Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease

Hormone-associated dietary patterns and premenopausal breast cancer risk

PURPOSE

Circulating levels of sex steroid hormones have previously been associated with premenopausal breast cancer risk. Few studies have considered the association between dietary patterns and premenopausal hormone levels. Our objective was to derive dietary patterns associated with premenopausal hormone levels and investigate the association between pattern scores and premenopausal breast cancer risk.

METHODS

Using reduced rank regression among a subset of participants from the Nurses' Health Study II (NHSII) (n = 8,962), we identified dietary patterns correlated with premenopausal levels of five sex steroid hormones measured in the follicular and luteal phases. Then, in the full NHSII cohort (n = 90,341), we used Cox proportional hazards models to calculate hazard ratios (HRs) for breast cancer risk associated with each dietary pattern score.

RESULTS

Dietary patterns were identified for luteal estradiol, luteal free estradiol, follicular estrone, luteal estrone, and free testosterone. However, these patterns explained a low percent variation in individual hormone levels, ranging from 2.5-4.1%. During 24 years of follow-up, 1,956 premenopausal breast cancer cases were ascertained. Dietary patterns associated with luteal free estradiol (HR for fifth versus first quintile = 1.29; 95% CI = 1.11-1.49; Ptrend < 0.01) and follicular estrone (HR for fifth versus first quintile = 1.28; 95% CI = 1.10-1.49; Ptrend < 0.01) were positively associated with premenopausal breast cancer risk.

CONCLUSION

Our findings indicate that while some dietary factors may marginally influence premenopausal hormone levels, the relation between sex steroid hormones and premenopausal breast cancer risk is likely not driven by diet. Future studies should consider other mechanisms through which diet may impact breast cancer risk, including inflammatory processes.

Incidence trends of early-onset breast cancer by lifestyle risk factors

BACKGROUND

The incidence of early-onset breast cancer (< 50 years) has been increasing over the past decades with the role of modifiable, lifestyle-related risk factors remaining mostly unidentified.

METHODS

To investigate the role of key lifestyle factors in the incidence trends of early-onset breast cancer (EOBC), we pooled data from six health studies in Finland in 1972-2015 and combined them with breast cancer data from the Finnish Cancer Registry. The cohort consisted of 56,253 women with 397 EOBCs. The effects of risk factors (hazard ratios) on EOBC and average annual percent change (AAPC) of incidence were estimated using Poisson regression models.

RESULTS

The highest annual increase in age-standardized incidence was observed among women aged 40-49 who were overweight (AAPC 4.0%, 95% CI 0.5-7.7%), currently smoking (AAPC 3.3%, 95% CI 0.1-6.6%) or moderately physically active (AAPC 2.9%, 95% CI 0.3-5.6%).

CONCLUSIONS

The increase in early-onset breast cancer incidence was highest among women aged 40-49 who were overweight, currently smoking, or moderately physically active, while no change by risk factors was found in women under 40 years of age. Our findings suggest a different type of cancer process in young adults and highlight the importance of lifestyle risk factors in the incidence of EOBC.

Human Cytomegalovirus Infection and Breast Cancer: A Literature Review of Clinical and Experimental Data

Breast cancer (BC) remains a significant global health challenge, highlighting the need for continued research into novel risk factors, diagnostic approaches, and personalized treatments. Among emerging risk factors, viral infections have been implicated as potential contributors to breast carcinogenesis and BC progression. Recent evidence suggests that specific oncogenic strains of human cytomegalovirus (HCMV) may have the capacity to transform human mammary epithelial cells. This review assesses clinical data regarding HCMV presence in both tumor and non-tumor breast tissues, examining the role of HCMV oncoproteins in BC development and progression. Current findings indicate a higher prevalence of HCMV infection in breast carcinomas compared to non-tumor tissues, associated with an elevated risk of BC. Additionally, the HCMV-driven breast carcinogenesis model proposed here suggests that HCMV oncoproteins may activate multiple oncogenic pathways, fostering cell proliferation, survival, and tumor development. A deeper understanding of the role of HCMV in BC could enhance risk stratification and support the creation of targeted therapeutic strategies.

Genetic and epigenetic alterations in night shift nurses with breast cancer: a narrative review

This narrative review explores the link between breast cancer and night shift work in nurses, focusing on genetic and epigenetic factors. Breast cancer disproportionately affects women globally, and night shift work is increasingly recognized as a potential risk factor. Nurses who work consecutive overnight shifts face elevated risks due to disruptions in their circadian rhythms. Studies suggest that working six or more successive night shifts, particularly over five years or more, may increase breast cancer risk. This review hypothesizes that disruptions in the sleep-wake cycle, such as changes in melatonin production and telomere length, could contribute to breast cancer susceptibility. Currently, there is limited genetic evidence to support this hypothesis. However, it is plausible that genetic and epigenetic alterations, including changes in genes like ER and HER2, may heighten the risk for night shift nurses. These alterations may involve variations in telomere length, DNA methylation, and disruptions in critical breast cancer-related genes. We highlight various genetic and epigenetic changes that may influence this increased susceptibility. Further research is needed to explore the underlying mechanisms and contributing factors in this association.

A narrative review on alcohol use in women: insight into the telescoping hypothesis from a biopsychosocial perspective

Background: There has been a dramatic rise in alcohol consumption and alcohol use disorder (AUD) among women. Recently, the field has made substantial progress toward better understanding sex and gender differences in AUD. This research has suggested accelerated progression to AUD and associated health consequences in women, a phenomenon referred to as "telescoping."Objective: To examine evidence for the telescoping hypothesis from a biopsychosocial perspective.Methods: This narrative review examined and integrated research on biological, psychological, and socio-environmental factors that may contribute to the development and progression of AUD in women.Results: Biopsychosocial research has revealed sex- and gender-specific risk factors and pathways to AUD onset and progression. Biological sex differences render females more vulnerable to alcohol-related toxicity across various biological systems, including the brain. Notably, sex and gender differences are consistently observed in the neural circuitry underlying emotional and stress regulation, and are hypothesized to increase risk for an internalizing pathway to AUD in women. Psychological research indicates women experience greater negative emotionality and are more likely to use alcohol as a means to alleviate negative emotions compared with men. Socio-environmental factors, such as familial and peer isolation, appear to interact with biological and psychological processes in a way that increases risk for negative emotionality and associated alcohol use in women.Conclusion: There appears to be a complex interplay of biopsychosocial factors that increase risk for AUD onset and progression in women through an internalizing pathway. Developing targeted interventions for women with AUD that specifically target internalizing processes is critical.

Do Salivary Cullin7 Gene Expression and Protein Levels Provide Advantages over Plasma Levels in Diagnosing Breast Cancer?

In addition to the tumor suppressor role of Cullin 7 (Cul7), one of the proteins belonging to the Cullin (Cul) family, studies have also suggested that Cul7 may act as an oncogene under certain conditions. The role of the Cul7 molecule in breast cancer is still unclear, and understanding its function could have significant implications for identifying novel therapeutic targets or improving diagnostic strategies in breast cancer management. In this study, the levels of the Cul7 molecule in plasma and noninvasive material saliva were investigated, and its possibility as a marker for breast cancer was discussed. Protein levels of blood and saliva samples taken from breast cancer patients and a healthy control group were measured by the ELISA (Enzyme-Linked Immunosorbent Assay) method. Gene expression levels between the two groups were analyzed by the qPCR (quantitative Polymerase Chain Reaction) method. In our study, Cul7 mRNA and protein expression levels were examined in 60 breast cancer patients and 20 healthy female controls, and a statistically insignificant difference was found between the patient and control groups in both plasma and saliva samples (p > 0.05). No correlation was found between the clinical characteristics of the patients and plasma and saliva Cul7 gene expression and protein levels (p > 0.05). Considering the possibility of Cul7 being a biomarker at the protein and mRNA levels, plasma is thought to be a better study material for Cul7. Our findings suggest that in the context of a study on salivary material, the expression of Cul7 at the mRNA level may have better potential utility as a biomarker.

The prevalence of anxiety symptoms/disorders in cancer patients: a meta-analysis

OBJECTIVE

Cancer can have negative effects on mental health. The aim of this study was to investigate the prevalence of anxiety symptoms/disorders in cancer patients' worldwide using meta-analysis.

METHODS

The study population was cancer patients who had cancer at the time of the study. The outcome studied in this study was anxiety symptoms/disorders. PubMed and Scopus were searched based on the syntax of keywords, this search was limited to articles published in English until September 2021. For this meta-analysis, data on the prevalence of anxiety were first extracted for each of the eligible studies. The random-effects method was used for the pool of all studies. Subgroup analysis was performed based on sex, anxiety disorders, cancer site, and continents. Heterogeneity in the studies was also assessed.

RESULT

After evaluating and screening the studies, eighty-four studies were included in the meta-analysis. Prevalence of anxiety symptoms/disorders in cancer patients showed that this prevalence is 23% (I2 = 99.59) in the 95% confidence interval between 22-25%. This prevalence was 20% (I 2 = 96.06%) in the 95% confidence interval between 15-24% in men and this prevalence is 31% (I 2 = 99.72%) in the 95% confidence interval between 28-34% in women. The highest prevalence of anxiety was in patients with ovarian, breast, and lung cancers.

DISCUSSION

It showed a high prevalence of anxiety symptoms/disorders in cancer patients, in addition to therapeutic interventions for cancer, the necessary interventions should be made on the anxiety of these patients. Methodological limitation was the heterogeneity between the studies included in the meta-analysis. Some types of cancer sites could not be studied because the number of studies was small or the site of cancer was not identified.

A 14-Year Analysis of Breast Cancer Risk Factors and Its Determinants of Mortality in Rural Southwestern Nigeria

Background

Research on breast cancer risk factors and mortality is gaining recognition and attention globally; there is need to add more information on its determinants among patients admitted in hospital. Some studies on risk factors and mortality of breast cancer in Nigeria hospitals conducted in the urban and suburban areas have been documented. Therefore, an addition of a study conducted in the setting of a rural health institution is necessary. This study assessed the risk factors and determinants of mortality among patients admitted for breast cancer in rural Southwestern Nigeria.

Methods

A retrospective observational study was conducted on 260 patients who were admitted for breast cancer between January 2010 and December 2023 using a data form and a standardized information form. The data were analyzed using SPSS version 22.0. The risk factors and the determinants of mortality of patients with breast cancer were identified using multivariate regression model.

Results

The breast cancer risk factors were old age, family history, tobacco smoking, combined oral contraceptives, and hormonal therapy use. The case fatality rate was 38.1%, and its determinants of mortality were patients who were older (adjusted odds ratio [AOR], 1.956; 95% confidence interval [CI]:1.341-4.333), obese (AOR, 2.635; 95% CI: 1.485-6.778), stage IV (AOR, 1.895; 95% CI: 1.146-8.9742), mastectomy (AOR, 2.512; 95% CI: 1.003-6.569), discontinued adjuvant chemotherapy (AOR, 1.785; 95% CI: 1.092-4.6311), and yet to commence adjuvant chemotherapy (AOR, 2.568; 95% CI: 1.367-5.002).

Conclusion

The study revealed that patients with breast cancer were associated with high mortality. Sustained health education to promote early diagnosis, managed co-morbidities, and access to treatment may contribute to reduction in breast cancer mortality in rural Nigeria.

Quality of Life of Breast Cancer Women under Treatment at a Tertiary Care Center of Western Maharashtra

Background

'Breast cancer' the most common cancer amongst females in India. Having good Quality of life (QoL) among the patients undergoing treatment is one of the vital and significant factors for ensuring holistic approach to treatment and well-being of cancer patients. The present study was conducted to assess the QoL and its determinants among breast cancer patients undergoing treatment at a tertiary care institute in western Maharashtra.

Material and Methodology

300 histopathologically confirmed breast cancer patients undergoing treatment at a tertiary care centre were divided into three groups to include 100 patients in each group. Group 1 (patients with duration of treatment 1 to 2 years) Group 2 (patients with duration of treatment 2 to 5 years) and Group 3 (more than 5 years). Validated tool Function Assessment of Cancer Therapy Breast specific (FACT-B) questionnaire was used to collect information on QoL and analysed using appropriate statistical tests.

Results

Mean age of patients was 53.2 + 10.08 years, 136 (45.33%) were from age group 51 to 65 years. Majority of the patients 106 (35.33%) were educated till secondary schooling and 172 (57.33 %) were belonging to the middle-upper class. Lump in breast was most common presenting symptom in 235 (78.33%) cases followed by nipple retraction. 275 (91.67 %) cases had infiltrating ductal Carcinoma and 144 (48%) patents were in Stage II cancer. Over all mean FACT-B score for QoL was 104.02 + 18.65 out of 141. Mean FACT-B score for Group 1, Group 2 and Group 3 was 88.18 +17.20, 105.89 + 11.78 and 118.28 + 12.45 respectively with (p< 0.05), suggests significant improvement in QoL with increase in time elapsed since treatment.

Conclusion

Socio-demographic factors, type of surgery and duration of treatment had significant effect on QoL among breast cancer patients. Apropos physicians, paramedic staff and domestic care givers need to be sensitised on importance of QoL for collective and deliberate efforts to achieve holistic care. QoL can be made integral part of breast cancer treatment and management policy or programme.

Network meta-analysis evaluating the impact of diverse exercise regimens on quality of life in women post-breast cancer surgery

BACKGROUND

This study used network meta-analysis to compare the effects of various exercise interventions, with the aim of identifying the most effective intervention measures.

METHODS

Data were extracted from 8 databases, comprising of PubMed, Web of Science, EBSCO, and Embase. The Cochrane risk of bias assessment tool was used to assess the quality of the research. Network meta-analysis and meta-analysis were performed using STATA15.0 and Review Manager 5.4, respectively.

RESULTS

This analysis incorporated 58 research papers that had 4998 participants, of which 2480 were assigned to the test group and 2518 to the control group. As revealed by the data, the following is a descending order of the impact of various exercise regimens on the quality of life (QoL) of women who have undergone breast cancer surgery: For the MOS item short form health survey, the recommended sequence was as follows: aerobic + resistance exercise, football, baduanjin, walking, tai chi, yoga, resistance exercise, slow-moving qigong, aerobic exercise, and usual care; for functional assessment of cancer therapy for breast cancer, the sequence was as follows: aerobic + resistance exercise, resistance exercise, relaxation, baduanjin, square dance, aerobic exercise, tai chi, yoga, Pilates, mixer dance, aquatic sports, cycle ergometer, and usual care; and for European Organization for Research and Treatment of Cancer quality of life questionnaire, the sequence was aerobic + resistance exercise, aerobic + yoga, aerobic exercise, Pilates, yoga, muscle strengthening, resistance exercise, square dance, usual care, walking, and aerobic + edema massage.

CONCLUSION

The majority of exercise interventions demonstrated a discernible impact on the QoL in women following breast cancer surgery. The effects of diverse exercise interventions on the 3 QoL outcome indicators in patients with breast cancer exhibited variability. However, irrespective of the QoL measurement technique used, aerobic and resistance exercise continue to be the most favorable choices.

Exposure to second-hand smoke and breast cancer risk in non-smoking women: a comprehensive systematic review and meta-analysis

Through the use of an innovative method to identify original publications, we conducted a meta-analysis of all epidemiological studies evaluating the association between second-hand smoke (SHS) exposure and breast cancer risk among female non-smokers published in English up to October 2022. Pooled relative risks (RR) were obtained through the use of random-effects models. Dose-response relationships were derived using log-linear functions. Out of 73 identified eligible studies, 63 original articles were included in the meta-analysis. The pooled RR for breast cancer for overall exposure to SHS was 1.24 (95% confidence interval, CI, 1.15-1.34, number of articles, n = 52). Regarding the setting of exposure, RRs were 1.17 (95% CI 1.08-1.27, n = 37) for SHS exposure at home, 1.03 (95% CI 0.98-1.08, n = 15) at the workplace, 1.24 (95% CI 1.11-1.37, n = 16) at home or workplace, and 1.45 (95% CI 1.16-1.80, n = 13) for non-specified settings. The risk of breast cancer increased linearly with higher duration (RR 1.29; 95% CI 1.04-1.59 for 40 years of SHS exposure, n = 12), intensity (RR 1.38; 95% CI 1.14-1.67 for 20 cigarettes of SHS exposure per day, n = 6), and pack-years (RR 1.50; 95% CI 0.92-2.45 for 40 SHS pack-years, n = 6) of SHS exposure. This meta-analysis shows a statistically significant excess risk of breast cancer in women exposed to SHS.

Breast cancer risk reduction: Beyond pharmacologic intervention

Breast cancer and cardiovascular disease share common risk factors, and are responsible for significant morbidity and mortality in women in North America. Nonpharmacologic approaches such as lifestyle modifications can decrease this risk but may be constrained by social determinants of health.

Ranking of Modifiable Lifestyle Risk Factors for Breast Cancer in Saudi Women: Population Attributable Risk and Nomogram

Purpose

Breast cancer is the most common cancer among women in the Saudi Arabia, and over 50% of the cases are detected at a late stage. This study aimed to estimate population attributable risk percentage (PAR%) of modifiable lifestyle risk factors for breast cancer in Saudi Arabia.

Patients and Methods

A secondary analysis of previously published papers was performed . Relative risks (RR) and odds ratios (OR) were obtained from published international epidemiological studies, and the prevalence of each risk factor in Saudi Arabia was obtained from various sources (eg, national surveys and published literature) to calculate PAR%. A nomogram was used to visually translate the RRs/ORs and their prevalence into PAR% using a practical tool.

Results

Seven modifiable lifestyle risk factors for breast cancer were identified in Saudi Arabia. The identified risk factors included lack of physical activity (sedentary lifestyle), oral contraception (current use), obesity (postmenopausal), hormone replacement therapy (current use), passive smoking, age at first birth (≥ 35 years), and tobacco smoking (current or daily smoking). The PAR% for these risk factors ranged from 0.5% for tobacco smoking to 23.1% for a lack of physical activity. Few modifiable lifestyle risk factors were excluded from this study, due to limited nor unavailable data in Saudi Arabia (eg, alcohol consumption, breastfeeding patterns and childbearing patterns, obesity according to menopausal status, and night-shift work).

Conclusion

Physical inactivity has the most significant modifiable health impact and is a major risk factor for breast cancer. Removing this risk factor would reduce the prevalence of breast cancer in the Saudi population by 23%. There is an immense need to prioritize cancer control strategies based on local needs, current data on cancer risk factors, and the disease burden.

Pregnancy, abortion, and birth control methods' complicity with breast cancer occurrence

Reproductive factors play significantly important roles in determining the breast cancer (BC) risk. The impact of pregnancy, abortion, and birth control methods on tumor development remains unclear. It has been found that early full-term pregnancies in young women can lower their lifetime risk of developing the type of cancer in question. However, having a first full-term pregnancy at an older age can increase this risk. The relationship between pregnancy and breast cancer (BC) is, however, much more complicated. Both induced and spontaneous abortions lead to sudden changes in hormonal balance, which could cause different effects on sensitive breast epithelial cells, making abortion a potential risk factor for breast cancer. The influence of hormonal contraception on carcinogenesis is not comprehensively understood, and therefore, more exhaustive analysis of existing data and further investigation is needed. This review explores how the mentioned reproductive factors affect the risk of breast cancer (BC), focusing on the molecular mechanisms that contribute to its complexity. By comprehending this intricate network of relationships, we can develop new strategies for predicting and treating the disease.

Nutrition Intervention and Microbiome Modulation in the Management of Breast Cancer

Breast cancer (BC) is one of the most common cancers worldwide and a leading cause of cancer-related deaths among women. The escalating incidence of BC underscores the necessity of multi-level treatment. BC is a complex and heterogeneous disease involving many genetic, lifestyle, and environmental factors. Growing evidence suggests that nutrition intervention is an evolving effective prevention and treatment strategy for BC. In addition, the human microbiota, particularly the gut microbiota, is now widely recognized as a significant player contributing to health or disease status. It is also associated with the risk and development of BC. This review will focus on nutrition intervention in BC, including dietary patterns, bioactive compounds, and nutrients that affect BC prevention and therapeutic responses in both animal and human studies. Additionally, this paper examines the impacts of these nutrition interventions on modulating the composition and functionality of the gut microbiome, highlighting the microbiome-mediated mechanisms in BC. The combination treatment of nutrition factors and microbes is also discussed. Insights from this review paper emphasize the necessity of comprehensive BC management that focuses on the nutrition-microbiome axis.

Biogenic nanoparticles: pioneering a new era in breast cancer therapeutics-a comprehensive review

Breast cancer, a widespread malignancy affecting women globally, often arises from mutations in estrogen/progesterone receptors. Conventional treatments like surgery, radiotherapy, and chemotherapy face limitations such as low efficacy and adverse effects. However, nanotechnology offers promise with its unique attributes like targeted delivery and controlled drug release. Yet, challenges like poor size distribution and environmental concerns exist. Biogenic nanotechnology, using natural materials or living cells, is gaining traction for its safety and efficacy in cancer treatment. Biogenic nanoparticles synthesized from plant extracts offer a sustainable and eco-friendly approach, demonstrating significant toxicity against breast cancer cells while sparing healthy ones. They surpass traditional drugs, providing benefits like biocompatibility and targeted delivery. Thus, this current review summarizes the available knowledge on breast cancer (its types, stages, histopathology, symptoms, etiology and epidemiology) with the importance of using biogenic nanomaterials as a new and improved therapy. The novelty of this work lies in its comprehensive examination of the challenges and strategies for advancing the industrial utilization of biogenic metal and metal oxide NPs. Additionally; it underscores the potential of plant-mediated synthesis of biogenic NPs as effective therapies for breast cancer, detailing their mechanisms of action, advantages, and areas for further research.

Therapeutic perspectives on PDE4B inhibition in adipose tissue dysfunction and chronic liver injury

INTRODUCTION

Chronic liver disease (CLD) is a complex disease associated with profound dysfunction. Despite an incredible burden, the first and only pharmacotherapy for metabolic-associated steatohepatitis was only approved in March of this year, indicating a gap in the translation of preclinical studies. There is a body of preclinical work on the application of phosphodiesterase 4 inhibitors in CLD, none of these molecules have been successfully translated into clinical use.

AREAS COVERED

To design therapies to combat CLD, it is essential to consider the dysregulation of other tissues that contribute to its development and progression. As such, proper therapies must combat this throughout the body rather than focusing only on the liver. To detail this, literature characterizing the pathogenesis of CLD was pulled from PubMed, with a particular focus placed on the role of PDE4 in inflammation and metabolism. Then, the focus is shifted to detailing the available information on existing PDE4 inhibitors.

EXPERT OPINION

This review gives a brief overview of some of the pathologies of organ systems that are distinct from the liver but contribute to disease progression. The demonstrated efficacy of PDE4 inhibitors in other human inflammatory diseases should earn them further examination for the treatment of CLD.

Breast cancer mortality in Chinese women and men from 1990 to 2019: Analysis of trends in risk factors

OBJECTIVE

This study aimed to examine the relative risk of risk factor in male and female breast cancer (BC) deaths in China and analyzed the changing trends in BC mortality rates from 1990 to 2019.

METHODS

Open data from the Global Burden of Disease database from 1990 to 2019 were analyzed to assess the number of BC deaths and age-standardized mortality rates (ASMR) in China. The age-period-cohort model was employed to study age effects, period effects, cohort effects, as well as local drift and net drift of the data, determining the impact of changing risk factors on crude mortality rates and ASMR of BC.

RESULTS

In 2019, the number of BC deaths across all age groups in China increased by 130.38% compared to 1990, with an increase of 125.68% in females and 648.80% in males. The ASMR for BC and male BC increased in 2019, while female BC ASMR declined. Overall, alcohol consumption and smoking as risk factors contributed to increased mortality rates of BC with advancing age. Over the entire study period, the net drift of alcohol consumption in females for BC was 0.06% (95% confidence interval [CI]: -0.24% to 0.36%), while for smoking it was -0.64% (95% CI: -0.83% to -0.45%). For males, the net drift of alcohol consumption for BC was 6.75% (95% CI: 5.55% to 7.96%), and for smoking, it was 6.09% (95% CI: 2.66% to 9.64%).

CONCLUSION

Hence, improving awareness of BC-related risk factors and implementing prevention strategies are necessary to alleviate future BC burdens.

Dietary patterns, cooking methods and breast cancer risk in Mexico: An exploratory case-control study

Background: Nutrition has an important influence on the risk of developing breast cancer (BC). Dietary patterns can capture the complex interplay of nutrients and cooking methods can contribute to the presence of heterocyclic amines, which are potent mammary carcinogens. Research on dietary patterns, cooking methods, and their association with BC in Mexican women is scarce. Aim: To evaluate the association of dietary patterns and cooking methods with BC risk among women from the Northwest region of Mexico. Methods: This case-control study included 120 women. Eligible cases (n = 60) were diagnosed and biopsy-confirmed in the past 2 years. Control subjects (n = 60) were hospital and population-based. Dietary intake and cooking methods were respectively assessed through a food frequency questionnaire (FFQ) and the National Cancer Institute survey. We obtained dietary patterns from a K-means cluster analysis (CA), and multivariate logistic regression tested the association of dietary patterns and cooking methods with BC risk. Results: Prudent and caloric dietary patterns were identified. The caloric pattern was associated with BC risk (Model 1: ORadj: 5.07, 95%CI:1.44-17.84, p = 0.011; Model 2: ORadj: 4.99 (95%CI:1.39-17.92, p = 0.014). Intense frying, meat grilling and poultry resulted in a significant BC risk (Model 1: ORadj: 5.54,95%CI: 2.13-14.41), p < 0.001; Model 2: ORadj: 5.12, 95%CI: 1.83-14.31, p = 0.002). At Oestrogen exposure of <32 years, there was an association between dietary patterns and BC risk (ORadj: 4.69, 95%CI: 1.01-21.92, p = 0.049). The relationship between BC risk and cooking intensity was found in both strata of exposure to oestrogens: <32 years (ORadj: 3.72, 95%CI:1.04-13.33, p = 0.044), and ≥32 years (ORadj: 6.06, 95%CI:1.34-27.42, p = 0.019). Conclusions: A caloric dietary pattern rich in refined carbohydrates and saturated fat, and intense meat product cooking may increase the risk of BC in Mexican women.

Impact of Alcohol Consumption on Breast Cancer Incidence and Mortality: The Women's Health Study

Background: Alcohol intake is associated with breast cancer (BC) risk, but estimates of greatest public health relevance have not been quantified in large studies with long duration. Materials and Methods: In this prospective cohort study of 39,811 women (median 25 years follow-up), we examined the association between alcohol consumption and BC incidence and mortality with adjusted hazard ratios (HRs), cubic splines, absolute risks, number needed to harm (NNH), and population-attributable fractions. Results: We documented 2,830 cases of BC, including 237 BC deaths. Each additional alcoholic drink/day was associated with a 10% higher rate (HR = 1.10, 95% confidence intervals [CIs]: 1.04-1.16) of total BC in a linear manner (p = 0.0004). The higher rate was apparent for estrogen receptor (ER)+ (HR = 1.12, 95% CI: 1.06-1.18) but not ER- tumors (HR = 0.95, 95% CI: 0.82-1.10), with a statistically significant difference between these associations (p = 0.03). We constructed models comparing BC incidence among 100,000 women followed for 10 years. Compared to a scenario where all women rarely or never consumed alcohol, we expect 63.79 (95% CI: 58.35-69.24) more cases (NNH = 1,567) had all women consumed alcohol at least monthly and 278.66 (95% CI: 268.70-288.62) more cases (NNH = 358) had all women consumed >1 drink/day. Approximately 4.1% of BC cases were attributable to consumption exceeding one drink/month. Conclusion: Alcohol consumption is associated with a linear dose-response increase in BC incidence even within recommended limits of up to one alcoholic drink/day, at least for ER+ tumors. Our estimates of risk differences, attributable fraction, and NNH quantify the burden that alcohol consumption imposes on women in the general population. ClinicalTrials.gov Identifier: NCT00000479.

Breast cancer and the steadily increasing maternal age: are they colliding?

BACKGROUND

Pregnancy-related cancers are mostly breast cancers, and their incidence is likely to increase as a result of the modern trend of delaying childbearing. In particular, advanced maternal age increases breast cancer risk, and younger breast cancer patients are more likely to die and metastasize. This study compared a population with a high incidence of delayed childbearing with another population with a lower mean age at childbirth in order to determine whether breast cancer diagnosis and childbearing age overlap.

METHODS

We retrospectively analyzed multiple data sources. The Surveillance, Epidemiology, and End Results (SEER) program, the United States National Center for Health Statistics as part of the National Vital Statistics System, the United Nations Population Division, the GLOBOCAN Cancer Observatory, the CLIO-INFRA project database, the Human Fertility Database, and anonymized local data were used.

RESULTS

As women's age at delivery increased, the convergence between their age distribution at breast cancer diagnosis and childbearing increased. In addition, the overlap between the two age distributions increased by more than 200% as the average age at delivery increased from 27 to 35 years.

CONCLUSIONS

As women's average childbearing age has progressively risen, pregnancy and breast cancer age distributions have significantly overlapped. This finding emphasizes the need for increased awareness and educational efforts to inform women about the potential consequences of delayed childbearing. By providing comprehensive information and support, women can make more informed decisions about their reproductive health and cancer prevention strategies.

The incidence of cancer following hospitalisation for a burn injury in Scotland 2009-2019: A retrospective cohort study

BACKGROUND

Studies suggest increased occurrence of cancer in persons who have experienced a burn injury with hospital admission.

OBJECTIVE

To determine the incidence of cancer among those hospitalised for burn injuries in Scotland compared with a similar group without a history of burn injury hospitalisation.

METHOD

A retrospective cohort design was used to compare cancer (ICD10 C00-97, excluding C44) incidence in two groups: 6805 burn injury patients discharged from Scottish hospitals between 2009 and 2019, and 25,946 subjects from the general population who were matched to burn patients by sex, year of birth, and degree of social deprivation. Cancer incidence was identified from the Scottish cancer registry. Cox proportional hazard regression was used to model time to cancer incidence adjusting for age, sex, degree of deprivation and presence of a comorbidity. Cancer risk was presented as standardised incidence ratios (SIRs) and hazard ratios (HR).

RESULTS

We found a higher prevalence of pre-existing conditions, particularly alcohol abuse among patients with burns. Pre-existing cancers were more common in the burn cohort (3.5%) than the comparison group (1.7%) and were excluded from further analysis. Over a median follow-up of 4-5 years, a total of 236 (3.5%) burn patients and 969 (3.7%) persons in the comparison group were diagnosed with cancer. At 0-6 months the cancer SIR for burn patients was 1.88 95% CI (1.40-2.52). After excluding the first six months of follow-up, the overall incidence of cancer was marginally elevated in burn patients (SIR 1.04, 95% CI 0.90-1.19, p = 0.62) and not statistically different from the incidence in comparison subjects (adjusted HR 1.03, 95% CI 0.88-1.21, p = 0.71).

CONCLUSIONS

Patients that suffer burn injury have a higher incidence of cancer than the general population and a group matched by age, sex and degree of deprivation. A higher incidence of adverse health-related behaviours such as smoking, alcohol use and pre-existing health conditions among many patients that suffer a burn most likely explain this observed increase. Any persisting inflammatory or immune dysfunction following burn injury is unlikely to account for the increase in cancers in this study.

The chronic alcohol consumption influences the gonadal axis in men: Results from a meta-analysis

BACKGROUND

Low testosterone concentrations affect 2-13% of adult males, with a direct association between reduction in testosterone (T) concentrations and cardiovascular events. Lifestyle habits have been linked to visceral fat accumulation and endocrine disorders like secondary hypogonadism. Alcohol intake has also been a topic of debate, with studies showing a detrimental effect on sperm production and underlying mechanisms. This meta-analysis aims to comprehensively evaluate the effect of alcohol consumption on T serum concentrations in adult men.

METHODS

The literature search included only controlled clinical trials comparing men who drink alcohol to men who do not, or who assumed placebo or nonalcoholic beverages. The primary outcome was the comparison of total testosterone serum concentrations between the study and control groups. The publications were examined for publication bias using Egger's test.

RESULTS

Twenty-one studies were included in the analysis for a total of 30 trials that examined the effects of alcohol consumption on testosterone level in 10,199 subjects. The meta-analysis showed that alcohol consumption overall is related to significant reduction in circulating concentrations of total testosterone (mean difference [MD] = -4.02; 95% CI -6.30, -1.73), free T (MD = -0.17; 95% CI -0.23, -0.12), sex hormone binding globulin (SHBG) (MD = -1.94; 95% CI -3.37, -0.48), an increase in estradiol (E2) (MD = 7.65; 95% CI 1.06, 14.23) and neutral effect on luteinizing hormone (LH) (MD = -0.15; 95% CI -0.36, 0.06), independently by age, body mass index (BMI), E2, and LH serum concentrations and alcohol intake. However, these results are evident only in healthy men exposed to chronic alcohol consumption and not in those with a recognized diagnosis of alcohol use disorder or after acute alcohol intake.

CONCLUSION

This study suggests how chronic alcohol consumption may inhibit the gonadal axis in healthy men, although the exact pathophysiological mechanisms connecting alcohol exposure and steroidogenesis are still not completely clarified.

Demographic disparities in the limited awareness of alcohol use as a breast cancer risk factor: empirical findings from a cross-sectional study of U.S. women

BACKGROUND

Alcohol use is an established yet modifiable risk factor for breast cancer. However, recent research indicates that the vast majority of U.S. women are unaware that alcohol use is a risk factor for breast cancer. There is limited information about the sociodemographic characteristics and alcohol use correlates of awareness of the alcohol use and breast cancer link, and this is critically important for health promotion and intervention efforts. In this study, we assessed prevalence of the awareness of alcohol use as a risk factor for breast cancer among U.S. women and examined sociodemographic and alcohol use correlates of awareness of this link.

METHODS

We conducted a 20-minute online cross-sectional survey, called the ABLE (Alcohol and Breast Cancer Link Awareness) survey, among U.S. women aged 18 years and older (N = 5,027) in the fall of 2021. Survey questions assessed awareness that alcohol use increases breast cancer risk (yes, no, don't know/unsure); past-year alcohol use and harmful drinking via the Alcohol Use Disorders Identification Test (AUDIT); and family, health, and sociodemographic characteristics. We conducted multivariate multinomial regression analysis to identify correlates of awareness that alcohol use increases breast cancer risk.

RESULTS

Overall, 24.4% reported that alcohol use increased breast cancer risk, 40.2% reported they were unsure, and 35.4% reported that there was no link between alcohol use and breast cancer. In adjusted analysis, awareness of alcohol use as a breast cancer risk factor, compared to not being aware or unsure, was associated with being younger (18-25 years old), having a college degree, and having alcohol use disorder symptoms. Black women were less likely than white women to report awareness of the alcohol use and breast cancer link.

CONCLUSIONS

Overall, only a quarter of U.S. women were aware that alcohol use increases breast cancer risk, although 40% expressed uncertainty. Differences in awareness by age, level of education, race and ethnicity and level of alcohol use offer opportunities for tailored prevention interventions, while the overall low level of awareness calls for widespread efforts to increase awareness of the breast cancer risk from alcohol use among U.S. women.

Targeting cisplatin resistance in breast cancer using a combination of Thymoquinone and Silymarin: an in vitro and in vivo study

Background: Breast cancer (BC) is considered the most diagnosed cancer among women globally. This is because of its high possibility of metastasis and high resistance to chemotherapy. Cisplatin is a platinum-based antitumor agent that is used to treat various types of cancer. However, the main obstacle to using this drug is drug resistance. Drug resistance is a cause of most relapses of cancer which eventually lead to death. Nowadays, combining natural products is a trend to overcome drug resistance. Thymoquinone (TQ) is a natural phytochemical that exists mainly in blackseed. It has been used in medicine for decades, especially as an anticancer agent. Silymarin is a milk thistle compound that exhibits anticancer, hepatoprotective, and neuroprotective activity. Hence, the combination of TQ and silymarin could be a probable solution to treat cancer and reduce chemoresistance.

Methods: This study tested this combination on cisplatin-sensitive (EMT6/P) and cisplatin-resistant (EMT6/CPR) mouse mammary cell lines. Apoptotic and antiproliferative activity was assessed for TQ and silymarin in vitro using caspase-3 and [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide] (MTT) assays, respectively. An in vivo study was performed to evaluate the effect of TQ and silymarin combination in mice inoculated with EMT6/P and EMT6/CPR cells. The safety profile was also examined using creatinine and liver enzyme assays.

Results: In vitro, the TQ and silymarin combination synergized in both cell lines. Also, this combination caused apoptosis induction at a higher rate than the single treatment in both cell lines. In vivo, TQ and silymarin combination resulted in a remarkable reduction in tumor size and enhanced the cure rate in mice implanted with EMT6/P and EMT6/CPR cell lines. According to the safety profile results, TQ and silymarin combination was safe.

Conclusion: In conclusion, the combination of TQ and silymarin provides a promising solution in treating BC resistant to cisplatin by inducing apoptosis. Further studies are needed to define the exact anticancer mechanisms of this combination.

A Public Health Emergency: Breast Cancer Among Black Communities in the United States

While Black people have a similar incidence of breast cancer compared to White people, they have a 40% increased death rate. Black people are more likely to be diagnosed with aggressive subtypes such as triple-negative breast cancer. However, despite biological factors, systemic racism and social determinants of health create delays in care and barriers to treatment. While genetic testing holds incredible promise for Black people, uptake remains low and results may be challenging to interpret. There is a need for more robust, multidisciplinary, and antiracist interventions to reverse breast cancer-related racial disparities.

Disparities in Breast Cancer Care-How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity

Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes.

Lifetime alcohol consumption patterns and young-onset breast cancer by subtype among Non-Hispanic Black and White women in the Young Women's Health History Study

PURPOSE

The role of alcohol in young-onset breast cancer (YOBC) is unclear. We examined associations between lifetime alcohol consumption and YOBC in the Young Women's Health History Study, a population-based case-control study of breast cancer among Non-Hispanic Black and White women < 50 years of age.

METHODS

Breast cancer cases (n = 1,812) were diagnosed in the Metropolitan Detroit and Los Angeles County SEER registry areas, 2010-2015. Controls (n = 1,381) were identified through area-based sampling and were frequency-matched to cases by age, site, and race. Alcohol consumption and covariates were collected from in-person interviews. Weighted multivariable logistic regression was conducted to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for associations between alcohol consumption and YOBC overall and by subtype (Luminal A, Luminal B, HER2, or triple negative).

RESULTS

Lifetime alcohol consumption was not associated with YOBC overall or with subtypes (all ptrend ≥ 0.13). Similarly, alcohol consumption in adolescence, young and middle adulthood was not associated with YOBC (all ptrend ≥ 0.09). An inverse association with triple-negative YOBC, however, was observed for younger age at alcohol use initiation (< 18 years vs. no consumption), aOR (95% CI) = 0.62 (0.42, 0.93). No evidence of statistical interaction by race or household poverty was observed.

CONCLUSIONS

Our findings suggest alcohol consumption has a different association with YOBC than postmenopausal breast cancer-lifetime consumption was not linked to increased risk and younger age at alcohol use initiation was associated with a decreased risk of triple-negative YOBC. Future studies on alcohol consumption in YOBC subtypes are warranted.

Prospective study design and data analysis in UK Biobank

Population-based prospective studies, such as UK Biobank, are valuable for generating and testing hypotheses about the potential causes of human disease. We describe how UK Biobank's study design, data access policies, and approaches to statistical analysis can help to minimize error and improve the interpretability of research findings, with implications for other population-based prospective studies being established worldwide.

European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO

INTRODUCTION

Breast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development. Management should focus on adequate classification and management whilst avoiding overtreatment. The aim of these guidelines is to provide updated information regarding the diagnosis and management of B3 lesions, according to updated literature review evidence.

METHODS

These guidelines provide practical recommendations which can be applied in clinical practice which include recommendation grade and level of evidence. All sections were written according to an updated literature review and discussed at a consensus meeting. Critical appraisal by the expert writing committee adhered to the 23 items in the international Appraisal of Guidelines, Research and Evaluation (AGREE) tool.

RESULTS

Recommendations for further management after core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB) diagnosis of a B3 lesion reported in this guideline, vary depending on the presence of atypia, size of lesion, sampling size, and patient preferences. After CNB or VAB, the option of vacuum-assisted excision or surgical excision should be evaluated by a multidisciplinary team and shared decision-making with the patient is crucial for personalizing further treatment. De-escalation of surgical intervention for B3 breast lesions is ongoing, and the inclusion of vacuum-assisted excision (VAE) will decrease the need for surgical intervention in further approaches. Communication with patients may be different according to histological diagnosis, presence or absence of atypia, or risk of upgrade due to discordant imaging. Written information resources to help patients understand these issues alongside with verbal communication is recommended. Lifestyle interventions have a significant impact on BC incidence so lifestyle interventions need to be suggested to women at increased BC risk as a result of a diagnosis of a B3 lesion.

CONCLUSIONS

These guidelines provide a state-of-the-art overview of the diagnosis, management and prognosis of B3 lesions in modern multidisciplinary breast practice.

Dose-response Relationships Between Cigarette Smoking and Breast Cancer Risk: A Systematic Review and Meta-analysis

BACKGROUND

The possible association between cigarette smoking and breast cancer risk has been quite controversial.

METHODS

We conducted a systematic review and meta-analysis of all available observational studies published on the issue up to January 2020. Random-effects models were used to compute pooled relative risks (RRs) for cigarette smoking status and dose-risk relationships were evaluated using one-stage random-effects dose-response models.

RESULTS

A total of 169 studies were selected, providing a pooled RR for breast cancer of 1.07 (95% confidence interval [CI], 1.05-1.10) for current, 1.08 (95% CI, 1.06-1.10) for former, and 1.09 (95% CI, 1.07-1.11) for ever smokers, compared to never smokers. Results were consistent in case-control and cohort studies. No meaningful differences were observed across strata of most covariates considered, nor according to relevant genetic mutations and polymorphisms (ie, BRCA mutation, N-acetyltransferase and glutathione S-transferase genotypes, and P53). Breast cancer risk increased linearly with intensity of smoking (RR 1.12; 95% CI, 1.08-1.16 for 20 cigarettes/day and 1.26; 95% CI, 1.17-1.36 for 40 cigarettes/day), and with increasing duration of smoking (RR 1.05; 95% CI, 1.03-1.08 for 20 years of smoking and 1.11; 95% CI, 1.06-1.16 for 40 years of smoking).

CONCLUSION

The present large and comprehensive meta-analysis-conducted using an innovative approach for study search-supports the evidence of a causal role of tobacco smoking on breast cancer risk.

Characterizing risky alcohol use, cigarette smoking, e-cigarette use, and physical inactivity among cancer survivors in the USA-a cross-sectional study

PURPOSE

Unhealthy lifestyle behaviors are associated with inferior health outcomes among cancer survivors, including increased mortality. It is crucial to identify vulnerable subgroups, yet investigations have been limited. Thus, this study aimed to examine sociodemographic and clinical characteristics associated with risky health behaviors among cancer survivors.

METHODS

We used national, cross-sectional survey data (Health Information National Trends Survey, HINTS 2017-2020) for 2579 cancer survivors. We calculated the prevalence of risky alcohol use, current cigarette smoking, e-cigarette use, and not meeting physical activity guidelines. We performed weighted logistic regression to obtain multivariable-adjusted odds ratios (OR) for the association between each unhealthy behavior with sociodemographic and clinical characteristics.

RESULTS

Overall, 25% showed risky alcohol use, 12% were current cigarette smokers, 3% were current e-cigarette users, and 68% did not meet physical activity guidelines. Cancer survivors who were males, non-Hispanic Whites or African Americans, without a college education, not married and with comorbidities or psychological distress were more likely to have unhealthy behaviors. Those with lung disease or depression were 2 times as likely to smoke cigarette or e-cigarettes and those with psychological distress were 1.6 times as likely to be physically inactive. Moreover, risky drinkers (OR = 1.75, 95% CI = 1.22-2.52) and e-cigarette smokers (OR = 16.40, 95% CI 3.29-81.89) were more likely to be current cigarette smokers.

CONCLUSIONS

We identified vulnerable subpopulations of cancer survivors with multiple unhealthy lifestyle behaviors.

IMPLICATIONS FOR CANCER SURVIVORS

Our findings inform clinicians and program and policy makers of the subgroups of cancer survivors to target for multiple health behavior interventions.

Extrahepatic Health Effects of Alcohol Use and Alcohol-associated Liver Disease

PURPOSE

Alcohol use disorder (AUD) is a growing public health concern and an important contributor to global morbidity and mortality. While the hepatotoxic effects of alcohol are well known, the adverse effects of alcohol are manifested in almost every organ system. With the growing public health impact of AUD, the aim of this narrative review is to highlight the epidemiology and burden of AUD and its association with extrahepatic diseases including malignancy and disorders of the gastrointestinal (GI), cardiovascular, immunologic, neurologic, endocrine, and hematologic systems.

METHODS

A narrative review of the literature was performed to identify studies addressing the epidemiology, pathophysiology, clinical manifestations, and therapy of extrahepatic health manifestations of alcohol use.

FINDINGS

In the United States, an estimated 14.5 million people have AUD and approximately 88,000 adults die yearly due to alcohol-related causes. The consumption of alcohol and AUD is associated with injuries, violence, cancers, nonmalignant conditions of the GI system, infections, effects on the cardiovascular system, and neurodegenerative diseases. These conditions contribute to the increased mortality associated with AUD and are burdensome to patients and caregivers.

IMPLICATIONS

Increased awareness of the extrahepatic manifestations of AUD, screening for AUD using validated screening tools, such as the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score, and offering evidence-based interventions to patients with AUD is imperative to reduce the public health burden of AUD. Although historically controversial, recent evidence suggests that any level of alcohol consumption can have negative health consequences. Further research is warranted to determine if any amount of alcohol is safe for consumption. Public health efforts are warranted to help curtail the growing burden of AUD.

Role of the intestinal microbiota and diet in the onset and progression of colorectal and breast cancers and the interconnection between both types of tumours

Colorectal cancer (CRC) is among the leading causes of mortality in adults of both sexes worldwide, while breast cancer (BC) is among the leading causes of death in women. In addition to age, gender, and genetic predisposition, environmental and lifestyle factors exert a strong influence. Global diet, including alcohol consumption, is one of the most important modifiable factors affecting the risk of CRC and BC. Western dietary patterns promoting high intakes of xenobiotics from food processing and ethanol have been associated with increased cancer risk, whereas the Mediterranean diet, generally leading to a higher intake of polyphenols and fibre, has been associated with a protective effect. Gut dysbiosis is a common feature in CRC, where the usual microbiota is progressively replaced by opportunistic pathogens and the gut metabolome is altered. The relationship between microbiota and BC has been less studied. The estrobolome is the collection of genes from intestinal bacteria that can metabolize oestrogens. In a dysbiosis condition, microbial deconjugating enzymes can reactivate conjugated-deactivated oestrogens, increasing the risk of BC. In contrast, intestinal microorganisms can increase the biological activity and bioavailability of dietary phytochemicals through diverse microbial metabolic transformations, potentiating their anticancer activity. Members of the intestinal microbiota can increase the toxicity of xenobiotics through metabolic transformations. However, most of the microorganisms involved in diet-microbiota interactions remain poorly characterized. Here, we provide an overview of the associations between microbiota and diet in BC and CRC, considering the diverse types and heterogeneity of these cancers and their relationship between them and with gut microbiota.

Investigating the trends of incidence rates of breast cancer in Southern Iran: a population based survey

BACKGROUND

The overall incidence of breast cancer is different all over the world and even within a nation. The present study aims to investigate the stratum-specific incidence trends of breast cancer in southern Iran.

METHODS

In this retrospective cohort study, the data of Fars Population-Based Cancer Registry was used during 2001-2018. New cancer cases with ICD-O-3 codes C50.0 to C50.9 were categorized based on age group, morphology, and topography. Age-specific incidence rates of breast cancer were calculated during 2001-2018. Annual overall and truncated age-standardized incidence rates and their 95% Confidence Intervals (CIs) were also calculated. Afterward, the Annual Percentage Changes (APCs) of the age-specific and age-standardized incidence rates of breast cancer during 2001-2018 were calculated using Joinpoint regression software.

RESULTS

An increasing trend was observed in the incidence of breast cancer among women during 2001-2018 (APC of age-standardized incidence rates: 9.5 (95% CI: 7.5, 11.5)).However, the trend was increasing less during the recent years. The APC of age-standardized rates decreased from 15.03 (95% CI: 10.4, 19.8) in 2007 to 6.15(95% CI: 4.0, 8.4) in 2018. The most common morphology of breast cancer was invasive ductal carcinoma (77.3% in females and 75.1% in males) and its trend was similar to the general trend of different types of breast cancer. The most common site of breast cancer was the upper outer quadrant. Most breast cancer cases were female and males accounted for 2.45% of the cases. Among females, 40-55 was the most prevalent age group.

CONCLUSION

The incidence of breast cancer among women living in southern Iran showed an increasing trend from 2001 to 2018. However, the rate of increase exhibited a milder slope during the more recent years. Based on the higher prevalence of breast cancer in the 40-55 age group observed in the present study, it offers valuable insight into the potential reduction of the breast cancer screening age from 50 to 40 years for healthy Iranian women. However, before implementing such a policy change, it is crucial to conduct additional studies that specifically examine the cost-effectiveness, as well as the potential benefits and risks associated with this alteration.

Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis

OBJECTIVES

Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.

METHODS

Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.

RESULTS

Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.

CONCLUSIONS

Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.

New Approaches and Recommendations for Risk-Adapted Breast Cancer Screening

Population-based breast cancer screening using mammography as the gold standard imaging modality has been in clinical practice for over 40 years. However, the limitations of mammography in terms of sensitivity and high false-positive rates, particularly in high-risk women, challenge the indiscriminate nature of population-based screening. Additionally, in light of expanding research on new breast cancer risk factors, there is a growing consensus that breast cancer screening should move toward a risk-adapted approach. Recent advancements in breast imaging technology, including contrast material-enhanced mammography (CEM), ultrasound (US) (automated-breast US, Doppler, elastography US), and especially magnetic resonance imaging (MRI) (abbreviated, ultrafast, and contrast-agent free), may provide new opportunities for risk-adapted personalized screening strategies. Moreover, the integration of artificial intelligence and radiomics techniques has the potential to enhance the performance of risk-adapted screening. This review article summarizes the current evidence and challenges in breast cancer screening and highlights potential future perspectives for various imaging techniques in a risk-adapted breast cancer screening approach. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 5.

Latin America and the Caribbean Code Against Cancer 1st edition: Tobacco and nicotine-related products, secondhand smoke, and alcohol and cancer

Tobacco, secondhand smoke (SHS), and alcohol, all carcinogens, are leading preventable cancer risk factors in Latin America and the Caribbean (LAC). Since 2000, smoking and SHS exposure have significantly decreased in the region. Yet alcohol consumption remains high. The entry of nicotine-related products such as electronic cigarettes (e-cigs) threatens achievements made in tobacco control and chronic diseases prevention, including cancer. E-cigs use is likely associated with smoking initiation among adolescents who had never smoked and dual use with combustible tobacco products. Therefore, the LAC Code Against Cancer recommends to the public actions they can take to reduce their risk of cancer: 1. Don't smoke or use any type of tobacco. If you do, quitting is possible, with professional help if needed. Don't use e-cigarettes either, as they lead to tobacco use. 2. Make your home a smoke-free place. Respect and promote laws that ensure smoke-free spaces to protect our health. and 3. Avoid drinking alcoholic beverages. This helps prevent several types of cancer. The Code recommends to policymakers a package of cost-effective policies based on the MPOWER and SAFER to prevent cancer at the population level. It also recommends that primary care health professionals: 1. Ask all their patients and their families whether they smoke or vape, inform them about the harms of smoking and vaping, and promote tobacco and nicotine related products cessation strategies among users. 2. Inform about the harms of exposure to SHS, especially among children, and promote smoke-free environments, and 3. Prevent alcohol use by their patients and their families, use tools to assess use, intensity, and frequency, and apply brief counseling intervention to support alcohol abstinence in primary care.

DCIS and LCIS: Are the Risk Factors for Developing In Situ Breast Cancer Different?

Ductal carcinoma in situ (DCIS) is widely accepted as a precursor of invasive ductal carcinoma (IDC). Lobular carcinoma in situ (LCIS) is considered a risk factor for invasive lobular carcinoma (ILC), and it is unclear whether LCIS is also a precursor. Therefore, it would be expected that similar risk factors predispose to both DCIS and IDC, but not necessarily LCIS and ILC. This study examined associations with risk factors using data from 3075 DCIS cases, 338 LCIS cases, and 1584 controls aged 35-60, recruited from the UK-based GLACIER and ICICLE case-control studies between 2007 and 2012. Analysis showed that breastfeeding in parous women was protective against DCIS and LCIS, which is consistent with research on invasive breast cancer (IBC). Additionally, long-term use of HRT in post-menopausal women increased the risk of DCIS and LCIS, with a stronger association in LCIS, similar to the association with ILC. Contrary to findings with IBC, parity and the number of births were not protective against DCIS or LCIS, while oral contraceptives showed an unexpected protective effect. These findings suggest both similarities and differences in risk factors for DCIS and LCIS compared to IBC and that there may be justification for increased breast surveillance in post-menopausal women taking long-term HRT.

A Concise Review on Natural Products and Their Derivatives for Breast Cancer Treatment

Cancer is a leading cause of death worldwide. Among other cancers, breast cancer has been found to produce maximum number of cases in 2020. Different factors including geographical, genetic, hormonal, oral contraceptives and modern lifestyle could be responsible for the development of breast cancer and different pathways can be targeted for breast cancer treatment. The various conventional approaches used for the treatment of breast cancer including radiotherapy, chemotherapy, hormone and immunotherapy. But due to the side effects associated with these conventional treatments such as non-selectivity, multidrug resistance and bioavailability, there is a need for the development of better therapeutic agents for breast cancer treatment. Several natural products have been explored for breast cancer treatment. However, many of these natural products suffered from the limitations of poor water solubility and possess toxic side effects. To overcome these limitations, several structural analogs of natural products have been synthesized and possess potent anti-breast cancer effects with less side effects over their precursor molecules. In the present manuscript, we describe the pathogenesis of breast cancer, some potent natural products used in the treatment of breast cancer and their selected structural analogs possessing potent anti-breast cancer effects. Database such as Science direct, Pubmed and Google scholar were searched using keywords 'risk factors', 'screening methods','receptors', and 'natural products and derivatives', Registered clinical trials on selected natural products were also analyzed. Present study concludes that eight selected natural products and their derivatives possess wide potential to exhibit anti-breast cancer effects and could be explored further to develop better chemotherapeutic agents against breast cancer.

The recent progress of endocrine therapy-induced osteoporosis in estrogen-positive breast cancer therapy

Breast cancer is a significant global health concern, and the discovery of endocrine therapy has played a crucial role in the treatment of estrogen-positive breast cancer. However, these therapies are often associated with osteoporosis-related adverse events, which increase the risk of fractures in breast cancer patients and can result in limited mobility and reduced quality of life. Previous studies have shown that osteoporosis is essential side effects of the breast cancer therapy, although the exact mechanisms remain mostly unclear. Current clinical treatments, such as bisphosphonates, cause side effects and may impact the therapeutic response to endocrine drugs. In this review, we explore the likelihood of endocrine therapy-induced osteoporosis in estrogen-positive breast cancer therapy and discuss the involved mechanisms as well as the therapeutic potential of drugs and drug combination strategies.

Effect of air pollution on the prevalence of breast and cervical cancer in China: a panel data regression analysis

The association between the prevalence of breast and cervical cancer in Chinese women and air pollution is obscure. The study aims to analyze the correlation between air pollution and the prevalence of breast and cervical cancer, and whether the gross domestic product (GDP) has a modifying effect on the impact of air pollution on the prevalence of breast and cervical cancer. Extracting panel data from 31 provinces and cities between 2006 and 2020, we evaluated the association between breast and cervical cancer prevalence and pollutant emissions from 2006 to 2015 with two-way fixed-effect models. We also analyzed the interaction between GDP and pollutant emissions and further check the robustness of the moderating effect results using group regression from 2016 to 2020. Cluster robust standard errors were used to correct for the heteroskedasticity and autocorrelation. The coefficients of models show that the coefficients of logarithmic soot and dust emissions are estimated to be significantly positive, and the coefficients of their square terms are significantly negative. The robust results suggest that the relationship between soot and dust emissions and breast or cervical cancer prevalence is non-linear, from 2006 to 2015. In the analysis of particulate matter (PM) data in 2016-2020, the PM-GDP interaction term was also significantly negative, indicating that GDP growth weakened the effect of PM on the prevalence of breast cancer and cervical cancer. In provinces with higher GDP, the indirect effect of PM emissions concerning breast cancer is -0.396 while in provinces with lower GDP, it is about -0.215. The corresponding coefficient concerning cervical cancer is about -0.209 in provinces with higher GDP but not significant in provinces with lower GDP. Our results suggest that there is an inverted U-shaped relationship between the prevalence of breast cancer and cervical cancer and air pollutants from 2006 to 2015. GDP growth has a significant negative moderating effect on the impact of air pollutants on the prevalence of breast cancer and cervical cancer. PM emissions have a higher effect on the prevalence of breast and cervical cancer in provinces with higher GDP and a lower impact in provinces with lower GDP.

A complex systems model of breast cancer etiology: The Paradigm II Model

BACKGROUND

Complex systems models of breast cancer have previously focused on prediction of prognosis and clinical events for individual women. There is a need for understanding breast cancer at the population level for public health decision-making, for identifying gaps in epidemiologic knowledge and for the education of the public as to the complexity of this most common of cancers.

METHODS AND FINDINGS

We developed an agent-based model of breast cancer for the women of the state of California using data from the U.S. Census, the California Health Interview Survey, the California Cancer Registry, the National Health and Nutrition Examination Survey and the literature. The model was implemented in the Julia programming language and R computing environment. The Paradigm II model development followed a transdisciplinary process with expertise from multiple relevant disciplinary experts from genetics to epidemiology and sociology with the goal of exploring both upstream determinants at the population level and pathophysiologic etiologic factors at the biologic level. The resulting model reproduces in a reasonable manner the overall age-specific incidence curve for the years 2008-2012 and incidence and relative risks due to specific risk factors such as BRCA1, polygenic risk, alcohol consumption, hormone therapy, breastfeeding, oral contraceptive use and scenarios for environmental toxin exposures.

CONCLUSIONS

The Paradigm II model illustrates the role of multiple etiologic factors in breast cancer from domains of biology, behavior and the environment. The value of the model is in providing a virtual laboratory to evaluate a wide range of potential interventions into the social, environmental and behavioral determinants of breast cancer at the population level.

What Is Known about Breast Cancer in Young Women?

Breast cancer (BC) is the second leading cause of cancer-related death in women under the age of 40 years worldwide. In addition, the incidence of breast cancer in young women (BCYW) has been rising. Young women are not the focus of screening programs and BC in younger women tends to be diagnosed in more advanced stages. Such patients have worse clinical outcomes and treatment complications compared to older patients. BCYW has been associated with distinct tumour biology that confers a worse prognosis, including poor tumour differentiation, increased Ki-67 expression, and more hormone-receptor negative tumours compared to women >50 years of age. Pathogenic variants in cancer predisposition genes such as BRCA1/2 are more common in early-onset BC compared to late-onset BC. Despite all these differences, BCYW remains poorly understood with a gap in research regarding the risk factors, diagnosis, prognosis, and treatment. Age-specific clinical characteristics or outcomes data for young women are lacking, and most of the standard treatments used in this subpopulation currently are derived from older patients. More age-specific clinical data and treatment options are required. In this review, we discuss the epidemiology, clinicopathologic characteristics, outcomes, treatments, and special considerations of breast cancer in young women. We also underline future directions and highlight areas that require more attention in future studies.

Alcohol Consumption and a Decline in Glomerular Filtration Rate: The Japan Specific Health Checkups Study

Previous studies have reported conflicting results on the clinical impact of alcohol consumption on the glomerular filtration rate (GFR). This retrospective cohort study aimed to assess the dose-dependent association between alcohol consumption and the slope of the estimated GFR (eGFR) in 304,929 participants aged 40-74 years who underwent annual health checkups in Japan between April 2008 and March 2011. The association between the baseline alcohol consumption and eGFR slope during the median observational period of 1.9 years was assessed using linear mixed-effects models with the random intercept and random slope of time adjusting for clinically relevant factors. In men, rare drinkers and daily drinkers with alcohol consumptions of ≥60 g/day had a significantly larger decline in eGFR than occasional drinkers (difference in multivariable-adjusted eGFR slope with 95% confidence interval (mL/min/1.73 m²/year) of rare, occasional, and daily drinkers with ≤19, 20-39, 40-59, and ≥60 g/day: -0.33 [-0.57, -0.09], 0.00 [reference], -0.06 [-0.39, 0.26], -0.16 [-0.43, 0.12], -0.08 [-0.47, 0.30], and -0.79 [-1.40, -0.17], respectively). In women, only rare drinkers were associated with lower eGFR slopes than occasional drinkers. In conclusion, alcohol consumption was associated with the eGFR slope in an inverse U-shaped fashion in men but not in women.

Acceptability of Primary Care Counseling and Brief Educational Messages to Increase Awareness about Alcohol and Breast Cancer Risks among Bisexual and Lesbian Women

This research had two aims: (1) to assess how often bisexual and lesbian women self-report screening and counseling for alcohol use in primary care settings; and (2) understand how bisexual and lesbian women respond to brief messages that alcohol increases breast cancer risk. The study sample consisted of 4891 adult U.S. women who responded to an online, cross-sectional Qualtrics survey in September-October 2021. The survey included the Alcohol Use Disorders Identification Test (AUDIT), questions about alcohol screening and brief counseling in primary care, and questions assessing awareness of the link between alcohol use and breast cancer. Bivariate analyses and logistic regression were conducted. Bisexual and lesbian women had higher odds of harmful drinking (AUDIT score ≥ 8) than heterosexual women (adjusted odds ratio [AOR] = 1.26, 95% confidence interval [CI] = 1.01-1.57 for bisexual women; AOR =1.78, 95% CI = 1.24-2.57 for lesbian women). However, bisexual and lesbian women were no more likely than heterosexual women to be advised about drinking in primary care. In addition, bisexual, lesbian, and heterosexual women had similar reactions to messages highlighting that alcohol is a risk factor for breast cancer. Women across all three sexual orientations who are harmful drinkers more often agreed to search for more information online or talk to a medical professional compared to non-harmful drinkers.

Proactive breast cancer risk assessment in primary care: a review based on the principles of screening

In the UK, the National Institute for Health and Care Excellence (NICE) recommends that women at moderate or high risk of breast cancer be offered risk-reducing medication and enhanced breast screening/surveillance. In June 2022, NICE withdrew a statement recommending assessment of risk in primary care only when women present with concerns. This shift to the proactive assessment of risk substantially changes the role of primary care, in effect paving the way for a primary care-based screening programme to identify those at moderate or high risk of breast cancer. In this article, we review the literature surrounding proactive breast cancer risk assessment within primary care against the consolidated framework for screening. We find that risk assessment for women under 50 years currently satisfies many of the standard principles for screening. Most notably, there are large numbers of women at moderate or high risk currently unidentified, risk models exist that can identify those women with reasonable accuracy, and management options offer the opportunity to reduce breast cancer incidence and mortality in that group. However, there remain a number of uncertainties and research gaps, particularly around the programme/system requirements, that need to be addressed before these benefits can be realised.

Effects of beer, wine, and baijiu consumption on non-alcoholic fatty liver disease: Potential implications of the flavor compounds in the alcoholic beverages

Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease and its global incidence is estimated to be 24%. Beer, wine, and Chinese baijiu have been consumed worldwide including by the NAFLD population. A better understanding of the effects of these alcoholic beverages on NAFLD would potentially improve management of patients with NAFLD and reduce the risks for progression to fibrosis, cirrhosis, and hepatocellular carcinoma. There is evidence suggesting some positive effects, such as the antioxidative effects of bioactive flavor compounds in beer, wine, and baijiu. These effects could potentially counteract the oxidative stress caused by the metabolism of ethanol contained in the beverages. In the current review, the aim is to evaluate and discuss the current human-based and laboratory-based study evidence of effects on hepatic lipid metabolism and NAFLD from ingested ethanol, the polyphenols in beer and wine, and the bioactive flavor compounds in baijiu, and their potential mechanism. It is concluded that for the potential beneficial effects of wine and beer on NAFLD, inconsistence and contrasting data exist suggesting the need for further studies. There is insufficient baijiu specific human-based study for the effects on NAFLD. Although laboratory-based studies on baijiu showed the antioxidative effects of the bioactive flavor compounds on the liver, it remains elusive whether the antioxidative effect from the relatively low abundance of the bioactivate compounds could outweigh the oxidative stress and toxic effects from the ethanol component of the beverages.

Alcohol and breast cancer

Breast cancer is one of the main causes of death in women worldwide. In women, breast cancer includes over half of all tumours caused by alcohol. This paper discusses both ethanol metabolism and the mechanisms of mammary tumourigenesis caused by alcohol. Numerous signalling pathways in neoplastic transformation following alcohol consumption in women have been presented. In addition, primary and secondary prevention, phytochemicals, synthetic chemicals, specific inhibitors of enzymes and selective receptor modulators have been described.

New Validated Short Questionnaire for the Evaluation of the Adherence of Mediterranean Diet and Nutritional Sustainability in All Adult Population Groups

High adherence to a Mediterranean diet (MD) is favourable for its sustainability and beneficial effects on health. The available questionnaires, according to the MD dietary pattern, include the assessment of moderate alcohol consumption; but some groups, such as young adults and pre-conceptional and pregnant women, are not allowed to consume it. The aim of this study was to validate a new short questionnaire (MedQ-Sus) excluding alcohol consumption, to measure the adherence to the MD and to evaluate the nutritional adherence to a sustainable diet. The Harvard validated questionnaire was used for the validation study. A total of 316 subjects (20 to 70 YOA) completed both questionnaires. A high Spearman correlation coefficient (rho = 0.69; p < 0.01) was found between the MedQ-Sus and Harvard scores; a statistically significant positive correlation was found for all eight food groups. The MedQ-Sus had a significant discriminative capacity between adherence and non-adherence to the MD (optimal cut-off point = 9.5, sensitivity 0.86, specificity = 0.65). A very high nutritional adherence to a sustainable diet was found in the subjects for olive oil (97%), dairy food (90%), fresh vegetables (89%), fish and fish products (73), fresh fruit (56%), and cereals and cereals products (42%). A very low adherence was found for legumes (22%) and meat and meat products (9%). The results showed MedQ-Sus is a valid and quick assessment instrument for the evaluation of the adherence to the MD in all population groups, and could also be useful to evaluate the nutritional sustainability of the diet.