of Columbia
| | - Keunsoo Kang
- Department of Microbiology, College of Science and Technology, Dankook University, Cheonan, Republic of Korea
| | - Brendan L Rooney
- Department of Oncology, Georgetown University, Washington, District of Columbia
| | - Grace Keegan
- Department of Oncology, Georgetown University, Washington, District of Columbia
| | - Vinona Muralidaran
- Department of Oncology, Georgetown University, Washington, District of Columbia
| | - Xiaojun Zou
- Department of Oncology, Georgetown University, Washington, District of Columbia
| | - Jodi A Flaws
- Department of Comparative Biosciences, University of Illinois Urbana-Champaign, Urbana, Illinois
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11
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Nissan N, Bauer E, Moss Massasa EE, Sklair-Levy M. Breast MRI during pregnancy and lactation: clinical challenges and technical advances. Insights Imaging 2022; 13:71. [PMID: 35397082 PMCID: PMC8994812 DOI: 10.1186/s13244-022-01214-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022] Open
Abstract
The breast experiences substantial changes in morphology and function during pregnancy and lactation which affects its imaging properties and may reduce the visibility of a concurrent pathological process. The high incidence of benign gestational-related entities may further add complexity to the clinical and radiological evaluation of the breast during the period. Consequently, pregnancy-associated breast cancer (PABC) is often a delayed diagnosis and carries a poor prognosis. This state-of-the-art pictorial review illustrates how despite currently being underutilized, technical advances and new clinical evidence support the use of unenhanced breast MRI during pregnancy and both unenhanced and dynamic-contrast enhanced (DCE) during lactation, to serve as effective supplementary modalities in the diagnostic work-up of PABC.
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Affiliation(s)
- Noam Nissan
- Radiology Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel. .,Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel.
| | - Ethan Bauer
- Sackler Medicine School, New-York Program, Tel Aviv University, Tel Aviv, Israel
| | - Efi Efraim Moss Massasa
- Joint Medicine School Program of Sheba Medical Center, St. George's, University of London and the University of Nicosia, Sheba Medical Center, Tel Hashomer, Israel
| | - Miri Sklair-Levy
- Radiology Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel
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12
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Breast Cancer in Pregnancy. Obstet Gynecol Clin North Am 2022; 49:181-193. [DOI: 10.1016/j.ogc.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Classification of Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Chintamani, Tandon M, Ghosh J. Breast Cancer with Associated Problems. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Viuff JH, Greiber IK, Karlsen MA, Storgaard L, Kroman N, Jensen MB, Eibye S, Hjortshøj CS, Ejlertsen B, Winther JF, Kjær SK, Mellemkjær L. Survival in Women Diagnosed With Breast Cancer During Pregnancy. Clin Breast Cancer 2021; 22:e517-e525. [PMID: 34963614 DOI: 10.1016/j.clbc.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/20/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Pregnancy rarely coincides with breast cancer, but when it does, uncertainties remain about how survival is affected. In a nation-wide study, we investigated survival in women diagnosed with breast cancer during pregnancy. MATERIALS AND METHODS Through health registries, we identified women with breast cancer at ages 15-44 years from 1973-2016 in Denmark and included 156 who were pregnant at diagnosis and 11,110 who were not. We compared overall mortality in pregnant and non-pregnant women using multivariate Cox regression stratified by time since cancer: <2 and ≥2 years. RESULTS During the first 2 years after diagnosis, the hazard ratio of overall death was 2.28 (95% CI: 1.48-3.52) for pregnant versus non-pregnant breast cancer patients after adjustment for age and calendar period and 1.62 (95% CI: 1.05-2.50) after further adjustment for extent of disease. Adjusting for additional tumor characteristics, the hazard ratio was still significantly increased. Beyond the first 2 years, there was no excess mortality. CONCLUSION Our study identifies the early period after breast cancer as a period of particular interest in future studies on survival after breast cancer in pregnancy. We found no evidence that survival is affected by pregnancy when 2 or more years have passed since diagnosis.
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Affiliation(s)
- Jakob H Viuff
- Unit of Virus Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Iben K Greiber
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mona Aa Karlsen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone Storgaard
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Simone Eibye
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Cristel S Hjortshøj
- Department of Pediatrics, Section of Pediatric Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Susanne K Kjær
- Unit of Virus Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Mellemkjær
- Unit of Virus Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
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16
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Zhang M, Zhou J, Wang L. Breast cancer and pregnancy: Why special considerations prior to treatment are needed in multidisciplinary care. Biosci Trends 2021; 15:276-282. [PMID: 34556594 DOI: 10.5582/bst.2021.01187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Breast cancer diagnosed during pregnancy poses ethical and professional challenges. Clinical management of that condition should ensure the safety of both the mother and fetus. Clinical trials on breast cancer exclude pregnant women, so sufficient evidence with which to formulate guidelines for the management of these patients is lacking. Failing to undergo a breast examination during pregnancy, breast symptoms explained by physiological changes such as pregnancy, and unnecessary abortions after the diagnosis of breast cancer lead to worse outcomes for these patients. Multidisciplinary teams including breast surgeons, obstetricians, radiologists, pathologists, and anesthesiologists need to make an early diagnosis and comprehensively evaluate patients in different gestational weeks and with different stages of breast cancer in order to optimize outcomes.
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Affiliation(s)
- Mingdi Zhang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
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17
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A retrospective clinical study of patients with pregnancy-associated breast cancer among multiple centers in China (CSBrS-008). Chin Med J (Engl) 2021; 134:2186-2195. [PMID: 34553700 PMCID: PMC8478375 DOI: 10.1097/cm9.0000000000001697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pregnancy-associated breast cancer (PABC) is a special type of breast cancer that occurs during pregnancy and within 1 year after childbirth. With the rapid social development and the adjustment of reproductive policies in China, the average age of females at first childbirth is increasing, which is expected to lead to an increase in the incidence of PABC. This study aimed to accumulate clinical experience and to investigate and summarize the prevalence, diagnosis, and treatment of PABC based on large multicenter samples in China. METHODS According to the Chinese Society of Breast Surgery, a total of 164 patients with PABC in 27 hospitals from January 2016 to December 2018 were identified. The pregnancy status, clinicopathological features, comprehensive treatment methods, and outcomes were retrospectively analyzed. Survival curves were plotted using the Kaplan-Meier method. RESULTS A total of 164 patients of PABC accounted for 0.30% of the total number of cases in the same period; of which, 83 patients were diagnosed during pregnancy and 81 patients during lactation. The median age of PABC was 33 years (24-47 years). Stage I patients accounted for 9.1% (15/164), stage II 54.9% (90/164), stage III 24.4% (40/164), and stage IV 2.4% (4/164). About 9.1% (15/164) of patients were luminal A. Luminal B patients accounted the most (43.3% [71/164]). About 15.2% (25/164) of patients were human epidermal growth factor receptor 2 (Her-2) overexpression and 18.9% (31/164) of patients were triple-negative breast cancer. For pregnancy breast cancer, 36.1% (30/83) of patients received direct surgery and 20.5% (17/83) received chemotherapy during pregnancy. About 31.3% (26/83) chose abortion or induction of labor. The median follow-up time was 36 months (3-59 months); 11.0% (18/164) patients had local recurrence or distant metastasis and 3.0% (5/164) died. CONCLUSIONS It is safe and feasible to standardize surgery and chemotherapy for PABC.
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18
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Karami K, Anbari K. Breast Cancer: A Review of Risk Factors and New Insights into Treatment. CURRENT CANCER THERAPY REVIEWS 2021. [DOI: 10.2174/1573394717999210120195208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Today, despite significant advances in cancer treatment have been made, breast cancer
remains one of the main health problems and considered a top biomedical investigation urgency.
The present study reviewed the common conventional chemotherapy agents and also some alternative
and complementary approaches such as oncolytic virotherapy, bacteriotherapy, nanotherapy,
immunotherapy, and natural products, which are recommended for breast cancer treatment. In addition
to current surgery approaches such as mastectomy, in recent years, a number of novel techniques
such as robotic mastectomies, nipple-sparing mastectomy, skin-sparing mastectomy, daycase
mastectomy were used in breast cancer surgery. In this review, we summarize new insights
into risk factors, surgical and non-surgical treatments for breast cancer.
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Affiliation(s)
- Kimia Karami
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Khatereh Anbari
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
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19
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Impact of breast cancer risk factors on clinically relevant prognostic biomarkers for primary breast cancer. Breast Cancer Res Treat 2021; 189:483-495. [PMID: 34185195 PMCID: PMC8357643 DOI: 10.1007/s10549-021-06294-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/12/2021] [Indexed: 12/13/2022]
Abstract
Purpose In addition to impacting incidence, risk factors for breast cancer may also influence recurrence and survival from the disease. However, it is unclear how these factors affect combinatorial biomarkers for aiding treatment decision-making in breast cancer. Methods Patients were 8179 women with histologically confirmed invasive breast cancer, diagnosed and treated in a large cancer hospital in Beijing, China. Individual clinicopathological (tumor size, grade, lymph nodes) and immunohistochemical (IHC: ER, PR, HER2, KI67) markers were used to define clinically relevant combinatorial prognostic biomarkers, including the Nottingham Prognostic Index (NPI: combining size, grade, nodes) and IHC4 score (combining ER, PR, HER2, KI67). Odds ratios (ORs) and 95% confidence intervals (CIs) for associations between breast cancer risk factors and quartiles (Q1–Q4) of NPI and IHC4 were assessed in multivariable polytomous logistic regression models. Results Overall, increasing parity (ORtrend(95% CI) = 1.20(1.05–1.37);Ptrend = 0.007), overweight (OR(95% CI)vs normal = 1.60(1.29–1.98)), and obesity (OR(95% CI) vs normal = 2.12(1.43–3.14)) were associated with higher likelihood of developing tumors with high (Q4) versus low (Q1) NPI score. Conversely, increasing age (ORtrend(95% CI) = 0.75(0.66–0.84);Ptrend < 0.001) and positive family history of breast cancer (FHBC) (OR(95% CI) = 0.66(0.45–0.95)) were inversely associated with NPI. Only body mass index (BMI) was associated with IHC4, with overweight (OR(95% CI) vs normal = 0.82(0.66–1.02)) and obese (OR(95% CI) vs normal = 0.52(0.36–0.76)) women less likely to develop high IHC4 tumors. Notably, elevated BMI was associated with higher NPI irrespective of hormone receptor-expression status. Conclusions Our findings indicate that factors affecting breast cancer incidence, particularly age, parity, FHBC, and BMI, may impact clinically relevant prognostic biomarkers with implications for surveillance, prognostication, and counseling. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06294-5.
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20
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Linoleic acid induces secretion of extracellular vesicles from MDA-MB-231 breast cancer cells that mediate cellular processes involved with angiogenesis in HUVECs. Prostaglandins Other Lipid Mediat 2021; 153:106519. [DOI: 10.1016/j.prostaglandins.2020.106519] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022]
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21
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Suelmann BBM, van Dooijeweert C, van der Wall E, Linn S, van Diest PJ. Pregnancy-associated breast cancer: nationwide Dutch study confirms a discriminatory aggressive histopathologic profile. Breast Cancer Res Treat 2021; 186:699-704. [PMID: 33635448 PMCID: PMC8019425 DOI: 10.1007/s10549-021-06130-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/05/2021] [Indexed: 11/10/2022]
Abstract
Purpose Breast cancer is the most common type of malignancy in pregnant women, occurring approximately once in every 3000 pregnancies. Pregnancy-associated breast cancer (PABC) is commonly defined as breast cancer diagnosed during or within one year after pregnancy, and it accounts for up to 6.9% of all breast cancers in women younger than 45 years old. Whether these cancers arise before or during pregnancy, and whether they are stimulated by the high hormonal environment of pregnancy, is currently unknown. This study assesses the histopathological profile of PABC in a large Dutch population-based cohort. Methods We identified 744 patients with PABC (in this cohort defined as breast cancer diagnosed during or within 6 months after pregnancy) diagnosed between 1988 and 2019, in the nationwide Dutch Pathology Registry (PALGA). An age-matched PALGA cohort of unselected breast cancer patients (≤ 45 years), diagnosed between 2013 and 2016, was used as a control. Histopathologic features of both cohorts were compared. Results The median age of PABC patients was 34.3 years old (range 19–45 years) and most breast cancers were diagnosed during pregnancy (74.2%). As compared to age-matched controls, PABC patients had tumors of higher Bloom–Richardson grade (grade I: 1.5% vs. 12.4%, grade II: 16.9% vs. 31.3%, grade III: 80.3% vs. 39.5%, p < 0.0001). Furthermore, estrogen (ER)- and progesterone (PR)-receptor expression was less frequently reported positive (ER: 38.9% vs. 68.2% and PR: 33.9% vs. 59.0%, p < 0.0001), while a higher percentage of PABC tumors overexpressed HER2 (20.0% vs. 10.0%, p < 0.0001). The most observed intrinsic subtype in PABC was triple-negative breast cancer (38.3% vs. 22.0%, p < 0.0001), whereas hormone-driven cancers were significantly less diagnosed (37.9% vs. 67.3%, p < 0.0001). Conclusion This study, based on a large population-based cohort of 744 PABC Dutch patients, underlines the more aggressive histopathologic profile compared to age-matched breast cancer patients ≤ 45 years. Further in-depth genetic analysis will be performed to unravel the origin of this discriminating phenotype. It definitely calls for timely detection and optimal treatment of this small but delicate subgroup of breast cancer patients. Supplementary Information The online version of this article (10.1007/s10549-021-06130-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- B B M Suelmann
- Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, Utrecht, GA, 3508, The Netherlands.
| | - C van Dooijeweert
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - S Linn
- Department of Medical Oncology, Netherlands Cancer Institute (AVL-NKI), Amsterdam, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Bajpai J, Simha V, Shylasree TS, Sarin R, Pathak R, Popat P, Mokal S, Dandekar S, Bhansal V, Ghosh J, Nair N, Gulia S, Rath S, Joshi S, Wadasadawala T, Sheth T, Parmar V, Banavali SD, Badwe RA, Gupta S. Pregnancy associated breast cancer (PABC): Report from a gestational cancer registry from a tertiary cancer care centre, India. Breast 2021; 56:88-95. [PMID: 33640524 PMCID: PMC7933532 DOI: 10.1016/j.breast.2021.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Pregnancy associated breast cancer (PABC) is a rare entity and defined as breast cancer diagnosed during pregnancy or one-year post-partum. There is sparse data especially from low and middle-income countries (LMIC) and merits exploration. Methods The study (2013–2020) evaluated demographics, treatment patterns and outcomes of PABC. Results There were 104 patients, median age of 31 years; 43 (41%) had triple-negative disease, 31(29.8%) had hormone-receptor (HR) positive and HER2 negative, 14 (13.5%) had HER2-positive and HR negative and 16(15.4%) had triple positive disease. 101(97%) had IDC grade III tumors and 74% had delayed diagnosis. 72% presented with early stage (24, EBC) or locally advanced breast cancer (53, LABC) and received either neoadjuvant (n = 49) or adjuvant (n = 26) chemotherapy and surgery. Trastuzumab, tamoxifen, and radiotherapy were administered post-delivery. At a median follow up of 27 (IQR:19–35) months, the estimated 3-year event-free survival (EFS) for EBC and LABC was 82% (95% CI: 65.2–100) and 56% (95% CI: 42–75.6%) and for metastatic 24% (95% CI: 10.1%–58.5%) respectively. Of the 104 patients, 34 were diagnosed antepartum (AP) and 15 had termination, 2 had preterm and 16 had full-term deliveries(FTDs). Among postpartum cohort (n = 70), 2 had termination, 1 had preterm, 67 had FTDs. 83(including 17 from AP) children from both cohorts were experiencing normal milestones. Conclusion Data from the first Indian PABC registry showed that the majority had delayed diagnosis and aggressive features(TNBC, higher grade). Treatment was feasible in majority and stage matched outcomes were comparable to non-PABCs. Pregnancy associated breast cancer (PABC) is a rare and Challenging entity with lack of data from low-middle income countries. First Indian data showed that stage matched oncologic outcomes were comparable to non-PABC. Obstetric outcomes were similar to non-cancer associated pregnancies with normal cognitive development. Creating awareness and early diagnosis is of utmost importance to improve prognosis in this unique entity
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Affiliation(s)
- Jyoti Bajpai
- Medical Oncology,Tata Memorial Centre, Mumbai, India.
| | - Vijay Simha
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | | | - Rajeev Sarin
- Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Reema Pathak
- Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Palak Popat
- Radio-diagnosis, Tata Memorial Centre, Mumbai, India
| | - Smruti Mokal
- Biostatistics, Tata Memorial Centre, Mumbai, India
| | | | | | - Jaya Ghosh
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | - Neeta Nair
- Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Seema Gulia
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | - Sushmita Rath
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | - Shalaka Joshi
- Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | | | | | - Vani Parmar
- Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - S D Banavali
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | - R A Badwe
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | - Sudeep Gupta
- Medical Oncology,Tata Memorial Centre, Mumbai, India
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23
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Allouch S, Gupta I, Malik S, Al Farsi HF, Vranic S, Al Moustafa AE. Breast Cancer During Pregnancy: A Marked Propensity to Triple-Negative Phenotype. Front Oncol 2021; 10:580345. [PMID: 33425733 PMCID: PMC7786283 DOI: 10.3389/fonc.2020.580345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/20/2020] [Indexed: 12/19/2022] Open
Abstract
Breast and cervical cancers comprise 50% of all cancers during pregnancy. In particular, gestational breast cancer is considered one of the most aggressive types of cancers, which is a rare but fatal disease. However, the incidence of this type of cancer is increasing over the years and its prevalence is expected to rise further as more women delay childbearing. Breast cancer occurring after pregnancy is generally triple negative with specific characterizations of a poorer prognosis and outcome. On the other hand, it has been pointed out that this cancer is associated with a specific group of genes which can be used as precise targets to manage this deadly disease. Indeed, combination therapies consisting of gene-based agents with other cancer therapeutics is presently under consideration. We herein review recent progress in understanding the development of breast cancer during pregnancy and their unique subtype of triple negative which is the hallmark of this type of breast cancer.
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Affiliation(s)
- Soumaya Allouch
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ishita Gupta
- College of Medicine, QU Health, Qatar University, Doha, Qatar.,Biomedical Research Center, Qatar University, Doha, Qatar
| | - Shaza Malik
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ala-Eddin Al Moustafa
- College of Medicine, QU Health, Qatar University, Doha, Qatar.,Biomedical Research Center, Qatar University, Doha, Qatar
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24
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Is It Possible to Personalize the Diagnosis and Treatment of Breast Cancer during Pregnancy? J Pers Med 2020; 11:jpm11010018. [PMID: 33379383 PMCID: PMC7823967 DOI: 10.3390/jpm11010018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022] Open
Abstract
The main goal of precision medicine in patients with breast cancer is to tailor the treatment according to the particular genetic makeup and the genetic changes in the cancer cells. Breast cancer occurring during pregnancy (BCP) is a complex and difficult clinical problem. Although it is not very common, both maternal and fetal outcome must be always considered when planning treatment. Pregnancy represents a significant barrier to the implementation of personalized treatment for breast cancer. Tailoring therapy mainly takes into account the stage of pregnancy, the subtype of cancer, the stage of cancer, and the patient’s preference. Results of the treatment of breast cancer in pregnancy are as yet not very satisfactory because of often delayed diagnosis, and it usually has an unfavorable outcome. Treatment of patients with pregnancy-associated breast cancer should be centralized. Centralization may result in increased experience in diagnosis and treatment and accumulated data may help us to optimize the treatment approaches, modify general treatment recommendations, and improve the survival and quality of life of the patients.
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25
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Bariatric Surgery is Associated With Reduced Risk of Breast Cancer in Both Premenopausal and Postmenopausal Women. Ann Surg 2020; 272:1053-1059. [PMID: 30998538 DOI: 10.1097/sla.0000000000003331] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This retrospective cohort study examined whether bariatric surgery is associated with reduced risk of breast cancer among pre- and postmenopausal women. BACKGROUND Obesity is associated with increased risk of breast cancer, but the impact of weight loss on breast cancer risk has been difficult to quantify. METHODS The cohort included obese (body mass index ≥35 kg/m) patients enrolled in an integrated health care delivery system between 2005 and 2012 (with follow-up through 2014). Female bariatric surgery patients (N = 17,998) were matched on body mass index, age, study site, and comorbidity index to 53,889 women with no bariatric surgery. Kaplan-Meier curves and Cox proportional hazards models were used to examine incident breast cancer up to 10 years after bariatric surgery. Pre- and postmenopausal women were examined separately, and further classified by estrogen receptor (ER) status. RESULTS The analysis included 301 premenopausal and 399 postmenopausal breast cancer cases. In multivariable adjusted models, bariatric surgery was associated with a reduced risk of both premenopausal (HR = 0.72, 95% CI, 0.54-0.94) and postmenopausal (HR = 0.55, 95% CI, 0.42-0.72) breast cancer. Among premenopausal women, the effect of bariatric surgery was more pronounced among ER-negative cases (HR = 0.36, 95% CI, 0.16-0.79). Among postmenopausal women, the effect was more pronounced in ER-positive cases (HR = 0.52, 95% CI, 0.39-0.70). CONCLUSIONS Bariatric surgery was associated with a reduced risk of breast cancer among severely obese women. These findings have significant public health relevance because the prevalence of obesity continues to rise, and few modifiable breast cancer risk factors have been identified, especially for premenopausal women.
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26
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Nsaful J, Vanderpuye V, Scott AA, Dedey F, Oppong SA, Appiah-Danquah R, Damale N, Fenu B, Wordui T, Yarney J, Clegg-Lamptey JN. Experiences and challenges in the management of pregnancy-associated breast cancer at the Korle Bu Teaching Hospital: a review of four cases. Ecancermedicalscience 2020; 14:1140. [PMID: 33281932 PMCID: PMC7685764 DOI: 10.3332/ecancer.2020.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is the commonest female cancer worldwide and the most common malignancy during pregnancy. The current management of breast cancer is based on patient and tumour characteristics, preferences and disease stage. In pregnancy-associated breast cancer, the gestational age influences treatment options. Sequencing of therapies is guided by safe imaging options, timing of delivery and prognosis. Systemic therapy options in the neoadjuvant, adjuvant and palliative settings are limited due to safety concerns of the unborn foetus. In resource-constrained regions, the application of safe options may be challenging. This paper reports four of such cases managed in Ghana using a multidisciplinary approach and local resource-appropriate evidence-based practices. Maternal and foetal outcomes were acceptable with none resulting in termination of pregnancy.
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Affiliation(s)
- Josephine Nsaful
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Aba Anoa Scott
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Florence Dedey
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Samuel A Oppong
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Rita Appiah-Danquah
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Nelson Damale
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Benjamin Fenu
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Theodore Wordui
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Joel Yarney
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Joe Nat Clegg-Lamptey
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
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27
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Newell MS. Breast Lumps in Lactating Women: US May Be Enough. Radiology 2020; 297:325-326. [DOI: 10.1148/radiol.2020203253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary S. Newell
- From the Department of Radiology and Imaging Sciences, Emory University 1365 Clifton Rd, Atlanta, GA 30322
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28
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Schairer C, Hablas A, Eldein IAS, Gaafar R, Rais H, Mezlini A, Ayed FB, Ayoub WB, Benider A, Tahri A, Khouchani M, Aboulazm D, Karkouri M, Eissa S, Bastawisy AE, Yehia M, Gadalla SM, Swain SM, Merajver SD, Brown LM, Pfeiffer RM, Soliman AS. Risk factors for inflammatory and non-inflammatory breast cancer in North Africa. Breast Cancer Res Treat 2020; 184:543-558. [PMID: 32876910 PMCID: PMC10440960 DOI: 10.1007/s10549-020-05864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Studies of the etiology of inflammatory breast cancer (IBC), a rare but aggressive breast cancer, have been hampered by limited risk factor information. We extend previous studies by evaluating a broader range of risk factors. METHODS Between 2009 and 2015, we conducted a case-control study of IBC at six centers in Egypt, Tunisia, and Morocco; enrolled were 267 IBC cases and for comparison 274 non-IBC cases and 275 controls, both matched on age and geographic area to the IBC cases. We administered questionnaires and collected anthropometric measurements for all study subjects. We used multiple imputation methods to account for missing values and calculated odds ratios (ORs) and 95% confidence intervals (CIs) using polytomous logistic regression comparing each of the two case groups to the controls, with statistical tests for the difference between the coefficients for the two case groups. RESULTS After multivariable adjustment, a livebirth within the previous 2 years (OR 4.6; 95% CI 1.8 to 11.7) and diabetes (OR 1.8; 95% CI 1.1 to 3.0) were associated with increased risk of IBC, but not non-IBC (OR 0.9; 95% CI 0.3 to 2.5 and OR 0.9; 95% CI 0.5 to 1.6 for livebirth and diabetes, respectively). A family history of breast cancer, inflammatory-like breast problems, breast trauma, and low socioeconomic status were associated with increased risk of both tumor types. CONCLUSIONS We identified novel risk factors for IBC and non-IBC, some of which preferentially increased risk of IBC compared to non-IBC. Upon confirmation, these findings could help illuminate the etiology and aid in prevention of this aggressive cancer.
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Affiliation(s)
- Catherine Schairer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | - Ali Tahri
- Clinique Spécialisée Menara, Marrakech, Morocco
| | | | | | | | | | | | | | - Shahinaz M Gadalla
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandra M Swain
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | | | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
- , 9609 Medical Center Drive, Rm 7E142, Bethesda, MD, 20892, USA.
| | - Amr S Soliman
- Medical School of the City University of New York, New York, USA
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29
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Paris I, Di Giorgio D, Carbognin L, Corrado G, Garganese G, Franceschini G, Sanchez AM, De Vincenzo RP, Accetta C, Terribile DA, Magno S, Di Leone A, Bove S, Masetti R, Scambia G. Pregnancy-Associated Breast Cancer: A Multidisciplinary Approach. Clin Breast Cancer 2020; 21:e120-e127. [PMID: 32778512 DOI: 10.1016/j.clbc.2020.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 01/20/2023]
Abstract
The diagnosis of breast cancer (BC) during pregnancy is uncommon. It has varied among different studies from 1:10,000 to 1:3000 of all pregnancies, with a median age of 33 years. Pregnancy-associated BC represents a challenge in terms of clinical management to guarantee both maternal and fetal security in choosing the right treatment. This situation is complex and requires a multidisciplinary approach, including the surgeon, anesthesiologist, oncologist, radiotherapist, psychologist, and maternal-fetal medicine specialist. In the present review, we examined the management of pregnancy-associated BC, focusing on pathophysiologic background, risk factors, diagnosis, staging procedures, anesthesia, surgical management, and systemic treatment.
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Affiliation(s)
- Ida Paris
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Danilo Di Giorgio
- Gynaecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Luisa Carbognin
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giacomo Corrado
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgia Garganese
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Gynaecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Franceschini
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alejandro Martin Sanchez
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Pasqualina De Vincenzo
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Accetta
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniela Andreina Terribile
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Magno
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alba Di Leone
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sonia Bove
- Gynaecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Riccardo Masetti
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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30
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Ramírez-Ricardo J, Leal-Orta E, Martínez-Baeza E, Ortiz-Mendoza C, Breton-Mora F, Herrera-Torres A, Elizalde-Acosta I, Cortes-Reynosa P, Thompson-Bonilla R, Perez Salazar E. Circulating extracellular vesicles from patients with breast cancer enhance migration and invasion via a Src‑dependent pathway in MDA‑MB‑231 breast cancer cells. Mol Med Rep 2020; 22:1932-1948. [PMID: 32582965 PMCID: PMC7411406 DOI: 10.3892/mmr.2020.11259] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/15/2020] [Indexed: 12/21/2022] Open
Abstract
Triple negative breast cancer (TNBC) is a breast cancer subtype associated with high rates of metastasis, heterogeneity, drug resistance and a poor prognosis. Extracellular vesicles (EVs) are vesicles of endosomal and plasma membrane origin, and are secreted by healthy and cancer cells. In cancer, EVs contribute to tumor progression by mediating escape from the immune system surveillance, and are involved in extracellular matrix degradation, invasion, angiogenesis, migration and metastasis. Furthermore, EVs have been identified in several human fluids. However, the role of EVs from patients with breast cancer in the migration and invasion of human breast cancer cells is not fully understood. The present study investigated whether EVs isolated from Mexican patients with breast cancer can induce cellular processes related to invasion in breast cancer. Moreover, plasma fractions enriched in EVs and deprived of platelet-derived EVs obtained from blood samples of 32 Mexican patients with biopsy-diagnosed breast cancer at different clinical stages who had not received treatment were analyzed. Furthermore, one control group was included, which consisted of 20 Mexican healthy females. The present results demonstrated that EVs from women with breast cancer promote migration and invasion, and increase matrix metalloproteinase (MMP)-2 and MMP-9 secretion in TNBC MDA-MB-231 cells. In addition, it was found that EVs from patients with breast cancer induced Src and focal adhesion kinase activation, and focal adhesions assembly with an increase in focal adhesions number, while the migration and invasion was dependent on Src activity. Collectively, EVs from Mexican patients with breast cancer induce migration and invasion via a Src-dependent pathway in TNBC MDA-MB-231 cells.
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31
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Noratto G, Layosa MA, Lage NN, Atienza L, Ivanov I, Mertens-Talcott SU, Chew BP. Antitumor potential of dark sweet cherry sweet (Prunus avium) phenolics in suppressing xenograft tumor growth of MDA-MB-453 breast cancer cells. J Nutr Biochem 2020; 84:108437. [PMID: 32615370 DOI: 10.1016/j.jnutbio.2020.108437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 12/26/2022]
Abstract
This study investigated in vivo the antitumor activity of dark sweet cherry (DSC) whole extracted phenolics (WE) and fractions enriched in anthocyanins (ACN) or proanthocyanidins (PCA) in athymic mice xenografted with MDA-MB-453 breast cancer cells. Mice were gavaged with WE, ACN or PCA extracts (150 mg/kg body weight/day) for 36 days. Results showed that tumor growth was suppressed at similar levels by WE, ACN and PCA compared to control group (C) without signs of toxicity or significant changes in mRNA oncogenic biomarkers in tumors or mRNA invasive biomarker in distant organs. Tumor protein analyses showed that WE, ACN and PCA induced at similar levels the stress-regulated ERK1/2 phosphorylation, known to be linked to apoptosis induction. However, ACN showed enhanced antitumor activity through down-regulation of total oncogenic and stress-related Akt, STAT3, p38, JNK and NF-kB proteins. In addition, immunohistochemistry analysis of Ki-67 revealed inhibition of tumor cell proliferation with potency WE ≥ ACN ≥ PCA. Differential quantitative proteomic high-resolution nano-HPLC tandem mass spectrometry analysis of tumors from ACN and C groups revealed the identity of 66 proteins associated with poor breast cancer prognosis that were expressed only in C group (61 proteins) or differentially up-regulated (P<.05) in C group (5 proteins). These findings revealed ACN-targeted proteins associated to tumor growth and invasion and the potential of DSC ACN for breast cancer treatment. Results lead to a follow-up study with highly immunodeficient mice/invasive cell line subtype and advanced tumor development to validate the anti-invasive activity of DSC anthocyanins.
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Affiliation(s)
- Giuliana Noratto
- Department of Nutrition and Food Science, Texas A&M University, College Station, TX, USA.
| | - Marjorie A Layosa
- Department of Nutrition and Food Science, Texas A&M University, College Station, TX, USA; Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines Los Baños, Laguna, Philippines
| | - Nara N Lage
- Department of Nutrition and Food Science, Texas A&M University, College Station, TX, USA; Research Center in Biological Sciences, Federal University of Ouro Preto, Minas Gerais, Brazil
| | - Liezl Atienza
- Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines Los Baños, Laguna, Philippines
| | - Ivan Ivanov
- Veterinary Physiology and Pharmacology, Texas A&M University, College Station, TX, USA
| | | | - Boon P Chew
- Department of Nutrition and Food Science, Texas A&M University, College Station, TX, USA
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32
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Thong T, Wang Y, Brooks MD, Lee CT, Scott C, Balzano L, Wicha MS, Colacino JA. Hybrid Stem Cell States: Insights Into the Relationship Between Mammary Development and Breast Cancer Using Single-Cell Transcriptomics. Front Cell Dev Biol 2020; 8:288. [PMID: 32457901 PMCID: PMC7227401 DOI: 10.3389/fcell.2020.00288] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/02/2020] [Indexed: 12/15/2022] Open
Abstract
Similarities between stem cells and cancer cells have implicated mammary stem cells in breast carcinogenesis. Recent evidence suggests that normal breast stem cells exist in multiple phenotypic states: epithelial, mesenchymal, and hybrid epithelial/mesenchymal (E/M). Hybrid E/M cells in particular have been implicated in breast cancer metastasis and poor prognosis. Mounting evidence also suggests that stem cell phenotypes change throughout the life course, for example, through embryonic development and pregnancy. The goal of this study was to use single cell RNA-sequencing to quantify cell state distributions of the normal mammary (NM) gland throughout developmental stages and when perturbed into a stem-like state in vitro using conditional reprogramming (CR). Using machine learning based dataset alignment, we integrate multiple mammary gland single cell RNA-seq datasets from human and mouse, along with bulk RNA-seq data from breast tumors in the Cancer Genome Atlas (TCGA), to interrogate hybrid stem cell states in the normal mammary gland and cancer. CR of human mammary cells induces an expanded stem cell state, characterized by increased expression of embryonic stem cell associated genes. Alignment to a mouse single-cell transcriptome atlas spanning mammary gland development from in utero to adulthood revealed that NM cells align to adult mouse cells and CR cells align across the pseudotime trajectory with a stem-like population aligning to the embryonic mouse cells. Three hybrid populations emerge after CR that are rare in NM: KRT18+/KRT14+ (hybrid luminal/basal), EPCAM+/VIM+ (hybrid E/M), and a quadruple positive population, expressing all four markers. Pseudotime analysis and alignment to the mouse developmental trajectory revealed that E/M hybrids are the most developmentally immature. Analyses of single cell mouse mammary RNA-seq throughout pregnancy show that during gestation, there is an enrichment of hybrid E/M cells, suggesting that these cells play an important role in mammary morphogenesis during lactation. Finally, pseudotime analysis and alignment of TCGA breast cancer expression data revealed that breast cancer subtypes express distinct developmental signatures, with basal tumors representing the most “developmentally immature” phenotype. These results highlight phenotypic plasticity of normal mammary stem cells and provide insight into the relationship between hybrid cell populations, stemness, and cancer.
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Affiliation(s)
- Tasha Thong
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Yutong Wang
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, United States
| | - Michael D Brooks
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Christopher T Lee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Clayton Scott
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, United States.,Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Laura Balzano
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, United States
| | - Max S Wicha
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States.,Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Justin A Colacino
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States.,Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States.,Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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33
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Li T, Zhou X, Wang J, Liu Z, Han S, Wan L, Sun X, Chen H. Adipose-derived mesenchymal stem cells and extracellular vesicles confer antitumor activity in preclinical treatment of breast cancer. Pharmacol Res 2020; 157:104843. [PMID: 32360582 DOI: 10.1016/j.phrs.2020.104843] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023]
Abstract
Both antitumor and protumor property of mesenchymal stem cells (MSCs) have been demonstrated. We hypothesize that this contradiction is due to the heterogeneity of MSC subsets and that extracellular vesicles (EVs) from distinct MSC subsets can transfer the corresponding antitumor activities. Here we evaluated the antitumor activities of two subsets of adipose-derived mesenchymal stem cells (ADSCs) and ADSC-derived EVs (ADSC-EVs) in immunocompetent syngeneic mouse models of breast cancer. We identified CD90high and CD90low ADSC subsets and demonstrated that CD90high ADSCs could be converted into CD90low ADSCs by stimulation with LPS. CD90low ADSCs and its derived EVs significantly inhibited tumor growth in tumor-bearing mice. Benefit of tumor control were associated with decreased tumor cell proliferation and migration, and enhanced tumor cell apoptosis mediated by ADSC-EVs. Antioncogenic miRNA-16-5p loaded CD90low ADSC-EVs further significantly enhanced antitumor activities. Taken together, this study represents the first attempt to apply our newly identified antitumor ADSCs and its derived EVs in preclinical treatment of breast cancer. This study also provides the evidence that EVs can serve as a novel and effective therapeutics or drug delivery vesicle. This new therapeutic approach could be potentially applicable to breast cancer and many other types of cancer.
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Affiliation(s)
- Tao Li
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China; Vaccine and Immunotherapy Center, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Xiaohe Zhou
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Jingzhe Wang
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Ziyao Liu
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Sen Han
- Vaccine and Immunotherapy Center, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Lu Wan
- Vaccine and Immunotherapy Center, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Xiaochun Sun
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Huabiao Chen
- Vaccine and Immunotherapy Center, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Experimental Therapeutics and Molecular Imaging Laboratory, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA.
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34
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Larouzee E, Allegre L, Boudy AS, Ilenko A, Selleret L, Zilberman S, Owen C, Gligorov J, Richard S, Thomassin-Naggara I, Chabbert-Buffet N, Darai E, Bendifallah S. Predicting the likelihood of recurrence of pregnancy-associated breast cancer: Nomogram based on analysis of the French cancer network: Cancer Associé à La Grossesse. J Gynecol Obstet Hum Reprod 2020; 50:101766. [PMID: 32325267 DOI: 10.1016/j.jogoh.2020.101766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Pregnancy associated breast cancer (PABC) are defined as breast cancer diagnosed during pregnancy and during the year following delivery. The prediction of poor prognosis events (PPE) such as recurrence is a major medical challenge of management for women with PABC. The aim of this study was to build a nomogram based on selected clinical and histological variables to predict recurrence. STUDY DESIGN This retrospective study included 96 patients with PABC from January 2002 to January 2018. A multivariate Cox analysis of selected risk factors was performed and a nomogram to predict recurrence was built. The nomogram was internally validated. RESULTS The overall recurrence rate was 22% (21/95) and the 3-years recurrence rate was 13% (12/95). Age at diagnosis, histological type, immuno-histological class, tumor stage (TNM), node stage (TNM) were associated with PPE in univariate analysis, and were included in the final Cox model to develop the nomogram. The predictive model had a concordance index of 0.83 (95% Confidence Interval (CI), 0.81-0.85) and 0.78 (95% CI, 0.76-0.80) before and after the 200 repetitions of bootstrap sample corrections, respectively, and showed a good calibration. CONCLUSION Our results support the use of the present nomogram based on 5 clinical and pathological characteristics to predict PPE in PABC with a high concordance. External validation is required to recommend this nomogram in routine practice.
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Affiliation(s)
- Elise Larouzee
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France.
| | - Lucie Allegre
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Anna Ilenko
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Sonia Zilberman
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Clémentine Owen
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Joseph Gligorov
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Sandrine Richard
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Nathalie Chabbert-Buffet
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 Sorbonne University, Paris, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 Sorbonne University, Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 Sorbonne University, Paris, France
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35
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Bisphenol A induces focal adhesions assembly and activation of FAK, Src and ERK2 via GPER in MDA-MB-231 breast cancer cells. Toxicol In Vitro 2020; 66:104871. [PMID: 32325111 DOI: 10.1016/j.tiv.2020.104871] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
Abstract
Bisphenol A (BPA) is an industrial synthetic chemical used in the production of polycarbonate plastics and epoxy resins. Human exposition to BPA is primarily through eating food, and drinking liquids, because BPA can leach from polycarbonate plastic containers, beverage cans and epoxy resins. BPA induces proliferation and migration in human breast cancer cells. The G protein-coupled estrogen receptor (GPER) is a G protein-coupled receptor coupled with Gs proteins that is activated by estrogen and estrogenic compounds and it is the receptor for BPA. However, the signal transduction pathways that mediate migration via BPA/GPER in triple negative breast cancer (TNBC) cells has not been studied in detail. Here, we demonstrate that BPA induces an increase of GPER expression and activation of FAK, Src and ERK2, and an increase of focal adhesion assembly via GPER in TNBC MDA-MB-231 cells. Moreover, BPA induces FAK and ERK2 activation, focal adhesion assembly and migration via epidermal growth factor receptor (EGFR) transactivation. Collectively our data showed that BPA via GPER and/or EGFR transactivation induces activation of signal transduction pathways that mediate migration in TNBC MDA-MB-231 cells.
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Popnikolov N, Brzezinska K, Platoff RM, Binnebose R, Rothstein-Rubin R, Komarnicky LT, Woodworth A. Upregulation of Prolactin Receptor Expression and Activation of Prolactin Signaling in an Aggressive Triple-Negative Breast Carcinoma During Pregnancy: A Case Report. Clin Breast Cancer 2020; 20:e529-e539. [PMID: 32360085 DOI: 10.1016/j.clbc.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/07/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Nikolay Popnikolov
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA.
| | - Katarzyna Brzezinska
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Rebecca M Platoff
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - Rhonda Binnebose
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA
| | | | - Lydia T Komarnicky
- Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA
| | - Amanda Woodworth
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA
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Clinical Presentations of Breast Disorders in Pregnancy and Lactation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1252:33-39. [PMID: 32816260 DOI: 10.1007/978-3-030-41596-9_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The breast tissue undergoes significant physiological change during pregnancy and lactation. These changes can give rise to some unique disorders during pregnancy , puerperium and lactation or exaggerate pre-existing conditions. Clinical examination becomes less reliable due to textural change and density of breast tissue as a result of hormonal changes. The main symptoms during pregnancy and lactation are breast pain, mastitis, lactational abscess, breast lump, and blood- stained nipple discharge.Lactational mastitis/ abscess must be treated without delay. Open incision and drainage of lactational abscess is rarely required, any lactational abscess should be treated with appropriate antibiotics and ultrasound guided aspiration of the pus.Any breast lump during pregnancy and lactation should be investigated with triple assessment. Pregnancy associated breast cancer (PABC ) must be ruled out. The choice of investigations and treatment needs careful consideration. While ultrasound is the investigation of choice, mammography can be performed with abdominal shielding if malignancy is suspected. Core biopsy is necessary for evaluation of any breast pathology but it comes with risk of infection, bleeding, hematoma and even milk fistula.The treating clinical specialist must be aware of certain unusual unique clinical conditions in pregnancy and lactation including accessory axillary breast tissue, gigantomastia and Raynaud's phenomenon.
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Slocum E, Germain D. Collagen and PAPP-A in the Etiology of Postpartum Breast Cancer. Discov Oncol 2019; 10:137-144. [PMID: 31631239 DOI: 10.1007/s12672-019-00368-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/29/2019] [Indexed: 01/14/2023] Open
Abstract
Pregnancy has a dual effect on the risk of breast cancer. On one hand, pregnancy at a young age is known to be protective. However, pregnancy is also associated with a transient increased risk of breast cancer. For women that have children after the age of 30, the risk remains higher than women who never had children for decades. Involution of the breast has been identified as a window of mammary development associated with the adverse effect of pregnancy. In this review, we summarize the current understanding of the role of involution and describe the role of collagen in this setting. We also discuss the role of a collagen-dependent protease, pappalysin-1, in postpartum breast cancer and its role in activating both insulin-like growth factor signaling and discoidin domain collagen receptor 2, DDR2. Together, these novel advances in our understanding of postpartum breast cancer open the way to targeted therapies against this aggressive breast cancer sub-type.
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Affiliation(s)
- Elizabeth Slocum
- Department of Medicine, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, 10029, USA
| | - Doris Germain
- Department of Medicine, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, 10029, USA.
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Gooch JC, Chun J, Kaplowitz E, Guth A, Axelrod D, Shapiro R, Roses D, Schnabel F. Pregnancy-associated breast cancer in a contemporary cohort of newly diagnosed women. Breast J 2019; 26:668-671. [PMID: 31448522 DOI: 10.1111/tbj.13510] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/28/2019] [Accepted: 06/26/2019] [Indexed: 01/14/2023]
Abstract
Pregnancy-associated breast cancer (PABC) refers to breast cancer (BC) diagnosed during pregnancy, lactation, or in the postpartum period. There is evidence that PABC is associated with a poorer prognosis, and that the development of the disease is influenced by the unique hormonal milieu of pregnancy. The purpose of this study was to investigate the clinicopathologic characteristics associated with PABC in a contemporary cohort of women with newly diagnosed BC. Our institutional Breast Cancer Database was queried for women diagnosed with BC between 2009-2018 who had at least one full-term pregnancy (FTP). Variables of interest included patient demographics and clinical and tumor characteristics. PABC was defined as breast cancer diagnosed within 24 months of delivery. Statistical analyses included Pearson's chi-square and logistic regression. Out of a total of 2202 women, 46 (2.1%) had PABC. Median follow-up in the total cohort was 5.5 years. After adjusting for age at first FTP, PABC was associated with younger age at diagnosis, older age at first FTP, non-Caucasian race, BRCA positivity, presentation with a palpable mass, higher pathologic stage, higher histologic grade, and ER-negative and triple-negative receptor status. The association of PABC with non-Caucasian race may be reflected in the increased proportion of triple-negative breast cancers in the PABC group. PABC was also associated with older age at first FTP. As more women delay childbearing, risk for PABC may increase. Our findings suggest that women who become pregnant at older ages should be followed carefully during pregnancy and the postpartum period, especially if they are BRCA mutation carriers. The optimal approach for monitoring older women during pregnancy and the postpartum period is unclear.
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Affiliation(s)
- Jessica C Gooch
- Division of Breast Surgical Oncology, Department of Surgery, Perlmutter Cancer Center, New York University Langone Health, New York, New York.,Division of Breast Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Jennifer Chun
- Division of Breast Surgical Oncology, Department of Surgery, Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Elianna Kaplowitz
- Division of Breast Surgical Oncology, Department of Surgery, Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Amber Guth
- Division of Breast Surgical Oncology, Department of Surgery, Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Deborah Axelrod
- Division of Breast Surgical Oncology, Department of Surgery, Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Richard Shapiro
- Division of Breast Surgical Oncology, Department of Surgery, Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Daniel Roses
- Division of Breast Surgical Oncology, Department of Surgery, Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Freya Schnabel
- Division of Breast Surgical Oncology, Department of Surgery, Perlmutter Cancer Center, New York University Langone Health, New York, New York
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Wang B, Yang Y, Jiang Z, Zhao J, Mao Y, Liu J, Zhang J. Clinicopathological characteristics, diagnosis, and prognosis of pregnancy-associated breast cancer. Thorac Cancer 2019; 10:1060-1068. [PMID: 30920126 PMCID: PMC6500985 DOI: 10.1111/1759-7714.13045] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/24/2019] [Accepted: 02/24/2019] [Indexed: 12/03/2022] Open
Abstract
Background The aim of this study was to evaluate the characteristics, diagnosis, prognosis, and effective treatment modalities of pregnancy‐associated breast cancer (PABC). Methods From 1 January 2005 to 31 December 2015, 142 patients with PABC were identified in the Cancer Institute and Hospital of Tianjin Medical University database. The clinicopathological features, treatment methods, and outcomes were retrospectively evaluated. Results The median age at diagnosis was 30 years. All patients presented with a palpable mass in the breast. The sensitivity of ultrasound and mammography in PABC diagnosis was 86% and 83.3%, respectively, which increased to 91.3% when a combination of mammography and ultrasound was used. The median tumor size was 5.5 cm, and 63.1% of patients had associated axillary lymph node metastases. The proportions of ER negative, PR negative and HER2 positive were 45.7%, 45.7% and 30%, respectively. The five‐year overall survival (OS) and disease‐free survival (DFS) rates were 76.8% and 63.5%, respectively. According to univariate analysis, T stage, N stage, and HER2 status were significant prognostic factors for OS and DFS. The time interval between the onset of the first symptom and the first meeting with a health professional was also significant for OS. Multivariate analysis showed that T stage and HER2 status were independent prognostic risk factors for OS and DFS. Conclusion PABC is an aggressive form of breast cancer associated with advanced stage at diagnosis. Despite the existing difficulties in diagnosis, imaging examinations are indispensable. Early diagnosis and multidisciplinary therapy, including anti‐HER2 targeted therapy, may be important to improve prognosis.
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Affiliation(s)
- Bin Wang
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Second Department of Breast Cancer
| | - Yanfang Yang
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Second Department of Breast Cancer
| | - Zhansheng Jiang
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Department of Integrative Oncology
| | - Jing Zhao
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Department of Ultrasound Diagnosis & Treatment
| | - Yiran Mao
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Department of Ultrasound Diagnosis & Treatment
| | - Jun Liu
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Second Department of Breast Cancer
| | - Jin Zhang
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Third Department of Breast Cancer
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Zhou X, Li T, Chen Y, Zhang N, Wang P, Liang Y, Long M, Liu H, Mao J, Liu Q, Sun X, Chen H. Mesenchymal stem cell‑derived extracellular vesicles promote the in vitro proliferation and migration of breast cancer cells through the activation of the ERK pathway. Int J Oncol 2019; 54:1843-1852. [PMID: 30864702 DOI: 10.3892/ijo.2019.4747] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/14/2019] [Indexed: 11/06/2022] Open
Abstract
Mesenchymal stem cells (MSCs) have been demonstrated to be involved in tumor progression and the modulation of the tumor microenvironment, partly through their secretome. Extracellular vesicles (EVs) are membranous nanovesicles secreted by multiple types of cells and have been demonstrated to mediate intercellular communication in both physiological and pathological conditions. However, numerous questions still remain regarding the underlying mechanisms and functional consequences of these interactions. The purpose of this study was to investigate the effects of human umbilical cord mesenchymal stem cell‑derived EVs (hUC‑MSC‑EVs) on the proliferation, migration and invasion of human breast cancer cells. We successfully generated and identified hUC‑MSCs and hUC‑MSC‑EVs which were used in this study. The results revealed that treatment of the MDA‑MB‑231 and MCF‑7 human breast cancer cells with medium containing hUC‑MSC‑EVs significantly enhanced the proliferation, migration and invasion of the cells in vitro. Treatment of the cells with medium containing hUC‑MSC‑EVs also reduced E‑cadherin expression and increased N‑cadherin expression, thus promoting the epithelial‑mesenchymal transition (EMT) of the breast cancer cells. Treatment of the breast cancer cells with extracellular signal‑regulated kinase (ERK) inhibitor prior to the interaction with hUC‑MSC‑EVs significantly reversed the enhanced proliferation, migration and invasion, as well as the EMT of the breast cancer cells induced by the hUC‑MSC‑EVs. On the whole, these data indicate that hUC‑MSC‑EVs promote the invasive and migratory potential of breast cancer cells through the induction of EMT via the ERK pathway, leading to malignant tumor progression and metastasis. Taken together, the findings of this study suggest that targeting pathways to reverse EMT may lead to the development of novel therapeutic approaches with which to combat breast cancer.
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Affiliation(s)
- Xiaohe Zhou
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Tao Li
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Yufei Chen
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Nannan Zhang
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Pengli Wang
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Yingying Liang
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Melissa Long
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Haoran Liu
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Jian Mao
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Qiuyan Liu
- National Key Laboratory of Medical Immunology, Second Military Medical University, Shanghai 200433, P.R. China
| | - Xiaochun Sun
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Huabiao Chen
- Jiangsu Key Laboratory of Clinical Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
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Chemosensitivity, tumor infiltrating lymphocytes (TILs), and survival of postpartum PABC patients treated by neoadjuvant chemotherapy. Breast 2018; 42:61-67. [DOI: 10.1016/j.breast.2018.08.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 11/20/2022] Open
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43
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Differentiated thyroid cancer: Why does it affect predominantly women during the reproductive period and have higher incidence of mutual association with breast cancer? Med Hypotheses 2018; 122:5-7. [PMID: 30593422 DOI: 10.1016/j.mehy.2018.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/27/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022]
Abstract
Differentiated thyroid cancer (DTC) is markedly more common in women than men, and its occurrence and risk for poorer prognosis are associated with pregnancy. Further, it is known that there is a high frequency of co-occurrence of DTC and breast cancer. Although the underlying mechanisms that contribute to these phenomena are not entirely clear, 2 hypotheses are proposed here. First, human chorionic gonadotropin (hCG) produced by the placenta may be involved, since hCG has a similar function to stimulate the thyroid as thyroid-stimulating hormone (TSH), the latter of which is known to play a role in causing DTC and may promote breast cancer through the secretion of thyroid hormones (THs). Second, thyrotropin-releasing hormone (TRH), which is stimulated by suckling in the puerperal period, induces the secretion of not only TSH and thus indirectly THs, but also prolactin (PRL), which can accelerate the development of breast cancer. These hypotheses also explain the pregnancy-associated transient increase in breast cancer risk, while inhibition of estrogen by PRL may have a long-term preventive effect on breast cancer. Pregnancy-associated hyperthyroidism may also account for female preponderance of thyroid disease in general as well as tumors in organs that the thyroid hormone targets such as cardiac myxoma and diffuse-type gastric carcinoma.
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Pugh AM, Giannini CM, Pinney SM, Hanseman DJ, Shaughnessy EA, Lewis JD. Characteristics and diagnosis of pregnancy and lactation associated breast cancer: Analysis of a self-reported regional registry. Am J Surg 2018; 216:809-812. [PMID: 30270029 DOI: 10.1016/j.amjsurg.2018.07.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/25/2018] [Accepted: 07/14/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pregnancy-associated breast cancer (PABC) is the most common malignancy in pregnancy. However due to its infrequent occurrence, PABC continues to be poorly understood. METHODS We performed a retrospective study using self-reported data from 1079 eligible women in a regional breast cancer registry. RESULTS The PABC cases were more likely than non-PABCs to be younger than age 35 and have nodal involvement at diagnosis. Despite diagnosis at a young age, there was not an association between PABC and family history. For method of diagnosis, PABC was found on self-exam, while non-PABCs were found on mammography. CONCLUSION In conclusion, PABC is rarely detected by mammography and diagnosis is highly dependent on detection during self-breast exam. Women who are or recently were pregnant should be encouraged to perform regular self-breast exams to report any changes for further evaluation. Patient and clinician education regarding risk and realities of PABC is essential.
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Affiliation(s)
- Amanda M Pugh
- Department of Surgery Division of Research, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, United States.
| | - Courtney M Giannini
- University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, United States
| | - Susan M Pinney
- Department of Environmental Health, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, United States
| | - Dennis J Hanseman
- Department of Surgery Division of Research, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, United States
| | - Elizabeth A Shaughnessy
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, United States
| | - Jaime D Lewis
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, United States
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45
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Yadamani S, Neamati A, Homayouni-Tabrizi M, Beyramabadi SA, Yadamani S, Gharib A, Morsali A, Khashi M. Treatment of the breast cancer by using low frequency electromagnetic fields and Mn(II) complex of a Schiff base derived from the pyridoxal. Breast 2018; 41:107-112. [DOI: 10.1016/j.breast.2018.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/07/2018] [Accepted: 07/07/2018] [Indexed: 12/21/2022] Open
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46
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Locally advanced cervical cancer complicating pregnancy: A case of competing risks from the Catholic University of the Sacred Heart in Rome. Gynecol Oncol 2018; 150:398-405. [PMID: 30126588 DOI: 10.1016/j.ygyno.2018.06.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A case of stage IB2 cervical cancer at 27 weeks of pregnancy, treated with neoadjuvant chemotherapy followed by radical Cesarean hysterectomy with full pelvic and infra-mesenteric lymphadenectomy, and adjuvant chemo-radiation is described. While she remains without disease, her baby was diagnosed with acute myelogenous leukemia. We highlight the pre-operative work-up, treatment options, safety, feasibility, and outcomes for the mother and her fetus.
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47
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Zhang S, Fei F, Wang H, Gu Y, Li C, Wang X, Zhao Y, Li Y. Stromal immunoglobulin κC expression is associated with initiation of breast cancer in TA2 mice and human breast cancer. Cancer Sci 2018; 109:1825-1833. [PMID: 29683229 PMCID: PMC5989835 DOI: 10.1111/cas.13620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/07/2018] [Accepted: 04/12/2018] [Indexed: 12/11/2022] Open
Abstract
The initiation of spontaneous breast cancer (SBC) in Tientsin Albino 2 (TA2) mice is related to mouse mammary tumor virus (MMTV) infection, and MMTV amplification is hormonally regulated. To explore the insertion site of MMTVLTR in TA2 mouse genome, reverse PCR and nested PCR were used to amplify the unknown sequence on both sides of the MMTV‐LTRSAG gene in SBC and normal breast tissue of TA2 mice. Furthermore, the clinicopathological significance of the insertion site was evaluated in 43 samples of normal breast tissue, 46 samples of breast cystic hyperplasia, 54 samples of ductal carcinoma in situ, 142 samples of primary breast cancer and 47 samples of lymph node metastatic breast cancer by RNA in situ hybridization. We confirmed that the insertion site of the MMTV‐LTRSAG gene was located between Igκv2‐112 and Igκv14‐111 in chromosome 6 of TA2 mouse. IGκC was localized in the stromal cells of TA2 mouse with SBC and in human breast cancer tissues. Tumor cells were negative for IGκC in RNA in situ hybridization. The positive staining index of IGκC in stromal cells was the highest in lymph node metastatic breast cancer, followed by primary breast cancer, ductal carcinoma in situ, and breast cystic hyperplasia. Furthermore, the positive staining index of IGκC was related to the expression of ER, PR, HER2 and Ki‐67. Our findings showed that stromal IGκC expression was associated with the initiation of SBC in TA2 mice. IGκC may be a high‐risk factor for the initiation and progression of human breast cancer.
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Affiliation(s)
- Shiwu Zhang
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China
| | - Fei Fei
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China.,Nankai University School of Medicine, Nankai University, Tianjin, China
| | - Hua Wang
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China
| | - Yanjun Gu
- Department of Pathology, Affiliated Hospital of Logistic University of People's Armed Police Force, Tianjin, China
| | - Chunyuan Li
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China.,Nankai University School of Medicine, Nankai University, Tianjin, China
| | - Xinlu Wang
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China.,Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yongjie Zhao
- Department of General Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Yuwei Li
- Departments of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
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Martínez MT, Bermejo B, Hernando C, Gambardella V, Cejalvo JM, Lluch A. Breast cancer in pregnant patients: A review of the literature. Eur J Obstet Gynecol Reprod Biol 2018; 230:222-227. [PMID: 29728277 DOI: 10.1016/j.ejogrb.2018.04.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 12/12/2022]
Abstract
Breast cancer diagnosed during pregnancy is a rare occurrence at present; however, in recent years a trend towards delayed childbirth is generating an increase in its incidence. This situation requires a multidisciplinary approach involving obstetricians, oncologists and surgeons. In this review we analyse diagnostic methods, different possible treatments and long-term patient prognosis. We conducted a search for articles published in PubMed, or in abstract form from the San Antonio Breast Cancer Symposium (SABCS), the European Society for Medical Oncology (ESMO), and the American Society of Clinical Oncology (ASCO) annual meeting, using the search terms: "Breast cancer and pregnancy". Breast cancer occurring during pregnancy requires extra effort to offer patients the best multidisciplinary management. There is no difference in the pathology-based classification, but breast cancer during pregnancy seems to be associated with different patterns of gene expression. Chemotherapy and surgery are generally safe and well-tolerated by patients during the second and third trimesters of pregnancy. The poorer prognosis could be attributed mainly to a delay in diagnosis and because breast cancer in young patients is a more aggressive disease. Finally, balancing the health of mother and child must be paramount.
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Affiliation(s)
- María Teresa Martínez
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, University of Valencia, The Centre of Networked Biomedical Cancer Research (CIBERONC), Spain.
| | - Begoña Bermejo
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, University of Valencia, The Centre of Networked Biomedical Cancer Research (CIBERONC), Spain
| | - Cristina Hernando
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, University of Valencia, The Centre of Networked Biomedical Cancer Research (CIBERONC), Spain
| | - Valentina Gambardella
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, University of Valencia, The Centre of Networked Biomedical Cancer Research (CIBERONC), Spain
| | - Juan Miguel Cejalvo
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, University of Valencia, The Centre of Networked Biomedical Cancer Research (CIBERONC), Spain
| | - Ana Lluch
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, University of Valencia, The Centre of Networked Biomedical Cancer Research (CIBERONC), Spain
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Boudy AS, Naoura I, Selleret L, Zilberman S, Gligorov J, Richard S, Thomassin-Naggara I, Chabbert-Buffet N, Ballester M, Bendifallah S, Darai E. Propensity score to evaluate prognosis in pregnancy-associated breast cancer: Analysis from a French cancer network. Breast 2018; 40:10-15. [PMID: 29665447 DOI: 10.1016/j.breast.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To compare the prognosis of pregnancy associated breast cancer occurring during pregnancy (BCP) to non-pregnancy associated breast cancers (non-BCP) in young women managed at a national expert center. METHODS Retrospective cohort study of a prospective database using propensity score matching (PSM) analysis with known prognostic factors. RESULTS We analyzed data of 49 patients with BCP and 104 with non-BCP diagnosed between 2002 and 2017 at Tenon University Hospital (Paris, France). The BCP tumors were often locally advanced (lymph node metastases in 59%), of high grade (55%) and highly proliferative (67% with Ki67 ≥ 20%). After PSM, breast cancer-free survival (p = 0.45) and breast cancer specific survival (p = 0.81) were similar in the two groups. The recurrence rate was 12% vs 18% (p = 0.45) and the death rate was 6% vs 8% (p = 0.74) for the BCP and non-BCP groups, respectively. No difference in recurrence type was observed between the groups (p = 0.60). CONCLUSIONS After PSM for known prognostic factors, the prognosis of BCP patients did not differ from that of young patients with non-BCP.
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Affiliation(s)
- Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France.
| | - Iptissem Naoura
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Sonia Zilberman
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Joseph Gligorov
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Sandrine Richard
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Nathalie Chabbert-Buffet
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 4. Faculté de Médecine Sorbonne Université, France
| | - Marcos Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 4. Faculté de Médecine Sorbonne Université, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 4. Faculté de Médecine Sorbonne Université, France
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Polivka J, Altun I, Golubnitschaja O. Pregnancy-associated breast cancer: the risky status quo and new concepts of predictive medicine. EPMA J 2018. [PMID: 29515683 DOI: 10.1007/s13167-018-0129-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The paper is motivated by severe concerns regarding currently applied care of the pregnancy-associated breast cancer (PABC) characterised by particularly poor outcomes of the disease. Psychological and ethical aspects play a crucial role in PABC: the highest priority not to damage the foetus significantly complicates any treatment generally, and it is quite usual that patients disclaim undergoing any breast cancer treatment during pregnancy. Although, due to global demographic trends, PABC is far from appearing rarely now, severe societal and economic consequences of the disease are still neglected by currently applied reactive medical approach. These actualities require creating new strategies which should be better adapted to the needs of the society at large by advancing the PABC care based on predictive diagnostic approaches specifically in premenopausal women, innovative screening programmes focused on young female populations, targeted prevention in high-risk groups, and optimised treatment concepts. The article summarises the facts and provides recommendations to advance the field-related research and medical services specifically dedicated to the PABC care.
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Affiliation(s)
- Jiri Polivka
- 1Department of Histology and Embryology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
- 2Biomedical Centre, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - Irem Altun
- 3CEMBIO, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Olga Golubnitschaja
- 4Radiological Clinic, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str 25, 53105 Bonn, Germany
- 5Breast Cancer Research Centre, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
- 6Centre for Integrated Oncology, Cologne-Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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