Breast cancer (1)

Obesity and lack of breastfeeding: a perfect storm to augment risk of breast cancer?

Triple-negative breast cancer (TNBC) is one of the most aggressive subtypes of breast cancer with higher rates of recurrence and distant metastasis, as well as decreased 5-year survival rates. Racial disparities are evident in the incidence and mortality rates of triple negative breast cancer particularly increased in young African American women. Concurrently, young African American women have multiple risk factors for TNBC including higher rates of premenopausal abdominal obesity (higher waist-hip ratio) and lower rates of breastfeeding with higher parity, implicating these factors as potentially contributors to poor outcomes. By understanding the mechanisms of how premenopausal obesity and lack of breastfeeding may be associated with increased risk of triple negative breast cancer, we can determine the best strategies for intervention and awareness to improve outcomes in TNBC.

Plasma C-peptide mammographic features and risk of breast cancer

Our study in the Nurses' Health Study (NHS) and NHS2, a nested case-control study with 1260 cases and 2221 controls, investigated the association between C-peptide levels, mammographic density (MD) parameters, V (a measure of gray scale variation), and breast cancer (BC) risk. We also examined how C-peptide and BC risk vary across quartiles of mammographic features. Linear and logistic regressions were used to study the associations between C-peptide and MD parameters, and breast cancer. C-peptide was inversely associated with percent MD and positively with non-dense area, but no associations were found with dense area and V measure. C-peptide was associated with an increased risk of invasive BC risk (top vs. bottom quartile, odds ratio = 1.46, 95% CI: 1.12-1.91). No multiplicative interactions were found between C-peptide, MD parameters, and BC risk. Our results suggest a positive association between C-peptide and BC risk, and MD parameters do not seem to modify this association.

Hesperidin suppressed metastasis, angiogenesis and tumour growth in Balb/c mice model of breast cancer

Considering the unfavourable response of breast cancer (BC) to treatment, we assessed the therapeutic potential hesperidin in mice bearing 4T1 BC tumours. Anti-tumour effects were assessed by measuring pathologic complete response (pCR), survival analysis, immunohistochemistry for E-cadherin, VEGF, MMP9, MMP2 and Ki-67, serum measurement of IFNγ and IL-4, and gene expression analysis of CD105, VEGFa, VEGFR2 and COX2. Survival of tumour-bearing mice was the highest in mice receiving a combination of hesperidin and doxorubicin (Dox) (80%) compared to the normal saline (43%), hesperidin 5 (54%), 10 (55.5%), 10 (60.5%) and 40 (66%) mg/kg, and 10 mg/kg Dox-treated (73%) groups (p < 0.0001 for all). Compared to the normal saline group, there was a significant elevation in IFNγ level in the animals receiving 20 (p = 0.0026) and 40 (p < 0.001) mg/kg hesperidin, 10 mg/kg Dox (p < 0.001), and combined hesperidin (20 mg/kg) and Dox (10 mg/kg) (p < 0.001). A significant reduction in the gene expression of CD 105 (p = 0.0106), VEGFa (p < 0.0001), VEGFR2 (p < 0.0001), and Cox2 (p = 0.034) and a significant higher pCR score (p = 0.006) were noticed in mice treated with 10 mg/kg Dox + 20 mg/kg hesperidin compared to those treated with 10 mg/kg Dox alone. Immunohistochemical staining showed significant reductions in Ki-67 (p < 0.001) and VEGF (p < 0.001) and a significant elevation in E-cadherin (p = 0.005) in the 10 mg/kg Dox + 20 mg/kg treatment group than in 10 mg/kg Dox alone group. Hesperidin can be considered as a potentially suitable anti-cancer agent for BC that can synergize with other chemotherapeutics.

Effects of Adriamycin-Cytoxan chemotherapy on hematological and electrolyte parameters among breast cancer patients

Background

Adriamycin-Cytoxan (AC) is a common chemotherapy treatment for breast cancer (BC) patients. Its electrolyte and hematological adverse effects have not been addressed adequately.

Objective

This study aimed to assess the effect of AC on hematological and electrolyte parameters among BC patients.

Methods

A hospital-based comparative cross-sectional study design was conducted from March to November 2022. Randomly selected AC-treated (n=100) and untreated (n=100) patients were included. Structured questionnaire and medical records were used to collect sociodemographic data. Anthropometric parameters, hematological indices, and serum electrolytes were measured. Cobas Integra 400+and SYSMEX-XT-4000i were used to analyze serum electrolytes and hematological indices respectively. The data were analyzed using SPSS version 25. Independent t-test and chi-square test were used. p-value <0.05 was considered statistically significant.

Results

AC-treated patients' mean total white blood cell (TWBC), neutrophil (NE), lymphocyte (LY), red blood cell (RBC), hemoglobin (Hgb), hematocrit (HCT), and sodium(Na+) values were significantly reduced (p<0.05) than patients with no treatment. However, mean eosinophils (EO), platelet (PLT) counts, red cell distribution-width (RDW), potassium (K+), and plateletcrit (PCT values were significantly increased (p<0.05).

Conclusion

The majority of blood cells and serum sodium were affected by AC treatment. Incorporating these parameters in the routine analysis and further studies on the detailed mechanism of action of this drug is required.

Breast cancer and occupation: Non-parametric and parametric net survival analyses among Swiss women (1990-2014)

Introduction

Occupation can contribute to differences in risk and stage at diagnosis of breast cancer. This study aimed at determining whether occupation, along with skill level and the socio-professional category, affect the breast cancer survival (BCS) up to 10 years after diagnosis.

Materials and methods

We used cancer registry records to identify women diagnosed with primary invasive breast cancer in western Switzerland over the period 1990-2014 and matched them with the Swiss National Cohort. The effect of work-related variables on BCS was assessed using non-parametric and parametric net survival methods.

Results

Study sample included 8,678 women. In the non-parametric analysis, we observed a statistically significant effect of all work-related variables on BCS. Women in elementary occupations, with low skill level, and in paid employment not classified elsewhere, had the lowest BCS, while professionals, those with the highest skill level and belonging to top management and independent profession category had the highest BCS. The parametric analysis confirmed this pattern. Considering elementary occupations as reference, all occupations but Craft and related trades had a hazard ratio (HR) below 1. Among professionals, technicians and associate professionals, and clerks, the protective effect of occupation was statistically significant and remained unchanged after adjustment for age, calendar period, registry, nationality, and histological type. After adjusting for tumor stage, the HRs increased only slightly, though turned non-significant. The same effect was observed in top management and independent professions and supervisors, low level management and skilled laborers, compared to unskilled employees.

Conclusion

These results suggest that work-related factors may affect BCS. Yet, this study was conducted using a limited set of covariates and a relatively small study sample. Therefore, further larger studies are needed for more detailed analyses of at risk occupations and working conditions and assessing the potential interaction between work-related variables and tumor stage.

LINC02381 suppresses cell proliferation and promotes apoptosis via attenuating IGF1R/PI3K/AKT signaling pathway in breast cancer

Identification of the genes and genetic networks involved in breast cancer development is a major need for prevention and therapy. LINC02381 (lncRNA) has already been introduced as a tumor suppressor in colorectal and gastric cancers. Here, we intended to investigate its potential functional effects on breast cancer. In the analysis performed on RNA-Seq and microarray data, the LINC02381 lncRNA was found to be significantly downregulated in the breast tumors and associated with poor survival of the patients. Then, the differential expression of LINC02381 was confirmed in breast tumor tissues and cancer cell lines using RT-qPCR. Overexpression of LINC02381 resulted in reduced IGF1R and p-AKT expression levels which indicates decreased PI3K pathway activity, detected by RT-qPCR and western blotting. At the cellular level, LINC02381 overexpression was followed by a decreased proliferation rate of transfected breast cell lines, detected by PI flow cytometry, RT-qPCR, colony formation, and MTT assays. Consistently, the results of Annexin-V/PI flow cytometry, RT-qPCR, caspase3/7 activity, and AO/EB-H33342/PI dual staining revealed that LINC02381 overexpression induced apoptosis and cell death. The reduced migration rate of these cells was also verified through wound healing assay and RT-qPCR against the EMT-involved genes. Our data show that LINC02381 exerts its tumor suppressor effect at least partly through attenuation of the IGF1R/PI3K/AKT signaling pathway, which originated from IGF1R downregulation.

An Insight into Molecular Targets of Breast Cancer Brain Metastasis

Brain metastasis is one of the major reasons of death in breast cancer (BC) patients, significantly affecting the quality of life, physical activity, and interdependence on several individuals. There is no clear evidence in scientific literature that depicts an exact mechanism relating to brain metastasis in BC patients. The tendency to develop breast cancer brain metastases (BCBMs) differs by the BC subtype, varying from almost half with triple-negative breast cancer (TNBC) (HER2^- ER^- PR^-), one-third with HER2⁺ (human epidermal growth factor receptor 2-positive, and around one-tenth with luminal subclass (ER⁺ (estrogen positive) or PR⁺ (progesterone positive)) breast cancer. This review focuses on the molecular pathways as possible therapeutic targets of BCBMs and their potent drugs under different stages of clinical trial. In view of increased numbers of clinical trials and systemic studies, the scientific community is hopeful of unraveling the underlying mechanisms of BCBMs that will help in designing an effective treatment regimen with multiple molecular targets.

Ligand-Specific Nano-Contrast Agents Promote Enhanced Breast Cancer CT Detection at 0.5 mg Au

For many cancer types, being undetectable from early symptoms or blood tests, or often detected at late stages, medical imaging emerges as the most efficient tool for cancer screening. MRI, ultrasound, X-rays (mammography), and X-ray CT (CT) are currently used in hospitals with variable costs. Diagnostic materials that can detect breast tumors through molecular recognition and amplify the signal at the targeting site in combination with state-of-the-art CT techniques, such as dual-energy CT, could lead to a more precise detection and assist significantly in image-guided intervention. Herein, we have developed a ligand-specific X-ray contrast agent that recognizes α5β1 integrins overexpressed in MDA-MB-231 breast cancer cells for detection of triple (−) cancer, which proliferates very aggressively. In vitro studies show binding and internalization of our nanoprobes within those cells, towards uncoated nanoparticles (NPs) and saline. In vivo studies show high retention of ~3 nm ligand-PEG-S-AuNPs in breast tumors in mice (up to 21 days) and pronounced CT detection, with statistical significance from saline and iohexol, though only 0.5 mg of metal were utilized. In addition, accumulation of ligand-specific NPs is shown in tumors with minimal presence in other organs, relative to controls. The prolonged, low-metal, NP-enhanced spectral-CT detection of triple (−) breast cancer could lead to breakthrough advances in X-ray cancer diagnostics, nanotechnology, and medicine.

Detection of Breast Cancer Using Histopathological Image Classification Dataset with Deep Learning Techniques

Cancer is one of the top causes of mortality, and it arises when cells in the body grow abnormally, like in the case of breast cancer. For people all around the world, it has now become a huge issue and a threat to their safety and wellbeing. Breast cancer is one of the major causes of death among females all over the globe, and it is particularly prevalent in the United States. It is possible to diagnose breast cancer using a variety of imaging modalities including mammography, computerized tomography (CT), magnetic resonance imaging (MRI), ultrasound, and biopsies, among others. To analyze the picture, a histopathology study (biopsy) is often performed, which assists in the diagnosis of breast cancer. The goal of this study is to develop improved strategies for various CAD phases that will play a critical role in minimizing the variability gap between and among observers. It created an automatic segmentation approach that is then followed by self-driven post-processing activities to successfully identify the Fourier Transform based Segmentation in the CAD system to improve its performance. When compared to existing techniques, the proposed segmentation technique has several advantages: spatial information is incorporated, there is no need to set any initial parameters beforehand, it is independent of magnification, it automatically determines the inputs for morphological operations to enhance segmented images so that pathologists can analyze the image with greater clarity, and it is fast. Extensive tests were conducted to determine the most effective feature extraction techniques and to investigate how textural, morphological, and graph characteristics impact the accuracy of categorization classification. In addition, a classification strategy for breast cancer detection has been developed that is based on weighted feature selection and uses an upgraded version of the Genetic Algorithm in conjunction with a Convolutional Neural Network Classifier. The practical application of the suggested improved segmentation and classification algorithms for the CAD framework may reduce the number of incorrect diagnoses and increase the accuracy of classification. So, it may serve as a second opinion tool for pathologists and aid in the early detection of diseases.

Artificial Intelligence-Based Breast Cancer Diagnosis Using Ultrasound Images and Grid-Based Deep Feature Generator

Purpose

Breast cancer is a prominent cancer type with high mortality. Early detection of breast cancer could serve to improve clinical outcomes. Ultrasonography is a digital imaging technique used to differentiate benign and malignant tumors. Several artificial intelligence techniques have been suggested in the literature for breast cancer detection using breast ultrasonography (BUS). Nowadays, particularly deep learning methods have been applied to biomedical images to achieve high classification performances.

Patients and Methods

This work presents a new deep feature generation technique for breast cancer detection using BUS images. The widely known 16 pre-trained CNN models have been used in this framework as feature generators. In the feature generation phase, the used input image is divided into rows and columns, and these deep feature generators (pre-trained models) have applied to each row and column. Therefore, this method is called a grid-based deep feature generator. The proposed grid-based deep feature generator can calculate the error value of each deep feature generator, and then it selects the best three feature vectors as a final feature vector. In the feature selection phase, iterative neighborhood component analysis (INCA) chooses 980 features as an optimal number of features. Finally, these features are classified by using a deep neural network (DNN).

Results

The developed grid-based deep feature generation-based image classification model reached 97.18% classification accuracy on the ultrasonic images for three classes, namely malignant, benign, and normal.

Conclusion

The findings obviously denoted that the proposed grid deep feature generator and INCA-based feature selection model successfully classified breast ultrasonic images.

Development of Coriandrum sativum Oil Nanoemulgel and Evaluation of Its Antimicrobial and Anticancer Activity

This study is aimed at developing coriander oil into a nanoemulgel and evaluating its antimicrobial and anticancer effects. Coriander (Coriandrum sativum) oil was developed into a nanoemulgel by using a self-nanoemulsifying technique with Tween 80 and Span 80. Hydrogel material (Carbopol 940) was then incorporated into the nanoemulsion and mixed well. After this, we evaluated the particle size, polydispersity index (PDI), rheology, antimicrobial effect, and cytotoxic activity. The nanoemulsion had a PDI of 0.188 and a particle size of 165.72 nm. Interesting results were obtained with the nanoemulgel against different types of bacteria, such as Pseudomonas aeruginosa, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus (MRSA), with a minimum inhibitory concentration (MIC) of 2.3 μg/ml, 3.75 μg/ml, and 6.5 μg/ml, respectively. In addition, the half-maximal inhibitory concentration (IC₅₀) of the nanoemulgel when applying it to human breast cancer cells (MCF-7), hepatocellular carcinoma cells (Hep3B), and human cervical epithelioid carcinoma cells (HeLa) was 28.84 μg/ml, 28.18 μg/ml, and 24.54 μg/ml, respectively, which proves that the nanoemulgel has anticancer effects. The development of C. sativum oil into a nanoemulgel by using a self-nanoemulsifying technique showed a bioactive property better than that in crude oil. Therefore, simple nanotechnology techniques are a promising step in the preparation of pharmaceutical dosage forms.

Risk Factors Affecting Survival Time of Breast Cancer Patients: The case of Southwest Ethiopia

BACKGROUND

Breast cancer is one of the non-communicable diseases and the main origin of the loss of life in the world. In Ethiopia, breast cancer is the second common cancer health problem for women. The main objective of this study was to identify the potential risk factors affecting the survival time of breast cancer patients in Southwest Ethiopia.

STUDY DESIGN

A retrospective study design.

METHODS

The data were taken from the patients' medical records that registered from January 1, 2015, to  January 31, 2020. A retrospective study design was used in this study. Different shared frailty survival models were employed to analyze the dataset.

RESULTS

Out of 642 recorded breast cancer patients, 447(69.6%) cases died during the study period, and 195 (30.4%) patients lost follow-up for unknown reasons. The median time to death for breast cancer patients was 10 months, and hospitals were used as a cluster effect. The result revealed that women with no smoking habit had about 3.35 times higher survival time than patients who had a smoking habit, and as breast cancer patients age increased, the survival time decreased by 0.99. Moreover, breast cancer patients in rural areas had about 0.14 times lower survival time, compared to breast cancer patients who were urban residents.

CONCLUSIONS

Age, place of residence, treatment taken, stage, histologic grade, tumor size, oral contraceptives, and smoking habits led to a shorter survival time. To reduce the burden of breast cancer, awareness should be given to the community.

The Impact of Improving Dermal Permeation on the Efficacy and Targeting of Liposome Nanoparticles as a Potential Treatment for Breast Cancer

Breast cancer is the most frequent malignancy in women. This work focuses on developing deformable liposomes as a potential carrier for breast cancer treatment and studying the impact of improving dermal permeation on the efficacy and targeting of liposomes. Raloxifene (RXF), an oestrogen antagonist, was used as a model drug. Using Box-Behnken design, different formulations of RXF-loaded deformable liposome (RLDL) were prepared using different propylene glycol, phospholipid and cholesterol concentrations. The percentage of entrapment efficiency (Y₁), particle size (Y₂), zeta potential (Y₃) and steady-state flux (Y₄) of the prepared formulations were all evaluated. Y₁ and Y₄ were significantly increased and Y₂ and Y₃ were significantly decreased when the propylene glycol concentration was increased. The optimization was obtained and the optimum formulation was that including phospholipid (1.40% w/w), cholesterol (0.15% w/w) and propylene glycol (10% v/v). The selected optimum formulation displayed a % EE of 78.34 ± 1.04% with a steady-state flux of 4.21 ± 0.02 µg/cm²/h. In order to investigate bioavailability, antitumor effectiveness and permeation, the optimum formulation was selected and included in a carbopol gel. The optimum gel formulation had 2.77 times higher bioavailability and, as a result, considerable antitumor action as compared to oral RXF. In conclusion, optimum RLDL gel may be an effective breast cancer treatment.

Estrogen-regulated AGR3 activates the estrogen receptor signaling pathway to promote tamoxifen resistance in breast cancer

PURPOSE

Anterior gradient 3 (AGR3) is associated with breast cancer progression, but its relationship with estrogen and tamoxifen resistance in breast cancer is still unclear. This study was designed to investigate the correlation of ARG3 and estrogen as well as the roles of ARG3 in tamoxifen resistance in breast cancer.

METHODS

Online database including GEPIA, UALCAN, and TCGA and rVista predictive tool were applied to analyze the expression patterns of AGR3 and its relationship with estrogen receptor 1. AGR3 knockdown and overexpression cell models were constructed. Luciferase reporter assay and ChIP were performed to investigate intermolecular interactions. Western blotting and qPCR were applied to assess targets at mRNA and protein levels, respectively. Cell counting and MTT assay were applied to determine the cell proliferation.

RESULTS

An elevation of AGR3 was observed in patients with breast cancer, especially in the patients with estrogen receptor (ER)-positive breast cancer. The TCGA dataset and in vitro data supported that AGR3 was positively correlated to ER. Further results demonstrated that ER protein bound to AGR3 promoter sites. AGR3 expression exhibited a positive correlation to cell viability. Besides, AGR3 promoted tamoxifen resistance in breast cancer.

CONCLUSION

AGR3 is associated with estrogen and promotes tamoxifen resistance in breast cancer.

Why We Will Continue to Lose Our Battle with Cancers If We Do Not Stop Their Triggers from Environmental Pollution

Besides our current health concerns due to COVID-19, cancer is a longer-lasting and even more dramatic pandemic that affects almost a third of the human population worldwide. Most of the emphasis on its causes has been posed on genetic predisposition, chance, and wrong lifestyles (mainly, obesity and smoking). Moreover, our medical weapons against cancers have not improved too much during the last century, although research is in progress. Once diagnosed with a malignant tumour, we still rely on surgery, radiotherapy, and chemotherapy. The main problem is that we have focused on fighting a difficult battle instead of preventing it by controlling its triggers. Quite the opposite, our knowledge of the links between environmental pollution and cancer has surged from the 1980s. Carcinogens in water, air, and soil have continued to accumulate disproportionally and grow in number and dose, bringing us to today's carnage. Here, a synthesis and critical review of the state of the knowledge of the links between cancer and environmental pollution in the three environmental compartments is provided, research gaps are briefly discussed, and some future directions are indicated. New evidence suggests that it is relevant to take into account not only the dose but also the time when we are exposed to carcinogens. The review ends by stressing that more dedication should be put into studying the environmental causes of cancers to prevent and avoid curing them, that the precautionary approach towards environmental pollutants must be much more reactionary, and that there is an urgent need to leave behind the outdated petrochemical-based industry and goods production.

Effects of fertility on breast cancer incidence trends: comparing France and US

PURPOSE

Breast cancer incidence rates are now higher in France than most other European countries as well as the United States (US). Increasing breast cancer incidence rates globally have often been attributed to declining fertility rates.

METHODS

We compared temporal trends in breast cancer incidence in France and the US, and examined the extent temporal trends in national fertility rates can explain the temporal trends in breast cancer incidence. This study of temporal trends used estimates of annual percent change (APC) from cancer registry data in France and the US (1978-2016) and national fertility data (1958-2011). We estimated the APCs for all ages (overall APC) and for specific age groups (under 50, 50-64 years, and 65 years and over).

RESULTS

The overall APC was over three times higher in France than the US (France APC = 1.63%, 95% CI 1.43-1.84; US APC = 0.51, 95% CI 0.31-0.72). The overall APCs remained positive and statistically significant after adjusting for fertility trends irrespective of assumptions on fertility lags (France APC = 1.61-0.91 for a 5-year to 20-year lag, respectively; US APC = 0.37-0.36 for a 5-year to 20-year lag, respectively). Similarly, among women under 50, the APC was over 3.5 times higher in France than the US (France APC = 1.22, 95% CI 1.07-1.37; US APC = 0.33, 95% CI 0.22-0.44), and APCs remained positive after adjusting for fertility (France APC = 1.21-1.28 for a 5-year to 20-year lag, respectively; US APC = 0.38-0.26 for a 5-year to 20-year lag, respectively).

CONCLUSIONS

Based on these trend analyses, changes in fertility rate trends do not fully explain the increase incidence in breast cancer seen in both France and the US, nor the magnitude of difference between the two countries. This was seen overall and in age-specific groups.

Photoacoustic dual-scan mammoscope: results from 38 patients

We have developed a photoacoustics-based imaging system, the dual-scan mammoscope (DSM), that combines optical contrasts with acoustic detection, to obtain the angiographic features in human breast. In this study, we investigated whether the system can differentiate malignant tumor and healthy breast. We have imaged 38 patients with various tumor types and compared results of tumor-bearing breast with healthy breast for each patient. We also compared the photoacoustic and ultrasound imaging results with clinical US. Vascular features in and around the tumor mass were visualized. We found that tumor-bearing breast contained vessels of larger caliber and exhibited stronger variations in the background signals than those in the contralateral healthy breasts. Preliminary data on photoacoustic and ultrasound images also indicate that the technique has potential in differentiating different tumor types. Overall, our results indicate that combining photoacoustic and ultrasound images can improve breast cancer screening.

Breast cancer among Danish women occupationally exposed to diesel exhaust and polycyclic aromatic hydrocarbons, 1964-2016

Objective:

The aim of this study was to explore the association between occupational exposure to diesel exhaust and polycyclic aromatic hydrocarbons (PAH), respectively, and breast cancer subtypes.

Methods:

The study included 38 375 women <70 years with incident breast cancer, identified in the Danish Cancer Registry, and 5 breast cancer-free controls per case who were randomly selected from the Danish Civil Registration System and matched on year of birth. Full employment history was obtained for all study subjects from a nationwide pension fund, and exposure to diesel exhaust and PAH was assessed using a job exposure matrix. Conditional logistic regression was used for estimation of odds ratios (OR) with adjustment for reproductive factors and socioeconomic status.

Results:

No noteworthy associations were observed for overall breast cancer in women exposed to diesel exhaust. However, diesel exhaust modestly elevated the risk of estrogen receptor negative breast tumors before age 50 [OR 1.26, 95% confidence interval (CI) 1.09–1.46]. Duration– and dose–response relationships were further observed for this subtype in this age group. No notable risk patterns were generally observed for PAH exposure.

Conclusion:

Occupational exposure to diesel exhaust may increase the risk of early-onset estrogen receptor negative breast tumors in women. Future studies exploring this association are warranted.

Occupational exposure to solar ultraviolet B radiation and risk of subtypes of breast cancer in Danish women

OBJECTIVES

Previous epidemiological studies have indicated that solar ultraviolet B radiation (UVR) may have a protective effect on breast cancer. However, the evidence remains inconclusive. Despite the fact that outdoor work history may be considered a reliable measure of long-term UVR exposure, objective information on lifetime employment has not been included in previous investigations focusing on breast cancer. To address this issue, we explored the association between occupational UVR exposure and female breast cancer, including subtypes.

METHODS

A total of 38 375 women under the age of 70 years were identified with primary breast cancer using the Danish Cancer Registry. Five female controls born on the same year, alive and free of breast cancer at the time of diagnosis of the index case, were randomly selected from the Danish Civil Registration System. The Danish Supplementary Pension Fund Register was used to retrieve full employment history, and a job exposure matrix was used to assess occupational UVR exposure. Conditional logistic regression with adjustment for important confounders was used to estimate the OR.

RESULTS

We observed no overall association between occupational UVR exposure and breast cancer. After the age of 50 years, longer duration of UVR exposure (≥20 years: OR=0.83, 95% CI 0.75 to 0.92) and highest cumulative exposure (OR=0.89, 95% CI 0.83 to 0.95) were inversely associated with risk. Our results did not reflect any notable risk difference by oestrogen receptor status.

CONCLUSIONS

This study indicates an inverse association between long-term occupational UVR exposure and late-onset breast cancer. This finding needs further attention in future occupational studies.

Relationships between Breast Feeding and Breast Cancer Subtypes: Lessons Learned from Studies in Humans and in Mice

There are differential risk relationships between parity and breast cancer according to estrogen receptor (ER) status, with an increased risk of ER^- disease reduced by breastfeeding. This may be particularly relevant for understanding the higher incidence of ER^- tumors in Black women, who are more likely to be parous and less likely to breastfeed than other U.S. groups. Potential mechanisms for these relationships may include effects of disordered breast involution on inflammatory milieu in the breast as well as epigenetic reprogramming in the mammary gland, which can affect cell fate decisions in progenitor cell pools. In normal breast tissue, parity has been associated with hypermethylation of FOXA1, a pioneer transcription factor that promotes the luminal phenotype in luminal progenitors, while repressing the basal phenotype. In breast tumors, relationships between FOXA1 methylation and parity were strongest among women who did not breastfeed. Here, we summarize the epidemiologic literature regarding parity, breastfeeding, and breast cancer subtypes, and review potential mechanisms whereby these factors may influence breast carcinogenesis, with a focus on effects on progenitor cell pools in the mammary gland.

Trends in Parity and Breast Cancer Incidence in US Women Younger Than 40 Years From 1935 to 2015

IMPORTANCE

During the past several decades, breast cancer incidence has been increasing for women younger than 40 years. The increase matches the decrease in parity, an established breast cancer risk factor, but secular trends in incidence have not been examined prior to the 1970s.

OBJECTIVE

To examine whether secular trends in parity explain the increase in breast cancer incidence among US women aged 25 to 39 years from 1935 to 2015.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study used population-based aggregate-level data from the Connecticut Tumor Registry (CTR) to examine breast cancer incidence and age-standardized rates among women aged 25 to 39 years from 1935 to 2015. National mean live births were calculated using birth data from the National Vital Statistics System (NVSS) from 1930 to 2015 (allowing for 5-year lag). Linear regression was used to compare a baseline model of year estimating age-adjusted breast cancer incidence rate with a model that adjusted for parity constructs.

MAIN OUTCOMES AND MEASURES

Breast cancer incidence rates among women aged 25 to 39 years from 1935 to 2015.

RESULTS

Among women in Connecticut aged 25 to 39 years from 1935 to 2015, incidence of breast cancer for women aged 25 to 39 years increased 0.65% (95% CI, 0.53%-0.77%) per year, from 16.3 breast cancer diagnoses per 100 000 women in 1935 to 38.5 breast cancer diagnoses per 100 000 women in 2015. This increase began nearly 4 decades before the secular decrease in parity (mean [SD] parity peaked at 2.26 [0.87] live births per woman in 1966 and in 2010 had decreased to 1.41 [0.71] live births per woman). Age-specific parity trends explained only 0% to 4% of the variability in incidence over time.

CONCLUSION AND RELEVANCE

These findings suggest that breast cancer incidence for women aged 25 to 39 years has been significantly increasing since the 1930s and cannot be attributed to changes in parity over time.

The estrogen effect; clinical and histopathological evidence of dichotomous influences in dogs with spontaneous mammary carcinomas

The purpose of this study was to investigate the associations and explore the relationships between hormonal factors (serum estrogen, estrogen receptors and ovariohysterectomy) and other clinical/histological prognostic factors and their impact on outcome in dogs with mammary carcinomas. Data from two separate prospective studies on dogs with spontaneous mammary carcinomas were used for this research. All dogs underwent standardized diagnostic testing, staging, surgery and follow-up examinations. Serum estrogen was analyzed by competitive enzyme immunoassay or radioimmunoassay, and tumor estrogen receptor (ER) expression was analyzed by immunohistochemistry. A total of 159 dogs were included; 130 were spayed and 29 remained. High serum estrogen was associated with an overall longer time to metastasis (p = 0.021). When stratifying based on spay group, the effect was only significant in spayed dogs, (p = 0.019). Positive tumor ER expression was also associated with a longer time to metastasis (p = 0.025), but similar to above, only in dogs that were spayed (p = 0.049). Further subgroup analysis revealed that high serum estrogen was significantly associated with improved survival in dogs with ER positive tumors, but only in spayed dogs (p = 0.0052). Interestingly, the effect of spaying was the opposite in dogs with ER negative tumors; here, intact dogs with high serum estrogen but ER negative tumors had a significantly longer time to metastasis (p = 0.036). Low serum estrogen was associated with increased risk for the development of non-mammary tumors in the post-operative period (p = 0.012). These results highlight the dual effect of estrogen in cancer: Estrogen acts as a pro-carcinogen in ER positive mammary tumors, but a may have a protective effect in ER negative tumors, potentially via non-receptor mechanisms. The latter is supported by the decreased risk for non-mammary tumors in dogs with high serum estrogen, and explains the increased incidence of certain non-mammary tumors in in dogs spayed at an early age.

Change in mammographic density across birth cohorts of Dutch breast cancer screening participants

High mammographic density is a well‐known risk factor for breast cancer. This study aimed to search for a possible birth cohort effect on mammographic density, which might contribute to explain the increasing breast cancer incidence. We separately analyzed left and right breast density of Dutch women from a 13‐year period (2003–2016) in the breast cancer screening programme. First, we analyzed age‐specific changes in average percent dense volume (PDV) across birth cohorts. A linear regression analysis (PDV vs. year of birth) indicated a small but statistically significant increase in women of: 1) age 50 and born from 1952 to 1966 (left, slope = 0.04, p = 0.003; right, slope = 0.09, p < 0.0001); 2) age 55 and born from 1948 to 1961 (right, slope = 0.04, p = 0.01); and 3) age 70 and born from 1933 to 1946 (right, slope = 0.05, p = 0.002). A decrease of total breast volume seemed to explain the increase in PDV. Second, we compared proportion of women with dense breast in women born in 1946–1953 and 1959–1966, and observed a statistical significant increase of proportion of highly dense breast in later born women, in the 51 to 55 age‐groups for the left breast (around a 20% increase in each age‐group), and in the 50 to 56 age‐groups for the right breast (increase ranging from 27% to 48%). The study indicated a slight increase in mammography density across birth cohorts, most pronounced for women in their early 50s, and more marked for the right than for the left breast.

What's new?

Women with dense breast tissue are at increased risk of breast cancer. Here, changes in mammographic density were investigated across birth cohorts in women enrolled in a breast cancer screening program in the Netherlands. The findings reveal an increase in the average fraction of dense tissue in the breast across cohorts. In particular, greater breast density was observed in a higher proportion of women in later‐born than earlier‐born birth cohorts. The increase was most significant among women in their early 50s and may be linked to a reported shift toward older age at menopause among women in Europe.

A Study of the Clinical Features and the Treatment of Breast Cancer in 374 Patients in Iran

For evaluation of clinical features and state of the art in the treatment of breast cancer in Iran, we studied 347 consecutive patients among 1123 hospital admissions (in 14 hospitals in three cities) who had undergone surgery for a mass in their breasts during a 2-year period, 1991 to 1992. Thirty-nine additional patients with breast cancer had been treated in the second year of the study, an increment of 8.9%. The relative frequency of positive biopsies for breast cancer was 31% for the entire series. In Teheran, Babol and Yazd, it was 35%, 24.2% and 18.1%, respectively. The mean age for the entire series was 48 ± 1 years. The mean age for patients from Yazd was 51 ± 9, which was higher than the mean age (41.5 ± 16) of patients from Babol. The pathologic diameter was >2.1 cm (pT2 and pT3) in 59.36% of the tumors. In 15.56% of the patients, the exact size of the tumor was not available. In 83.45% of the patients, the tumors were reported as infiltrating ductal carcinoma. Of 173 patients in whom regional nodes had been histologically examined, 80% had metastatic involvement (stage II disease). Modified radical mastectomy had been used more than radical mastectomy in this series, but the choice of the operation was not related to the size of tumor.

Ifosfamide and Etoposide in Previously Treated Patients with Advanced Breast Cancer

Aims and background

Ifosfamide is an active alkylating agent in the treatment of breast cancer, as a first-line therapy and in advanced disease. Since the combination of etoposide with an alkylating agent produces a synergistic and tolerable activity in various malignancies, in the present study, ifosfamide and etoposide were administered to patients with advanced breast cancer to evaluate the response characteristics and the toxicity profile.

Study design

The combination of ifosfamide, mesna and etoposide was prospectively administered to 41 previously treated patients with stage IV breast carcinoma. The treatment schedule consisted of ifosfamide, 1500 mg/m2, infused over 24 hrs with 1500 mg/m2 mesna on days 1 to 5 and 120 mg/m2 etoposide, infused over 1 hr on days 1 to 3, to be repeated every 4th week.

Results

After a median follow-up of 10 months, an objective response rate of 23% (overall 2.5% complete remission and 20.5% partial remission) and a median response duration of 5.3 months were obtained in 39 assessable patients. The non-responder group consisted of 28.3% stable disease and 48.7% progressive disease. The prior status of chemotherapy was the only significant prognostic factor with an impact on the response rate. The overall toxicity was generally mild, with grade 3 myelotoxicity encountered in 25.7% of patients.

Conclusions

The tolerable side effect profile of the ifosfamide and etoposide combination might be advantageous as regards the quality of life. To improve the rate and/or the duration of response and to clarify the precise role of the ifosfamide-etoposide combination in previously treated advanced breast cancer, further trials are warranted.

The University of Wisconsin Breast Cancer Epidemiology Simulation Model: An Update

The University of Wisconsin Breast Cancer Epidemiology Simulation Model (UWBCS), also referred to as Model W, is a discrete-event microsimulation model that uses a systems engineering approach to replicate breast cancer epidemiology in the US over time. This population-based model simulates the lifetimes of individual women through 4 main model components: breast cancer natural history, detection, treatment, and mortality. A key feature of the UWBCS is that, in addition to specifying a population distribution in tumor growth rates, the model allows for heterogeneity in tumor behavior, with some tumors having limited malignant potential (i.e., would never become fatal in a woman's lifetime if left untreated) and some tumors being very aggressive based on metastatic spread early in their onset. The model is calibrated to Surveillance, Epidemiology, and End Results (SEER) breast cancer incidence and mortality data from 1975 to 2010, and cross-validated against data from the Wisconsin cancer reporting system. The UWBCS model generates detailed outputs including underlying disease states and observed clinical outcomes by age and calendar year, as well as costs, resource usage, and quality of life associated with screening and treatment. The UWBCS has been recently updated to account for differences in breast cancer detection, treatment, and survival by molecular subtypes (defined by ER/HER2 status), to reflect the recent advances in screening and treatment, and to consider a range of breast cancer risk factors, including breast density, race, body-mass-index, and the use of postmenopausal hormone therapy. Therefore, the model can evaluate novel screening strategies, such as risk-based screening, and can assess breast cancer outcomes by breast cancer molecular subtype. In this article, we describe the most up-to-date version of the UWBCS.

Insulin-Like Growth Factor II (IGF-II) Immunohistochemistry in Breast Cancer: Relationship with the Most Important Morphological and Biochemical Prognostic Parameters

Recent in situ hybridization experiments have shown a high content of IGF-II mRNA in breast cancer stroma. The aim of this study was to examine the relationship between IGF-II protein expression and several prognostic parameters in 75 infiltrating ductal carcinomas (IDC) of the breast. Tissue sections were evaluated for proliferative activity, IGF-II protein, ER, PgR, p53, and p21 expression using immunohistochemical procedures. The degree of stromal proliferation was assessed. Menopausal status, axillary lymph node involvement and nuclear grade were known. Thirty-five patients (44.3%) were premenopausal and 47 (62.6%) had lymph node metastases. Marked stromal proliferation was found in 34 (45.3%) specimens and high nuclear grade in 20 (26.5%). Eighteen tumors (24%) showed no IGF-II immunostaining. In the positive cases, IGF-II was detected both in the tumor stroma and in the cytoplasm of epithelial cancer cells: a high IGF-II content was found in 12 specimens (16.0%), a low content in 14 (18.7%) and a moderate content in 31 (41.3%). Twenty-four tumors (32.0%) showed high proliferative activity. Both ER and PgR were expressed in the nucleus of cancer cells: 49 tumors (65.3%) were ER positive (ER+) and 34 (45.3%) PgR positive (PgR+). p21 protein was detected in 37 tumors (49.6%) and p53 in 12 (16%). IGF-II protein was not correlated with menopausal status, lymph node metastases, nuclear grade, proliferative activity, ER or p53. In contrast, IGF-II correlated strongly with stromal proliferation (p=0.008), PgR (p=0.03) and p21 (p=0.01). This study demonstrates that in IDC of the breast IGF-II protein is expressed in the epithelium and stroma of the majority of tumors and is correlated with stromal amount, PgR and p21 expression. These preliminary results indicate that IGF-II expression in breast cancer is connected with two important regulators of breast cancer growth and differentiation.

Vitamin D receptor polymorphisms or serum levels as key drivers of breast cancer development? The question of the vitamin D pathway

As total vitamin D levels are often lower in black than in white Americans, the former are frequently classified as vitamin D-deficient. To fully understand African vitamin D (25(OH)D) status, other factors should be considered, e.g. vitamin D blood carrier, vitamin D-binding protein (DBP), vitamin D receptor (VDR) and DBP polymorphisms. A prospective study on an indigenous black Tanzanian and a Caucasian Italian population was performed on 50 healthy donors from both populations and 35 Caucasian and 18 African breast cancer patients. 25(OH)D and DBP serum levels were analyzed by ELISA. A1012G, Cdx2 and Fok1 VDR polymorphisms and DBP polymorphisms rs4588 and rs7041 were genotyped by real-time PCR. Vitamin D and DBP levels were lower in healthy African donors than in Caucasians. Africans had a significantly higher frequency of AA and CC for Cdx2 and Fok1 polymorphisms, respectively. These allelic variants were related to a higher transcription of VDR gene and a higher activity of VDR receptor. With regard to polymorphism distribution, Africans showed innate higher levels and activity of VDR. We conclude that a strengthening of the vitamin D pathway could have a protective role against the development of breast cancer in the African population.

Population Attributable Risk of Modifiable and Nonmodifiable Breast Cancer Risk Factors in Postmenopausal Breast Cancer

We examined the proportions of multiple types of breast cancers in the population that were attributable to established risk factors, focusing on behaviors that are modifiable at menopause. We estimated the full and partial population attributable risk percentages (PAR%) by combining the relative risks and the observed prevalence rates of the risk factors of interest. A total of 8,421 cases of invasive breast cancer developed in postmenopausal women (n = 121,700) in the Nurses' Health Study from 1980-2010. We included the following modifiable risk factors in our analyses: weight change since age 18 years, alcohol consumption, physical activity level, breastfeeding, and menopausal hormone therapy use. Additionally, the following nonmodifiable factors were included: age, age at menarche, height, a combination of parity and age at first birth, body mass index at age 18 years, family history of breast cancer, and prior benign breast disease. When we considered all risk factors (and controlled for age), the PAR% for invasive breast cancers was 70.0% (95% confidence interval: 55.0, 80.7). When considering only modifiable factors, we found that changing the risk factor profile to the lowest weight gain, no alcohol consumption, high physical activity level, breastfeeding, and no menopausal hormone therapy use was associated with a PAR% of 34.6% (95% confidence interval: 22.7, 45.4). The PAR% for modifiable factors was higher for estrogen receptor-positive breast cancers (PAR% = 39.7%) than for estrogen receptor-negative breast cancers (PAR% = 27.9%). Risk factors that are modifiable at menopause account for more than one-third of postmenopausal breast cancers; therefore, a substantial proportion of breast cancer in the United States is preventable.

Organochlorine Residues and Risk of Breast Cancer

Considerable attention has recently been focused on the possible role of estrogenic compounds as etiologic agents in the development of human breast cancer. This review summarizes data from relevant laboratory and epidemiological studies to assess the hypothesis that exposure to organochlo-rines, and specifically 2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane (DDT), increases breast cancer risk. Organochlorine compounds, including pesticides such as DDT and industrial compounds such as the polychlorinated biphenyls (PCBs), have had a long history of use. In general, these compounds are characterized by their high lipophilicity and environmental persistence. DDT was widely used in agriculture and public health programs from 1943 to 1972, when it was removed from use in the Western world. DDT is still used, however, in many developing nations. The International Agency for Research on Cancer concluded that there was adequate evidence that DDT was carcinogenic in laboratory animals, yet epidemiological evidence has not been compelling. The estrogenic activity of o, p'-DDT has been well characterized; however, the affinity of estrogen receptors for this compound is very weak and reported to be 1/2,000–1/10,000 that of 17β-estradiol. Epidemiologically, some investigators have reported elevated levels of 1,1-dichloro-2,2-bis(p-chloro-phenyl)ethylene, a DDT metabolite, and PCBs in breast adipose tissue and blood serum taken from breast cancer patients when compared with controls, while others have reported the absence of such an association. While the etiology of breast cancer is not fully understood, it is generally recognized that estrogenic compounds may increase the risk of disease. Contemporary human exposure to DDT and other organochlorines is very limited and would likely play an insignificant role when compared with other sources of exposure, such as estrogen replacement therapy and phytoestrogens in food.

Human somatostatin receptor-3 distinctively induces apoptosis in MCF-7 and cell cycle arrest in MDA-MB-231 breast cancer cells

Somatostatin (SST) mediates cytostatic and pro-apoptotic effects through five somatostatin receptors (SSTR1-5). The modest clinical benefits of SST analogs in cancers of different origin such as breast cancer are attributed to diminished SSTRs expression at tumor sites. In the present study, SSTR3 was overexpressed in MCF-7 and MDA-MB-231, and analyzed for downstream signaling molecules associated with cytostatic and cytotoxic effect. Cells overexpressing SSTR3 displayed inhibition of EGF induced proliferation and enhanced antiproliferative effect of SSTR3-specific agonist in comparison to non-transfected cells. SSTR3 overexpression in MCF-7 cells (R3-MCF-7) constitutively enhanced TUNEL staining, PARP-1 and p27(Kip1) expression suggesting apoptosis and cell-cycle arrest. Conversely, R3-MB-231 cells with SSTR3 overexpression exerted cytostatic and were devoid of any cytotoxic effects. The expression of PTP-1C and the status of ERK1/2, p38 and PI3K phosphorylation was modulated in a cell-specific manner. These findings provide new insights in understanding the antiproliferative role of SSTR3 in breast tumor biology.

Receptor activator for nuclear factor-κB ligand signaling promotes progesterone-mediated estrogen-induced mammary carcinogenesis

Breast cancer is a leading cause of cancer-related death in women. Prolonged exposure to the ovarian hormones estrogen and progesterone increases the risk of breast cancer. Although estrogen is known as a primary factor in mammary carcinogenesis, very few studies have investigated the role of progesterone. Receptor activator for nuclear factor-κB (NF-κB) ligand (RANKL) plays an important role in progesterone-induced mammary carcinogenesis. However, the molecular mechanism underlying RANKL-induced mammary carcinogenesis remains unknown. In our current study, we show that RANKL induces glioma-associated oncogene homolog 1 (GLI-1) in estrogen-induced progesterone-mediated mammary carcinogenesis. In vivo experiments were carried out using ACI rats and in vitro experiments were carried out in MCF-7 cells. In ACI rats, mifepristone significantly reduced the incidence of mammary tumors. Likewise, mifepristone also inhibited the proliferation of MCF-7 cells. Hormone treatments induced RANKL, receptor activator of NF-κB (RANK), and NF-κB in a protein kinase B-dependent manner and inhibited apoptosis by activation of anti-apoptotic protein Bcl2 in mammary tumors and MCF-7 cells. Mechanistic studies in MCF-7 cells reveal that RANKL induced upstream stimulatory factor-1 and NF-κB, resulting in subsequent activation of their downstream target GLI-1. We have identified that progesterone mediates estrogen-induced mammary carcinogenesis through activation of GLI-1 in a RANKL-dependent manner.

Correlation of serum toll like receptor 9 and trace elements with lipid peroxidation in the patients of breast diseases

Toll-like receptors are recognized as redox sensitive receptor proteins and have been implicated in cellular response to oxidative stress. Altered pro-oxidant-antioxidant balance leads to an increased oxidative damage and consequently play an important role in breast diseases. The study was designed to access the oxidative stress status by quantification of byproducts generated during lipid peroxidation and inadequate trace elements during oxidative damage and its effects on the toll like receptor (TLR) activity in patients of breast diseases. Decreased levels of selenium, copper, zinc, magnesium and iron with elevated levels of malondialdehyde (marker of lipid peroxidation) were accompanied by decreased TLR activity in patients of benign breast diseases as well as breast carcinoma. A similar pattern was observed with the advancement of disease and its subsequent progression in breast carcinoma patients. Results of multinomial regression analysis suggest benign breast disease patients are at higher risk of developing breast cancer with high odds ratio of lipid damage.

The effectiveness of nano chemotherapeutic particles combined with mifepristone depends on the PR isoform ratio in preclinical models of breast cancer

There is clinical and experimental evidence suggesting that antiprogestins might be used for the treatment of selected breast cancer patients. Our aim was to evaluate the effect of albumin-bound paclitaxel (Nab-paclitaxel) and pegylated doxorubicin liposomes (PEG-LD) in combination with mifepristone (MFP) in experimental breast cancer models expressing different ratios of progesterone receptor (PR) isoforms A and B. We used two antiprogestin-responsive (PRA>PRB) and two resistant (PRA<PRB) murine mammary carcinomas growing in BALB/c, GFP-BALB/c or nude mice, along with human T47D-YA and T47D-YB xenografts growing in immunocompromised NSG mice. MFP improved the therapeutic effects of suboptimal doses of Nab-paclitaxel or PEG-LD in murine and human carcinomas with higher levels of PRA than PRB. MFP induced tissue remodeling in PRA-overexpressing tumors, increasing the stromal/tumor cell ratio and the number of functional vessels. Accordingly, an increase in nanoparticles and drug accumulation was observed in stromal and tumor cells in MFP-treated tumors. We conclude that MFP induces an increase in vessels during tissue remodeling, favoring the selective accumulation of nanoparticles inside the tumors. We propose that antiprogestins have the potential to enhance the efficacy of chemotherapy in breast tumors with a high PRA/PRB ratio.

p90/CIP2A mediates breast cancer cell proliferation and apoptosis

Cancerous inhibitor of PP2A (p90/CIP2A) was recently characterized as an innovative oncoprotein in human malignancies. p90/CIP2A inhibited c-Myc-associated PP2A phosphatase activity to promote cell proliferation and tumor growth. A growing number of studies have demonstrated that the overexpression of p90/CIP2A in various human malignancies. But the function of p90/CIP2A in cancer progression is still poorly understood. In the current research, we aim to explore the biological function of p90/CIP2A in breast cancer. shRNA knockdown was performed in MDA-MB-231 and LM2-4 cell lines. Cell proliferation assay, colony formation assay and flow cytometry were carried out to evaluate the role of p90/CIP2A in cell proliferation and apoptosis. p90/CIP2A depletion in breast cancer cells inhibited proliferation and increased paclitaxel-induced apoptosis. Furthermore, p90/CIP2A silencing down-regulated the expression of c-Myc and the level of p-ERK1/2. Taken together, our data suggest that p90/CIP2A as a crucial oncoprotein has been involved in cell proliferation and apoptosis, which may serve as a therapeutic target in breast cancer treatment.