European cancer mortality predictions for the year 2019 with focus on breast cancer

Mortality due to cervical and breast cancer in health regions of Brazil: impact of public policies on cancer care

OBJECTIVE

This analysis assessed the association between regional income, screening coverage for cervical and breast cancer, and temporal trends in mortality from these cancers in different Brazilian health regions.

STUDY DESIGN

Spatiotemporal ecological study across 450 health regions of Brazil.

METHODS

Data from 2010 Demographic Census were used to assess income. Variations in income distribution within health regions were measured using the Gini index. Data on screening coverage were obtained from the Ambulatory Information System (SIA/SUS). Mortality was assessed from the Global Burden of Disease Study 2019 data. The average annual percentage change (AAPC) in cervical and breast cancer mortality rates, 2010-2018, was calculated by health regions. Results were presented in regional maps. The associations between income, screening coverage and mortality changes were estimated by bivariate spatial correlation.

RESULTS

Health regions located in the South and Southeast regions of Brazil had the greatest percentages of screening coverage and highest per capita incomes with the lowest Gini index values. From 2010 to 2018, mortality rates for cervical cancer were highest in the North and Northeast health regions. Breast cancer mortality rates were highest in the South and Southeast health regions. The AAPC in breast and cervical cancer mortality had a negative association with per capita income and screening coverage, and a positive association with the Gini index.

CONCLUSIONS

There are large regional variations in income, screening coverage, and mortality rates for women with breast and cervical cancer. These inequities could be mitigated by policies to address income disparities and improved access to screening.

Permanent Indian ink tattoos for breast cancer radiotherapy: A United Kingdom study of the emotional impact on patients following radiotherapy

INTRODUCTION

Post-operative radiotherapy for early breast cancer is recommended for over 30,000 people every year in the United Kingdom. The majority of these patients will be advised to have radiotherapy alignment tattoos; permanent skin marks applied with Indian ink and a lancing needle, black/green/blue in colour and approximately 2 mm in diameter. The tattoos assist the therapeutic radiographers to position the patient accurately and reproducibly for each treatment fraction. The aim of this study was to investigate the emotional impact of radiotherapy tattoos on people following breast cancer radiotherapy.

METHODS

An electronic questionnaire was distributed by the charitable organisation, Breast Cancer Now, to their members who had undergone radiotherapy for early breast cancer. Based on the responses to the open and closed questions, an overall impact score was assigned to each respondent, and representative quotes extracted to contextualise the themes identified. Statistical tests were performed to evaluate the relationship between overall impact scores and several variables such as age at the time of radiotherapy, skin type, and age at the time of completing the questionnaire.

RESULTS

204 people responded to the questionnaire. 100% had permanent Indian ink tattoos during breast cancer radiotherapy. 95% could still see the midline tattoo. 22 subthemes were identified; 4 positive, 4 neutral and 14 negative. Radiotherapy tattoos served as a constant negative reminder for 27% and affected clothing choices in 14% of respondents. 11% described feelings of 'hating' them. 6% were assigned positive overall impact scores, 43% neutral, and 51% had negative overall impact scores. The black/green/blue ink pigment used was commonly described as unnatural; contributing strongly to the negative appearance of the tattoos.

CONCLUSION

Permanent Indian ink tattoos have a negative impact on emotional well-being in the months and years following radiotherapy for early breast cancer for many people. In contrast, a very small minority feel positively about the tattoos.

IMPLICATIONS FOR PRACTICE

Our findings are unlikely to be unique to this diagnostic cohort and supports the need to offer alternatives that are less-impactful to the recipient, accessible for people of all skin colours, and fit-for-purpose in terms of radiotherapy set-up. Acknowledgement of the significant negative impact and collaboration between industry, healthcare professionals and patient representatives is key to identifying and implementing suitable alternatives as standard of care.

Factors associated with deferral or non-performance of an organized breast cancer screening program during the COVID-19 pandemic in France

BACKGROUND

Delays in detection and treatment of breast cancer can lead to increased mortality. To date, participation in organized breast cancer screenings (OBCS) has been suboptimal worldwide. The objective of this study was to investigate the factors associated with deferral or non-performance of mammography during the COVID-19 pandemic for women who had previously participated in OBCS.

METHODS

A retrospective observational study was conducted on a cohort of 6282 women from the Aube Department of France, who were invited to an OBCS in 2020. Participants were divided into women who promptly underwent screening after receiving an invitation (between 22 and 25 months elapsed since the last mammogram), women who underwent late screening (≥26 months since the last mammogram), and those who were never screened. Data were collected from a self-reported questionnaire. Comparative and multivariable analyses modeling the probability of each type of attendance were performed using these data.

RESULTS

In total, 2301 women (aged 50-74 years) returned a valid questionnaire. Compared to women who promptly underwent mammography, non- and late-screening participants were younger, had less frequent gynecological follow-up and a less frequent history of colorectal cancer screening. Women with higher education status and those residing in socially disadvantaged areas were more likely to attend late.

CONCLUSION

The absence of regular gynecological follow-up and the absence of colorectal cancer screening were significant factors associated with deferral of or non-attendance at OBCS.

Effect of resistance exercise on physical fitness, quality of life, and fatigue in patients with cancer: a systematic review

Objective

The purpose of this study is to conduct a systematic review to assess the effects of different forms of resistance exercises (resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises) on physical fitness, quality of life (QOL), and fatigue of patients with cancer.

Methods

We conducted a systematic review using the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We searched PubMed, Web of Science, and Scopus databases for the studies from the establishment of the database to September 2023, including randomized controlled trials and clinical trials that evaluated the effects of different resistance exercise on physical fitness, QOL, and fatigue in all patients with cancer. Two reviewers independently assessed the quality of all the included studies using the Cochrane Handbook for Systematic Reviews of Interventions and MINORS scale. We divided the intervention into three types: resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises.

Results

In total, 48 studies (3,843 participants) met the inclusion criteria. The three exercise intervention forms have significant effects on physical fitness and QOL, but the improvement effect on fatigue is not clear. A total of 34 studies reported significant and beneficial effects of resistance exercise on physical fitness across all types of cancer. There were 28 studies that reported significant or borderline improvement effects of resistance on QOL, and only 10 studies reported significant effects of resistance exercise interventions on fatigue improvement in patients with cancer.

Conclusions

Resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises all have a positive effect on improving fitness and QOL in patients with cancer. Resistance exercise has an advantage in improving muscle strength, while combined resistance exercise has an advantage in improving QOL; however, there are no consistent findings in improving fatigue, although low-intensity resistance exercise is effective.

Systematic review registration

www.inplasy.com, identifier INPLASY2023110034.

A review concerning the breast cancer-related tumour microenvironment

Breast cancer (BC) is currently the most common malignant tumour in women and one of the leading causes of their death around the world. New and increasingly personalised diagnostic and therapeutic tools have been introduced over the last few decades, along with significant advances regarding the study and knowledge related to BC. The tumour microenvironment (TME) refers to the tumour cell-associated cellular and molecular environment which can influence conditions affecting tumour development and progression. The TME is composed of immune cells, stromal cells, extracellular matrix (ECM) and signalling molecules secreted by these different cell types. Ever deeper understanding of TME composition changes during tumour development and progression will enable new and more innovative therapeutic strategies to become developed for targeting tumours during specific stages of its evolution. This review summarises the role of BC-related TME components and their influence on tumour progression and the development of resistance to therapy. In addition, an account on the modifications in BC-related TME components associated with therapy is given, and the completed or ongoing clinical trials related to this topic are presented.

Invasive lobular breast cancer: Focus on prevention, genetics, diagnosis, and treatment

Invasive lobular cancer (ILC) is the most common of the breast cancer special types, accounting for up to 15% of all breast malignancies. The distinctive biological features of ILC include the loss of the cell adhesion molecule E-cadherin, which drives the tumor's peculiar discohesive growth pattern, with cells arranged in single file and dispersed throughout the stroma. Typically, such tumors originate in the lobules, are more commonly bilateral compared to invasive ductal cancer (IDC) and require a more accurate diagnostic examination through imaging. They are luminal in molecular subtype, and exhibit estrogen and progesterone receptor positivity and HER2 negativity, thus presenting a more unpredictable response to neoadjuvant therapies. There has been a significant increase in research focused on this distinctive breast cancer subtype, including studies on its pathology, its clinical and surgical management, and the high-resolution definition of its genomic profile, as well as the development of new therapeutic perspectives. This review will summarize the heterogeneous pattern of this unique disease, focusing on challenges in its comprehensive clinical management and on future insights and research objectives.

LILRB2 promotes immune escape in breast cancer cells via enhanced HLA-A degradation

PURPOSE

Increased expression of leukocyte immunoglobulin-like receptor subfamily B member 2 (LILRB2) is associated with immune evasion in breast cancer (BC). The aim of this study to elucidate the role of LILRB2 in BC progression.

METHODS

LILRB2 expression in tumor tissues was detected by immunohistochemical staining. Human leukocyte antigen A (HLA-A) expression in BC cells was detected by Western blotting, and HLA-A ubiquitination was detected by immunoprecipitation and histidine pulldown assay. An in-situ tumor model was established in nude BALB/c mice to verify the role of LILRB2 in immune escape. Finally, the functions and potential mechanisms of LILRB2 in BC progression were explored using in silico data.

RESULTS

LILRB2 was upregulated in BC tissues and cells, and correlated positively with poor prognosis. LILRB2 promoted BC progression by downregulating HLA-A expression. Mechanistically, LILRB2 facilitates the ubiquitination and subsequent degradation of HLA-A by promoting the interaction between the ubiquitin ligase membrane-associated ring finger protein 9 (MARCH9) and HLA-A. In syngeneic graft mouse models, LILRB2-expressing BC cells evaded CD8 + T cells and inhibited the secretion of cytokines by the cytotoxic CD8 + T cells.

CONCLUSION

LILRB2 downregulates HLA-A to promote immune evasion in BC cells and is a promising new target for BC treatment.

Effectiveness of a community-based multicomponent lifestyle intervention (the ADA programme) to improve the quality of life of French breast cancer survivors: protocol for a pragmatic cluster randomised trial and embedded qualitative study

INTRODUCTION

Breast cancer survivors (BCSs) are often faced with multiple mental and physical sequelae and are at increased risk of emotional distress, degraded health-related quality of life (HRQoL), chronic pain and fatigue.Physical activity is strongly associated with improved HRQoL and survival rates; however, adherence rates to recommendations for a healthy lifestyle are seldom satisfactory among BCSs. Also, few studies have examined the effectiveness of multicomponent and personalised interventions that integrate physical activity and motivational techniques to improve the HRQoL of BCS.

METHOD AND ANALYSIS

"Activité physique adaptée Doublée d'un Accompagnement d'après cancer" (ADA) is an integrated programme of physical activity enriched with a dietary and supportive care approach targeting BCS in the early post-treatment phase. The effectiveness of the ADA intervention will be evaluated using a cluster randomised controlled trial design with two arms (ADA programme vs usual care; 1:1 ratio).The ADA intervention aims to recruit 160 participants and will be implemented by Siel Bleu, a non-profit association specialised in health prevention via adapted physical activity. Measurements will be performed at baseline, 3, 6 and 12 months after the start of the intervention. The primary outcome will be participants' HRQoL, at 12 months measured by the Functional Assessment of Chronic Illness Therapy-Fatigue global score. Secondary outcome will include participants' physical, social, emotional and functional well-being. The effect of the intervention on physical activity level, motivation for physical activity, relation to food and self-efficacy will also be evaluated.

ETHICS AND DISSEMINATION

The study was approved by the 'CPP Paris XI' Institutional Review Board on 5 May 2022 (Ref no.: 21.04512.000048-22004). The study's findings will be shared through various channels, including academic publications, simplified reports for wider audiences and active engagement with medical and institutional organisations as well as patients' associations.

TRIAL REGISTRATION NUMBER

NCT05658341.

Identifying factors that indicate the possibility of non-visible cases on mammograms using mammary gland content ratio estimated by artificial intelligence

Background

Mammography is the modality of choice for breast cancer screening. However, some cases of breast cancer have been diagnosed through ultrasonography alone with no or benign findings on mammography (hereby referred to as non-visibles). Therefore, this study aimed to identify factors that indicate the possibility of non-visibles based on the mammary gland content ratio estimated using artificial intelligence (AI) by patient age and compressed breast thickness (CBT).

Methods

We used AI previously developed by us to estimate the mammary gland content ratio and quantitatively analyze 26,232 controls and 150 non-visibles. First, we evaluated divergence trends between controls and non-visibles based on the average estimated mammary gland content ratio to ensure the importance of analysis by age and CBT. Next, we evaluated the possibility that mammary gland content ratio ≥50% groups affect the divergence between controls and non-visibles to specifically identify factors that indicate the possibility of non-visibles. The images were classified into two groups for the estimated mammary gland content ratios with a threshold of 50%, and logistic regression analysis was performed between controls and non-visibles.

Results

The average estimated mammary gland content ratio was significantly higher in non-visibles than in controls when the overall sample, the patient age was ≥40 years and the CBT was ≥40 mm (p < 0.05). The differences in the average estimated mammary gland content ratios in the controls and non-visibles for the overall sample was 7.54%, the differences in patients aged 40-49, 50-59, and ≥60 years were 6.20%, 7.48%, and 4.78%, respectively, and the differences in those with a CBT of 40-49, 50-59, and ≥60 mm were 6.67%, 9.71%, and 16.13%, respectively. In evaluating mammary gland content ratio ≥50% groups, we also found positive correlations for non-visibles when controls were used as the baseline for the overall sample, in patients aged 40-59 years, and in those with a CBT ≥40 mm (p < 0.05). The corresponding odds ratios were ≥2.20, with a maximum value of 4.36.

Conclusion

The study findings highlight an estimated mammary gland content ratio of ≥50% in patients aged 40-59 years or in those with ≥40 mm CBT could be indicative factors for non-visibles.

Resting state functional connectome in breast cancer patients with fear of cancer recurrence

This study aimed to investigate network-level brain functional changes in breast cancer patients and their relationship with fear of cancer recurrence (FCR). Resting-state functional MRI was collected from 43 patients with breast cancer and 40 healthy controls (HCs). Graph theory analyses, whole-brain voxel-wise functional connectivity strength (FCS) analyses and seed-based functional connectivity (FC) analyses were performed to identify connection alterations in breast cancer patients. Correlations between brain functional connections (i.e. FCS and FC) and FCR level were assessed to further reveal the neural mechanisms of FCR in breast cancer patients. Graph theory analyses indicated a decreased clustering coefficient in breast cancer patients compared to HCs (P = 0.04). Patients with breast cancer exhibited significantly higher FCS in both higher-order function networks (frontoparietal, default mode, and dorsal attention systems) and primary somatomotor networks. Among the hyperconnected regions in breast cancer, the left inferior frontal operculum demonstrated a significant positive correlation with FCR. Our findings suggest that breast cancer patients exhibit less segregation of brain function, and the left inferior frontal operculum is a key region associated with FCR. This study offers insights into the neural mechanisms of FCR in breast cancer patients at the level of brain connectome.

Ten-year clinical outcome, toxicity and compliance of dose-dense sequential adjuvant administration of cyclophosphamide & epirubicin followed by docetaxel in patients with early breast cancer: A hellenic cooperative oncology group observational study (HE 10/10) with concurrent investigation of significance of tumor infiltrating lymphocytes

BACKGROUND

Dose-dense sequential (dds) chemotherapy has changed the clinical outcome of patients with early breast cancer (BC). To investigate the impact of dose intensity (DI) in the adjuvant setting of BC, this observational trial (HE 10/10) was conducted assessing the long-term survival outcome, safety and toxicity of a currently widely used chemotherapeutic regimen. In addition, the prognostic significance of tumor infiltrating lymphocytes (TILs) and infiltrating CD8+ lymphocytes were also evaluated in the same cohort.

PATIENTS AND METHODS

Totally, 1054 patients were prospectively enrolled in the current study with 1024 patients being eligible, while adequate tissue was available for 596 of them. TILs, CD8+ lymphocytes in intratumoral areas in contact with malignant cells (iCD8), CD8+ lymphocytes in tumor stroma (sCD8) as well as the total number of CD8+ lymphocytes within the tumor area (total CD8) were assessed by immunohistochemistry.

RESULTS

Within a median follow-up of 125.18 months, a total of 200 disease-free survival (DFS) events (19.5%) were reported. Importantly, the 10-year DFS and OS rates were 78.4% (95% CI 75.0-81.5) and 81.7% (95% CI 79.0-84.1), respectively. Interestingly, higher CD8+ T cells as well as TILs in the tumor microenvironment were associated with an improved long-term survival outcome.

CONCLUSIONS

In conclusion, this study confirms the significance of dds adjuvant chemotherapeutic regimen in terms of long-term survival outcome, safety and toxicity as well as the prognostic significance of TILs and infiltrating CD8+ lymphocytes in BC patients with early-stage disease.

Navigating challenges: optimising methods for primary cell culture isolation

Primary cell lines are invaluable for exploring cancer biology and investigating novel treatments. Despite their numerous advantages, primary cultures are laborious to obtain and maintain in culture. Hence, established cell lines are still more common. This study aimed to evaluate a range of techniques for isolating primary breast cancer cultures, employing distinct enzymatic compositions, incubation durations, and mechanical approaches, including filtration. Out of several protocols, we opted for a highly effective method (Method 5) that gave rise to a primary cell culture (BC160). This method combines mechanical disaggregation and enzymatic digestion with hyaluronidase and collagenase. Moreover, the paper addresses common issues in isolating primary cultures, shedding light on the struggle against fibroblasts overgrowing cancer cell populations. To make primary cell lines a preferred model, it is essential to elaborate and categorise isolation methods, develop approaches to separate heterogeneous cultures and investigate factors influencing the establishment of primary cell lines.

Population-level impact of adjuvant trastuzumab emtansine on the incidence of metastatic breast cancer: an epidemiological prediction model of women with HER2-positive early breast cancer and residual disease following neoadjuvant therapy

PURPOSE

Treating early-stage breast cancer (eBC) may delay or prevent subsequent metastatic breast cancer (mBC). In the phase 3 KATHERINE study, women with human epidermal growth factor receptor 2 (HER2)-positive eBC with residual disease following neoadjuvant therapy containing trastuzumab and a taxane experienced 50% reductions in disease recurrence or death when treated with adjuvant trastuzumab emtansine (T-DM1) vs adjuvant trastuzumab. We predicted the population-level impact of adjuvant T-DM1 on mBC occurrence in five European countries (EU5) and Canada from 2021-2030.

METHODS

An epidemiological prediction model using data from national cancer registries, observational studies, and clinical trials was developed. Assuming 80% population-level uptake of adjuvant treatment, KATHERINE data were extrapolated prospectively to model projections. Robustness was evaluated in alternative scenarios.

RESULTS

We projected an eligible population of 116,335 women in Canada and the EU5 who may be diagnosed with HER2-positive eBC and have residual disease following neoadjuvant therapy from 2021-2030. In EU5, the cumulative number of women projected to experience relapsed mBC over the 10-year study period was 36,009 vs 27,143 under adjuvant trastuzumab vs T-DM1, a difference of 8,866 women, equivalent to 25% fewer cases with the use of adjuvant T-DM1 in EU5 countries from 2021-2030. Findings were similar for Canada.

CONCLUSION

Our models predicted greater reductions in the occurrence of relapsed mBC with adjuvant T-DM1 vs trastuzumab in the indicated populations in EU5 and Canada. Introduction of T-DM1 has the potential to reduce population-level disease burden of HER2-positive mBC in the geographies studied.

Flower-like porous BCN assembled by nanosheets for paclitaxel delivery

Developing smart drug delivery systems has become a feasible solution to overcome the challenges in cancer chemotherapeutics. In this work, porous boron carbon nitride (ZBCN) nanomaterials with flower-like structures assembled with BCN nanosheets were synthesized by using ZIF-L as a template. The rich hydroxyl groups on the BCN surfaces make it highly dispersible and stable in aqueous solutions. Additionally, ZBCN exhibits stable photoluminescence properties that can be utilized for cellular uptake and tracking of drug delivery. Furthermore, the flower-like ZBCN structure contributes to a large specific surface area of up to 340 m2 g-1 and a pore volume of 1.03 cm3 g-1; and the presence of rich macropores results in a high drug loading capacity of 116 wt% for paclitaxel. In vitro and in vivo anticancer experiments demonstrated that ZBCN exhibits excellent performance in delivering anticancer drugs, with in vivo tumor inhibition of 58%. This study presents a novel template method for preparing porous BCN nanomaterials, offering a promising platform for high-performance anticancer drug delivery.

Cardiac Arrhythmias in Oncological Patients-Epidemiology, Risk Factors, and Management within the Context of the New ESC 2022 Guidelines

PURPOSE OF REVIEW

To provide an update on epidemiology, risk factors, and management of cardiac arrhythmias in oncological patients within the context of the new European Society of Cardiology 2022 guidelines on cardio-oncology.

RECENT FINDINGS

One of the side effects of different chemotherapeutics is their pro-arrhythmic activity. Both atrial and ventricular arrhythmias may be induced by cancer itself or by anticancer treatment. Recent studies report on the cardiotoxic activity of such promising therapies as BRAF and MEK inhibitors, or CAR-T therapy. Risk factors of arrhythmias in oncological patients overlap with cardiovascular diseases risk factors, but there are some groups of anticancer drugs that increase the risk of cardiotoxicity. It is crucial to be aware of the risks associated with the oncological treatment and know how to act in case of cardiotoxicity.

Resistance to Resilience: Understanding Post-surgical Hormone Therapy in Breast Cancer Care

Breast cancer is one of the most common types of cancer affecting women worldwide. Over the years, breast cancer has become a major public health concern, and its incidence is rising globally. The treatment of breast cancer does not stop with surgical intervention, but adjuvant therapies are administered to improve patient outcomes post-surgery based on the type of breast cancer diagnosed. This review focuses on the value of hormone therapy (HT) in improving the prognosis of breast cancer patients and why adhering to adjuvant treatment post-surgery is difficult for patients. HT aims to reduce the chances of breast cancer recurrence after surgical treatment. Even though HT is life-saving, patients tend to not adhere to the therapy due to various factors such as side effects, age-related issues, and socioeconomic status. Most patients stop adhering to the therapy as the duration can be as long as 5-10 years, and the quality of life is greatly impacted due to the side effects of the treatment. This review examines the possible factors leading to non-adherence to HT and tries to propose possible interventions that might improve patient compliance with the treatment. This article not only focuses on the impact of side effects of HT on patients' quality of life but also tries to understand the problems faced by breast cancer patients in adhering to HT.

Practice variation in venous resection during pancreatoduodenectomy for pancreatic cancer: A nationwide cohort study

BACKGROUND

Practice variation exists in venous resection during pancreatoduodenectomy, but little is known about the potential causes and consequences as large studies are lacking. This study explores the potential causes and consequences of practice variation in venous resection during pancreatoduodenectomy for pancreatic cancer in the Netherlands.

METHODS

This nationwide retrospective cohort study included patients undergoing pancreatoduodenectomy for pancreatic cancer in 18 centers from 2013 through 2017.

RESULTS

Among 1,311 patients undergoing pancreatoduodenectomy, 351 (27%) had a venous resection, and the overall median annual center volume of venous resection was 4. No association was found between the center volume of pancreatoduodenectomy and the rate of venous resections, nor between patient and tumor characteristics and the rate of venous resections per center. Female sex, lower body mass index, neoadjuvant therapy, venous involvement, and stenosis on imaging were predictive for venous resection. Adjusted for these factors, 3 centers performed significantly more, and 3 centers performed significantly fewer venous resections than expected. In patients with venous resection, significantly less major morbidity (22% vs 38%) and longer overall survival (median 16 vs 12 months) were observed in centers with an above-median annual volume of venous resections (>4).

CONCLUSION

Patient and tumor characteristics did not explain significant practice variation between centers in the Netherlands in venous resection during pancreatoduodenectomy for pancreatic cancer. The clinical outcomes of venous resection might be related to the volume of the procedure.

Insights into the involvement of long non-coding RNAs in doxorubicin resistance of cancer

Doxorubicin is one of the most classical chemotherapeutic drugs for the treatment of cancer. However, resistance to the cytotoxic effects of doxorubicin in tumor cells remains a major obstacle. Aberrant expression of long non-coding RNAs (lncRNAs) has been associated with tumorigenesis and development via regulation of chromatin remodeling, transcription, and post-transcriptional processing. Emerging studies have also revealed that dysregulation of lncRNAs mediates the development of drug resistance through multiple molecules and pathways. In this review, we focus on the role and mechanism of lncRNAs in the progress of doxorubicin resistance in various cancers, which mainly include cellular drug transport, cell cycle disorder, anti-apoptosis, epithelial-mesenchymal transition, cancer stem cells, autophagy, tumor microenvironment, metabolic reprogramming and signaling pathways. This review is aimed to provide potential therapeutic targets for future cancer therapy, especially for the reversal of chemoresistance.

Hyaluronic acid-modified yeast β-glucan particles delivering doxorubicin for treatment of breast cancer

Breast cancer is one of the most threatening cancers that poses a great risk to women's health. The anti-tumor drug doxorubicin (DOX) is one of commonly used drugs in the treatment of breast cancer. However, the cytotoxicity of DOX has always been an urgent challenge to be solved. In this study, we report an alternative drug delivery system delivering DOX for reducing its physiological toxicity by using the yeast β-glucan particle (YGP) with a hollow and porous vesicle structure. Briefly, amino groups were grafted onto the surface of YGP with the silane coupling agent, then the oxidized hyaluronic acid (OHA) was attached by Schiff base reaction to get HA-modified YGP (YGP@N=C-HA), finally DOX was encapsulated into YGP@N=C-HA to get DOX-loaded YGP@N=C-HA (YGP@N=C-HA/DOX). In vitro release experiments exhibited the pH-responsive DOX release from YGP@N=C-HA/DOX. Cell experiments displayed that YGP@N=C-HA/DOX had good killing effect on both MCF-7 and 4T1 cells and could be internalized into these cells through CD44 receptors, showing targetability to cancer cells. Furthermore, YGP@N=C-HA/DOX could effectively inhibit tumor growth and reduce the physiological toxicity of DOX. Thus, the YGP-based vesicle provides an alternative strategy for lowering the physiological toxicity of DOX in the medical treatment of breast cancer.

Pretreatment 18-FDG-PET/CT parameters can serve as prognostic imaging biomarkers in recurrent NSCLC patients treated with reirradiation-chemoimmunotherapy

BACKGROUND AND PURPOSE

Our study aimed to assess whether quantitative pretreatment 18F-FDG-PET/CT parameters could predict prognostic clinical outcome of recurrent NSCLC patients who may benefit from ablative reirradiation.

MATERIALS AND METHODS

Forty-eight patients with recurrent NSCLC of all UICC stages who underwent ablative thoracic reirradiation were analyzed. Twenty-nine (60%) patients received immunotherapy with or without chemotherapy in addition to reirradiation. Twelve patients (25%) received reirradiation only and seven (15%) received chemotherapy and reirradiation. Pretreatment 18-FDG-PET/CT was mandatory in initial diagnosis and recurrence, based on which volumetric and intensity quantitative parameters were measured before reirradiation and their impact on overall survival, progression-free survival, and locoregional control was assessed.

RESULTS

With a median follow-up time of 16.7 months, the median OS was 21.8 months (95%-CI: 16.2-27.3). On multivariate analysis, OS and PFS were significantly influenced by MTV (p < 0.001 for OS; p = 0.006 for PFS), TLG (p < 0.001 for OS; p = 0.001 for PFS) and SUL peak (p = 0.0024 for OS; p = 0.02 for PFS) of the tumor and MTV (p = 0.004 for OS; p < 0.001 for PFS) as well as TLG (p = 0.007 for OS; p = 0.015 for PFS) of the metastatic lymph nodes. SUL peak of the tumor (p = 0.05) and the MTV of the lymph nodes (p = 0.003) were only PET quantitative parameters that significantly impacted LRC.

CONCLUSION

Pretreatment tumor and metastastic lymph node MTV, TLG and tumor SUL peak significantly correlated with clinical outcome in recurrent NSCLC patients treated with reirradiation-chemoimmunotherapy.

Preparation and in Vitro Evaluation of Tamoxifen-Conjugated, Eco-Friendly, Agar-Based Hybrid Magnetic Nanoparticles for Their Potential Use in Breast Cancer Treatment

Tamoxifen is the drug of choice as hormonal therapy for hormone receptor-positive breast cancers and can reduce the risk of breast cancer recurrence. However, oral tamoxifen has a low bioavailability due to liver and intestinal metabolic passes. To overcome this problem and utilize the potential of this drug to its maximum, inorganic nanoparticle carriers have been exploited and tested to increase its bioavailability. Biocompatibility and unique magnetic properties make iron oxide nanoparticles an excellent choice as a drug delivery system. In this study, we developed and tested a "green synthesis" approach to synthesize iron nanoparticles from green tea extract and coated them with agar for longer stability (AG-INPs). Later, these hybrid nanoparticles were conjugated with tamoxifen (TMX). By using this approach, we synthesized stable agar-coated tamoxifen-conjugated iron nanoparticles (TMX-AG-INPs) and characterized them with Fourier-transform infrared (FTIR) spectroscopy. The average particle size of AG-INPs was 26.8 nm, while the average particle size of tamoxifen-loaded iron nanoparticles, TMX-AG-INPs, was 32.1 nm, as measured by transmission and scanning electron microscopy. The entrapment efficiency of TMX-AG-INPs obtained by the drug release profile was 88%, with a drug loading capacity of 43.5%. TMX-AG-INPs were significantly (p < 0.001) efficient in killing breast cancer cells when tested in vitro on the established breast cancer cell line MCF-7 by cell viability assay, indicating their potential to control cell proliferation.

Structure-guided identification of novel dual-targeting estrogen receptor α degraders with aromatase inhibitory activity for the treatment of endocrine-resistant breast cancer

Drug resistance is a major challenge in conventional endocrine therapy for estrogen receptor (ER) positive breast cancer (BC). BC is a multifactorial disease, in which simultaneous aromatase (ARO) inhibition and ERα degradation may effectively inhibit the signal transduction of both proteins, thus potentially overcoming drug resistance caused by overexpression or mutation of target proteins. In this study, guided by the X-ray structure of a hit compound 30a in complex with ER-Y537S, a structure-based optimization was performed to get a series of multiacting inhibitors targeting both ERα and ARO, and finally a novel class of potent selective estrogen receptor degraders (SERDs) based on a three-dimensional oxabicycloheptene sulfonamide (OBHSA) scaffold equipped with aromatase inhibitor (AI) activity were identified. Of these dual-targeting SERD-AI hybrids, compound 31q incorporating a 1H-1,2,4-triazole moiety showed excellent ERα degradation activity, ARO inhibitory activity and remarkable antiproliferative activity against BC resistant cells. Furthermore, 31q manifested efficient tumor suppression in MCF-7 tumor xenograft models. Taken together, our study reported for the first time the highly efficient dual-targeting SERD-AI hybrid compounds, which may lay the foundation of translational research for improved treatment of endocrine-resistant BC.

Mechanism of inflammasomes in cancer and targeted therapies

Inflammasomes, composed of the nucleotide-binding oligomerization domain(NOD)-like receptors (NLRs), are immune-functional protein multimers that are closely linked to the host defense mechanism. When NLRs sense pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs), they assemble into inflammasomes. Inflammasomes can activate various inflammatory signaling pathways, including nuclear factor kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathways, and produce a large number of proinflammatory cytokines, which are closely associated with multiple cancers. They can also accelerate the occurrence and development of cancer by providing suitable tumor microenvironments, promoting tumor cell proliferation, and inhibiting tumor cell apoptosis. Therefore, the exploitation of novel targeted drugs against various inflammasomes and proinflammatory cytokines is a new idea for the treatment of cancer. In recent years, more than 50 natural extracts and synthetic small molecule targeted drugs have been reported to be in the research stage or have been applied to the clinic. Herein, we will overview the mechanisms of inflammasomes in common cancers and discuss the therapeutic prospects of natural extracts and synthetic targeted agents.

Is the (Neo)adjuvant Therapy of Patients with Primary HER2-positive Breast Cancer Cost-Covering?: Process Cost Analysis of Neoadjuvant and Post-Neoadjuvant Systemic Therapy of Patients with Primary HER2-positive Breast Cancer

Introduction HER2 positivity is one of the most important predictive factors in the treatment of breast cancer patients. Thanks to new targeted anti-HER2 drugs, the prognosis for HER2-positive breast cancer patients has been significantly improved, and the treatment can now be designed according to the risk situation and the response to treatment. At the same time, these innovative targeted anti-HER2 drugs are associated with high costs and require long and involved patient care. Materials and Methods In this paper, we compare the treatment costs of three post-neoadjuvant treatment regimens (trastuzumab vs. trastuzumab/pertuzumab vs. T-DM1) in early stage HER2-positive breast cancer from the perspective of the oncological outpatient clinic of a certified breast center at a university hospital, and evaluate the cost coverage. Results The highest costs in systemic therapy were the material costs. These were the highest for dual blockade with trastuzumab/pertuzumab, followed by T-DM1 and trastuzumab monotherapy. According to our study, all three of these post-neoadjuvant therapy variants achieve a positive contribution margin. While all three models have similar contribution margins, the treatment pathway with T-DM1 is associated with a 30% lower contribution margin. Conclusions Although these model calculations are associated with limitations in view of the introduction of biosimilar antibodies, it can be shown that modern therapeutic approaches do not always have to be associated with lower profits.

Projections of cancer mortality by 2025 in central China: A modeling study of global burden of disease 2019

Background

In China, there are few studies that have reported future estimations for cancer mortality. Therefore, this study aimed to assess cancer mortality in China and identify priorities for future cancer control strategies.

Methods

Based on the Global Burden of Disease 2019 study, we extracted data on cancer-related deaths from 1990 to 2019 in Hunan Province, China. Under the current trends evaluated using a joinpoint regression model, we fitted a linear regression model for cancer mortality projections by 2025.

Results

The age-standardized mortality rate of total cancer in Hunan, China, declined slowly and is projected to be 140.80 (95% confidence interval [CI]: 140.12-141.48) by 2025, with the mortality rate in men approximately twice that in women. In 2025, the top five causes of cancer-related deaths in males are projected to be lung, liver, colorectal, stomach, and esophageal cancers, with the corresponding causes in females being lung, breast, colorectal, liver, and cervical cancers. Between 2019 and 2025, male mortality rates due to liver and pancreatic cancer are expected to increase, while those due to the six leading female cancers will increase. Excess male deaths were associated with liver and esophageal cancers, while all main cancers in females will have excess mortality, except for colorectal cancer.

Conclusion

A comprehensive cancer spectrum characteristic of both developing and developed countries will remain in Hunan, China. Lung cancer remains the most common cause of cancer-related deaths, and tobacco control efforts are urgently required. Additional efforts should be made to promote universal screening, improve access to cancer healthcare services, optimize medical payment models, and enhance access to valuable anticancer drugs.

Key aspects for conception and construction of co-culture models of tumor-stroma interactions

The tumor microenvironment is crucial in the initiation and progression of cancers. The interplay between cancer cells and the surrounding stroma shapes the tumor biology and dictates the response to cancer therapies. Consequently, a better understanding of the interactions between cancer cells and different components of the tumor microenvironment will drive progress in developing novel, effective, treatment strategies. Co-cultures can be used to study various aspects of these interactions in detail. This includes studies of paracrine relationships between cancer cells and stromal cells such as fibroblasts, endothelial cells, and immune cells, as well as the influence of physical and mechanical interactions with the extracellular matrix of the tumor microenvironment. The development of novel co-culture models to study the tumor microenvironment has progressed rapidly over recent years. Many of these models have already been shown to be powerful tools for further understanding of the pathophysiological role of the stroma and provide mechanistic insights into tumor-stromal interactions. Here we give a structured overview of different co-culture models that have been established to study tumor-stromal interactions and what we have learnt from these models. We also introduce a set of guidelines for generating and reporting co-culture experiments to facilitate experimental robustness and reproducibility.

Dietary Trace Element Intake and Risk of Breast Cancer: A Mini Review

Trace elements are essentially required for various physiological and metabolic functions, and any disturbance in the trace elements homeostasis may result in the development of chronic diseases including breast cancer. Breast cancer is the most prevalent cancer type reported in women equally affecting both the high-income and low-income countries. This review therefore aimed to evaluate the impact of dietary trace element intake in relation to the incidence of breast cancer. We focused on five trace elements, thus emphasizing dietary selenium, zinc, iron, copper, and cadmium intake and risk of breast cancer. A systematic approach was applied to perform this review through entering a search term in PubMed and Scopus databases. A total of 24 articles were included after meeting the inclusion and exclusion criteria. Most of the studies regarding dietary iron intake showed a detrimental effect of increased dietary heme iron on breast cancer incidence risk. In addition, there is a limited evidence of high dietary intake of selenium and zinc to reduce the risk of breast cancer. Also, a few studies showed a relationship between high cadmium consumption and risk of breast cancer. More studies related to cadmium and copper exposure are needed to confirm this relationship. As a result, the findings of this review suggested that high dietary heme iron is a potential risk factor for breast cancer.

Synthesis Optimization of BaGdF5:x%Tb3+ Nanophosphors for Tunable Particle Size

X-ray photodynamic therapy (XPDT) is aimed at the treatment of deep-located malignant tumors thanks to the high penetration depth of X-rays. In XPDT therapy, it is necessary to use materials that effectively absorb X-rays and convert them into visible radiation-nanophosphors. Rare-earth elements, fluorides, in particular, doped BaGdF₅, are known to serve as efficient nanophosphor. On the other hand, the particle size of nanophosphors has a crucial impact on biodistribution, cell uptake, and cytotoxicity. In this work, we investigated various Tb:Gd ratios in the range from 0.1 to 0.5 and optimized the terbium content to achieve the maximum luminescence under X-ray excitation. The effect of temperature, composition of the ethylene glycol/water solvent, and the synthesis technique (solvothermal and microwave) on the size of the nanophosphors was explored. It was found that the synthesis techniques and the solvent composition had the greatest influence on the averaged particle size. By varying these two parameters, it is possible to tune the size of the nanophosphor particles, which make them suitable for biomedical applications.

Circ_0007534 as new emerging target in cancer: Biological functions and molecular interactions

Circular RNA (circRNAs), an important member of the non-coding RNA (ncRNA) family, are widely expressed in a variety of biological cells. Owing to their stable structures, sequence conservations, and cell- or tissue-specific expressions, these RNA have become a popular subject of scientific research. With the development of sequencing methods, it has been revealed that circRNAs exert their biological function by sponging microRNAs (miRNAs), regulating transcription, or binding to proteins. Humans have historically been significantly impacted by various types of cancer. Studies have shown that circRNAs are abnormally expressed in various cancers and are involved in the occurrence and development of malignant tumors, such as tumor cell proliferation, migration, and invasion. As one of its star molecules, circ_0007534 is upregulated in colorectal, cervical, and pancreatic cancers; is closely related to the occurrence, development, and prognosis of tumors; and is expected to become a novel tumor marker and therapeutic target. This article briefly reviews the expression and mechanism of circ_0007534 in malignant tumors based on the domestic and foreign literature.

Over-the-Counter Breast Cancer Classification Using Machine Learning and Patient Registration Records

This study aims to determine the feasibility of machine learning (ML) and patient registration record to be utilised to develop an over-the-counter (OTC) screening model for breast cancer risk estimation. Data were retrospectively collected from women who came to the Hospital Universiti Sains Malaysia, Malaysia for breast-related problems. Eight ML models were used: k-nearest neighbour (kNN), elastic-net logistic regression, multivariate adaptive regression splines, artificial neural network, partial least square, random forest, support vector machine (SVM), and extreme gradient boosting. Features utilised for the development of the screening models were limited to information in the patient registration form. The final model was evaluated in terms of performance across a mammographic density. Additionally, the feature importance of the final model was assessed using the model agnostic approach. kNN had the highest Youden J index, precision, and PR-AUC, while SVM had the highest F2 score. The kNN model was selected as the final model. The model had a balanced performance in terms of sensitivity, specificity, and PR-AUC across the mammographic density groups. The most important feature was the age at examination. In conclusion, this study showed that ML and patient registration information are feasible to be used as the OTC screening model for breast cancer.

Digital and Interactive Health Interventions Minimize the Physical and Psychological Impact of Breast Cancer, Increasing Women's Quality of Life: A Systematic Review and Meta-Analysis

Digital and interactive health interventions (DIHIs), such as virtual-reality-based therapy (VRBT) and smartphone-app-based therapy (SABT), may be useful for reducing the impact of the signs and symptoms of breast cancer (BC) in women. The aim of this meta-analysis was to explore the effect of DIHIs on improving pain, anxiety, depression, quality of life (QoL), and upper extremity (UE) disability-related lymphedema in women with BC.

METHODS

We searched PubMed Medline, Web of Science, Scopus, CINAHL, Physiotherapy Evidence Database, and SciELO for the period ending February 2022. We included studies that assessed the effect of DIHIs on UE motor disability, pain, anxiety, depression, and QoL in women with BC. The effect size was calculated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI).

RESULTS

Twenty studies providing data from 1613 women with BC were included. With respect to UE disability, DIHIs increased flexion (SMD, 1.92; 95%CI: -1.16, 2.68), abduction (SMD, 1.66; 95%CI: 0.91, 2.42), external rotation shoulder range of motion (SMD, 1.1; 95%CI: 0.36, 1.85), UE function (SMD, -0.72; 95%CI: -1.31, -0.13), and handgrip strength (SMD, 0.4; 95%CI: 0.21, 0.59). DIHIs reduced pain (SMD, -0.8; 95%CI: -1.31, -0.26), anxiety (SMD, -1.02; 95%CI: -1.71, -0.34), and depression (SMD, -1.57; 95%CI: -3.1, -0.08). Finally, DIHIs increased overall health (SMD, 0.6; 95%CI: 0.31, 0.89).

CONCLUSIONS

Right at the end of therapy, DIHIs are effective at improving UE function, pain, anxiety, depression, and QoL in women with BC. VRBT has a greater effect than SABT for the assessed outcomes.

Cancer mortality in Italian populations: differences between Italy and the USA

BACKGROUND

The comparison of cancer mortality rates and risk factors among foreign-born populations in a host country with those in the country of origin provides insights into differences in access to care, timely diagnosis, and disease management between the two countries.

METHODS

Using 2008-2018 cancer mortality data for the Italian population and for Italy-born Americans, we calculated age-standardized mortality rates (ASMRs) and standardized mortality ratios (SMRs).

RESULTS

ASMRs were lower in Italy-born Americans (201.5 per 100 000) compared to Italians (255.1 per 100 000). For all neoplasms combined, SMRs for Italy-born American men and women were 0.75 [95% confidence interval (CI), 0.73-0.77] and 0.78 (95% CI, 0.76-0.80), respectively. Among men, the SMRs were significantly below 1 for oral cavity, stomach, colorectal, liver, lung, prostate, bladder and kidney cancer. Among women, the SMRs were 0.69 for oral, 0.40 for stomach, 0.61 for colorectal, 0.72 for liver, 0.73 for breast and 0.53 for kidney cancers. Mortality was not reduced for lung (1.02, 95% CI, 0.94-1.10) cancer in women.

CONCLUSION

Generational differences in smoking prevalence patterns between the US and Italy may explain the advantages for Italy-born Americans for lung and other tobacco-related cancers compared to their Italian men counterparts. Lower prevalence of Helicobacter pylori, alcohol consumption, hepatitis B and C virus in the USA may justify the lower mortality for stomach and liver cancer, among Italy-born Americans. Earlier and more widespread adoption of cancer screening and effective treatments in the USA is likely to be influential in breast, colorectal and prostate cancer mortality.

Tumor-Stroma Interaction in PDAC as a New Approach for Liquid Biopsy and its Potential Clinical Implications

The extremely poor prognosis for patients with pancreatic ductal adenocarcinoma (PDAC) has remained unchanged for decades. As a hallmark of PDAC histology, the distinct desmoplastic response in the tumor microenvironment is considered a key factor exerting pro- and antitumor effects. Increasing emphasis has been placed on cancer-associated fibroblasts (CAFs), whose heterogeneity and functional diversity is reflected in the numerous subtypes. The myofibroblastic CAFs (myCAFs), inflammatory CAFs (iCAFs) and antigen presenting CAFs (apCAFs) are functionally divergent CAF subtypes with tumor promoting as well as repressing effects. Precise knowledge of the underlying interactions is the basis for a variety of treatment approaches, which are subsumed under the term antistromal therapy. Clinical implementation is still pending due to the lack of benefit-as well as paradoxical preclinical findings. While the prominent significance of CAFs in the immediate environment of the tumor is becoming clear, less is known about the circulating (c)CAFs. cCAFs are of particular interest as they seem not only to be potential new liquid biopsy biomarkers but also to support the survival of circulating tumor cells (CTC) in the bloodstream. In PDAC, CTCs correlate with an unfavorable outcome and can also be employed to monitor treatment response, but the current clinical relevance is limited. In this review, we discuss CTCs, cCAFs, secretomes that include EVs or fragments of collagen turnover as liquid biopsy biomarkers, and clinical approaches to target tumor stroma in PDAC.

PSOWNNs-CNN: A Computational Radiology for Breast Cancer Diagnosis Improvement Based on Image Processing Using Machine Learning Methods

Early diagnosis of breast cancer is an important component of breast cancer therapy. A variety of diagnostic platforms can provide valuable information regarding breast cancer patients, including image-based diagnostic techniques. However, breast abnormalities are not always easy to identify. Mammography, ultrasound, and thermography are some of the technologies developed to detect breast cancer. Using image processing and artificial intelligence techniques, the computer enables radiologists to identify chest problems more accurately. The purpose of this article was to review various approaches to detecting breast cancer using artificial intelligence and image processing. The authors present an innovative approach for identifying breast cancer using machine learning methods. Compared to current approaches, such as CNN, our particle swarm optimized wavelet neural network (PSOWNN) method appears to be relatively superior. The use of machine learning methods is clearly beneficial in terms of improved performance, efficiency, and quality of images, which are crucial to the most innovative medical applications. According to a comparison of the process's 905 images to those of other illnesses, 98.6% of the disorders are correctly identified. In summary, PSOWNNs, therefore, have a specificity of 98.8%. Furthermore, PSOWNNs have a precision of 98.6%, which means that, despite the high number of women diagnosed with breast cancer, only 830 (95.2%) are diagnosed. In other words, 95.2% of images are correctly classified. PSOWNNs are more accurate than other machine learning algorithms, SVM, KNN, and CNN.

Trends of cancer mortality in Xi'an City, China: 2005-2020

PURPOSE

Describe and predict the malignant tumor deaths in Xi'an so as to provide evidence for the government to formulate the prevention and treatment plans.

METHODS

Overall malignant tumor death in Xi'an in the past 16 years was described. The multi-decrease life table was used to calculate cumulative mortality risk by cause and life expectancy reduction years by cause of malignant tumors in 2020. The join point regression models were used to analyze the change trend of standard mortality of malignant tumors in Xi'an from 2005 to 2020. The appropriate gray models were selected to predict the death of malignant tumors in Xi'an in the next decade.

RESULTS

The mortality of total malignant tumors in Xi'an showed that men are higher than women and the elderly are higher than other groups. As for 2020, lung cancer had the highest risk of death for both men and women, while leukemia had the highest life expectancy reduction years by cause. From 2005 to 2020, standardized mortality of majority malignant tumors showed downward trends, which were particularly obvious in recent years. The prediction results of several major malignant tumors showed that in the next decade, the mortality of most malignant tumors had downward trends, but combined with the increase of population in the future, the number of malignant tumor deaths in Xi'an will continue to increase.

CONCLUSIONS

Malignant tumors in Xi'an have decreasing mortality trends in recent years, and effective measures to prevent and treat tumors should be strengthened in the future.

The Global Burden of Leukemia and Its Attributable Factors in 204 Countries and Territories: Findings from the Global Burden of Disease 2019 Study and Projections to 2030

Background. Leukemia is a common malignancy that has four main subtypes and is a threat to human health. Understanding the epidemiological status of leukemia and its four main subtypes globally is important for allocating appropriate resources, guiding clinical practice, and furthering scientific research. Methods. Average annual percentage changes (AAPCs) were calculated to estimate the change trends of age-standardized rates (ASRs) from 1990 to 2019 in 204 countries and territories. The risk factors for leukemia death and disability-adjusted life-year (DALY) were also analyzed. In addition, the future trends in ASRs were projected through 2030. Results. The total number of incident cases, deaths, and DALYs from leukemia in 2019 was 0.64, 0.33, and 11.66 million, respectively. Decreasing trends in age-standardized incidence rate (ASIR), the age-standardized death rate (ASDR), and age-standardized DALY rate were detected on a global level while increasing trends in ASIR were detected in the high-sociodemographic index (SDI) regions. The leukemia burden was heavier in males than in females. By cause, acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL) were more likely to impose a burden on the elderly, while acute lymphoblastic leukemia (ALL) showed a greater impact in the younger population. A significant positive correlation was observed between SDI and AAPC in ASIR, while SDI was negatively correlated with AAPCs in both ASDR and age-standardized DALY rate. Smoking remained the most significant risk factor associated with leukemia-related death and DALY, especially in males. Similar deaths and DALYs were caused by smoking and high body mass index (BMI) in females. Future projections through 2030 estimated that ASIR and ASDR will continue to increase, while the DALY rate is predicted to decline. Conclusions. Patterns and trends of leukemia burden are correlated with SDI. The estimated contributions to leukemia deaths indicate that timely measures are needed to reduce smoking and obesity.

Construction and Validation of Angiogenesis-Related Prognostic Risk Signature to Facilitate Survival Prediction and Biomarker Excavation of Breast Cancer Patients

This study is aimed at exploring the potential mechanism of angiogenesis, a biological process-related gene in breast cancer (BRCA), and constructing a risk model related to the prognosis of BRCA patients. We used multiple bioinformatics databases and multiple bioinformatics analysis methods to complete our exploration in this research. First, we use the RNA-seq transcriptome data in the TCGA database to conduct a preliminary screening of angiogenesis-related genes through univariate Cox curve analysis and then use LASSO regression curve analysis for secondary screening. We successfully established a risk model consisting of seven angiogenesis-related genes in BRCA. The results of ROC curve analysis show that the risk model has good prediction accuracy. We can successfully divide BRCA patients into the high-risk and low-risk groups with significant prognostic differences based on this risk model. In addition, we used angiogenesis-related genes to perform cluster analysis in BRCA patients and successfully divided BRCA patients into three clusters with significant prognostic differences, namely, cluster 1, cluster 2, and cluster 3. Subsequently, we combined the clinical-pathological data for correlation analysis, and there is a significant correlation between the risk model and the patient’s T and stage. Multivariate Cox regression curve analysis showed that the age of BRCA patients and the risk score of the risk model could be used as independent risk factors in the progression of BRCA. In particular, based on this angiogenesis-related risk model, we have drawn a matching nomogram that can predict the 5-, 7-, and 10-year overall survival rates of BRCA patients. Subsequently, we performed a series of pan-cancer analyses of CNV, SNV, OS, methylation, and immune infiltration for this risk model gene and used GDSC data to explore drug sensitivity. Subsequently, to gain insight into the protein expression of these risk model genes in BRCA, we used the immunohistochemical data in the THPA database for verification. The results showed that the protein expressions of IL18, RUNX1, SCG2, and THY1 molecules in BRCA tissues were significantly higher than those in normal breast tissues, while the protein expressions of PF4 and TNFSF12 molecules in BRCA tissues were significantly lower than those in normal breast tissues. Finally, we conducted multiple GSEA analyses to explore the biological pathways these risk model genes can cross in cancer progression. In summary, we believe that this study can provide valuable data and clues for future studies on angiogenesis in BRCA.

Breast Computed Tomography: Diagnostic Performance of the Maximum Intensity Projection Reformations as a Stand-Alone Method for the Detection and Characterization of Breast Findings

OBJECTIVES

This study aimed to evaluate the diagnostic performance of the maximum intensity projection (MIP) reformations of breast computed tomography (B-CT) images as a stand-alone method for the detection and characterization of breast imaging findings.

MATERIALS AND METHODS

A total of 160 women undergoing B-CT between August 2018 and December 2020 were retrospectively included; 80 patients with known breast imaging findings were matched with 80 patients without imaging findings according to age and amount of fibroglandular tissue (FGT). A total of 71 benign and 9 malignant lesions were included. Images were evaluated using 15-mm MIP in 3 planes by 2 radiologists with experience in B-CT. The presence of lesions and FGT were evaluated, using the BI-RADS classification. Interreader agreement and descriptive statistics were calculated.

RESULTS

The interreader agreement of the 2 readers for finding a lesion (benign or malignant) was 0.86 and for rating according to BI-RADS classification was 0.82. One of 9 cancers (11.1%) was missed by both readers due to dense breast tissue. BI-RADS 1 was correctly applied to 73 of 80 patients (91.3%) by reader 1 and to 74 of 80 patients (92.5%) by reader 2 without recognizable lesions. BI-RADS 2 or higher with a lesion in at least one of the breasts was correctly applied in 69 of 80 patients (86.3%) by both readers. For finding a malignant lesion, sensitivity was 88.9% (95% confidence interval [CI], 51.75%-99.72%) for both readers, and specificity was 99.3% (95% CI, 96.4%-100%) for reader 1 and 100% (95% CI, 97.20%-100.00%) for reader 2.

CONCLUSIONS

Evaluation of B-CT images using the MIP reformations may help to reduce the reading time with high diagnostic performance and confidence.

Sex, Gender and Age Differences in Treatment Allocation and Survival of Patients With Metastatic Pancreatic Cancer: A Nationwide Study

Background

Biological sex, gender and age have an impact on the incidence and outcome in patients with metastatic pancreatic cancer. The aim of this study is to investigate whether biological sex, gender and age are associated with treatment allocation and overall survival (OS) of patients with metastatic pancreatic cancer in a nationwide cohort.

Methods

Patients with synchronous metastatic pancreatic cancer diagnosed between 2015 and 2019 were selected from the Netherlands Cancer Registry (NCR). The association between biological sex and the probability of receiving systemic treatment were examined with multivariable logistic regression analyses. Kaplan Meier analyses with log-rank test were used to describe OS.

Results

A total of 7470 patients with metastatic pancreatic cancer were included in this study. Fourty-eight percent of patients were women. Women received less often systemic treatment (26% vs. 28%, P=0.03), as compared to men. Multivariable logistic regression analyses with adjustment for confounders showed that women ≤55 years of age, received more often systemic treatment (OR 1.82, 95% CI 1.24-2.68) compared to men of the same age group. In contrast, women at >55 years of age had a comparable probability to receive systemic treatment compared to men of the same age groups. After adjustment for confounders, women had longer OS compared to men (HR 0.89, 95% CI 0.84-0.93).

Conclusion

This study found that women in general had a lower probability of receiving systemic treatment compared to men, but this can mainly be explained by age differences. Women had better OS compared to men after adjustment for confounders.

Artificial Ovary for Young Female Breast Cancer Patients

In recent decades, there has been increasing attention toward the quality of life of breast cancer (BC) survivors. Meeting the growing expectations of fertility preservation and the generation of biological offspring remains a great challenge for these patients. Conventional strategies for fertility preservation such as oocyte and embryo cryopreservation are not suitable for prepubertal cancer patients or in patients who need immediate cancer therapy. Ovarian tissue cryopreservation (OTC) before anticancer therapy and autotransplantation is an alternative option for these specific indications but has a risk of retransplantation malignant cells. An emerging strategy to resolve these issues is by constructing an artificial ovary combined with stem cells, which can support follicle proliferation and ensure sex hormone secretion. This promising technique can meet both demands of improving the quality of life and meanwhile fulfilling their expectation of biological offspring without the risk of cancer recurrence.

Impact of exercise interventions on physical fitness in breast cancer patients and survivors: a systematic review

Background

This systematic review aims to identify the effects of exercise interventions in patients with breast cancer (BCP) and survivors (BCS) on selected variables of physical fitness.

Methods

A comprehensive literature search was conducted using Medline and Scopus. Randomized controlled trials with isolated exercise interventions in BCP and BCS women (< 5 years from therapy completion) were included. The risk of bias (RoB) assessment was conducted using the Cochrane RoB-2-tool. Variables regarding cardiorespiratory fitness (CRF), strength (ST), fatigue (F) and health-related quality of life (HRQoL) were discussed.

Results

Of the 336 studies initially identified, 22 met all the inclusion criteria and were deemed eligible. RoB assessment indicated that the studies had predominantly “some concerns” or had “low RoB”, with only 3 studies presenting a “high RoB”. The mean duration and frequency of exercise interventions were 19 weeks and 3 sessions/week, performed at moderate intensity (65% VO₂max and 66% 1RM, for aerobic and resistance-training interventions, respectively).

Conclusions

Exercise interventions seem to be a valuable strategy in BCP to avoid the decline of CRF, ST, F and HRQoL. Conversely, improved physical function among BCS is observed for the same variables. Resistance training and combined interventions seem to provide the most encouraging variations of the selected outcomes.

PROSPERO registration ID

CRD42021237917.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12282-022-01347-z.

The Gender Gap in Life Expectancy in Urban and Rural China, 2013–2018

Background

Gender differences in mortality are embedded within mortality transitions. Rural residents generally lag behind their urban counterparts in the transitions. The study objective is to identify major causes of death that drive gender differences in mortality in urban and rural China.

Methods

We use age-, gender-, urban-rural- and cause-specific mortality data (2013–2018) derived from the national mortality surveillance system that covered about 24% of the Chinese population. We apply Arriaga's method to decompose age- and cause-specific contributions to the gender gap in life expectancy at birth. Analyses are stratified by urban-rural residence.

Results

Women had a higher life expectancy at birth than men in both urban and rural areas. Cancers, cardiovascular disease, external causes, and respiratory disease accounted for more than 90% of the gender gap in both areas during 2013–2018. In urban areas, the gender gap decreased from 5.17 years in 2013–2015 to 4.98 years in 2016–2018. In rural areas, the gender gap stayed rather constant (2013–2015: 5.68 years; 2016–2018: 5.65 years). Traffic accidents, among external causes, contributed the most to decreasing the gender gap (urban: −0.07 years; rural: −0.10 years), especially in the 0–44 age group. However, the decrease in the gender gap was counteracted by an increase in the gender gap attributable to ischemic heart disease (urban: +0.05 years; rural: +0.08 years) and lung cancer (urban: +0.02 years; rural: +0.05 years) in older age groups. The gender gap attributable either to cerebrovascular disease or to chronic lower respiratory disease decreased in urban areas but increased in rural areas.

Conclusions

The urban-rural variations in the cause-specific contributions to the gender gap in China suggest the necessity of implementing urban-rural-specific interventions to improve population health and health equity.

Feasibility of personalized screening and prevention recommendations in the general population through breast cancer risk assessment: results from a dedicated risk clinic

PURPOSE

A personalized approach to prevention and early detection based on known risk factors should contribute to early diagnosis and treatment of breast cancer. We initiated a risk assessment clinic for all women wishing to undergo an individual breast cancer risk assessment.

METHODS

Women underwent a complete breast cancer assessment including a questionnaire, mammogram with evaluation of breast density, collection of saliva sample, consultation with a radiologist, and a breast cancer specialist. Women aged 40 or older, with 0 or 1 first-degree relative with breast cancer diagnosed after the age of 40 were eligible for risk assessment using MammoRisk, a machine learning-based tool that provides an individual 5-year estimated risk of developing breast cancer based on the patient's clinical data and breast density, with or without polygenic risk scores (PRSs). DNA was extracted from saliva samples for genotyping of 76 single-nucleotide polymorphisms. The individual risk was communicated to the patient, with individualized screening and prevention recommendations.

RESULTS

A total of 290 women underwent breast cancer assessment, among which 196 women (68%) were eligible for risk assessment using MammoRisk (median age 52, range 40-72). When PRS was added to MammoRisk, 40% (n = 78) of patients were assigned a different risk category, with 28% (n = 55) of patients changing from intermediate to moderate or high risk.

CONCLUSION

Individual risk assessment is feasible in the general population. Screening recommendations could be given based on individual risk. The use of PRS changed the risk score and screening recommendations in 40% of women.

The Effect of Acetylsalicylic Acid (ASA) on the Mechanical Properties of Breast Cancer Epithelial Cells

BACKGROUND

In most communities, the risk of developing breast cancer is increasing. By affecting the cyclooxygenase 1 and 2 (COX-1 and COX-2) enzymes and actin filaments, acetylsalicylic acid (Aspirin) has been shown to reduce the risk of breast cancer and prevent cell migration in both laboratory and clinical studies.

METHODS

The purpose of this study is to determine the mechanical properties of normal and cancerous breast tissue cells, as well as the short-term effect of aspirin on cancer cells. To this end, the mechanical properties and deformation of three cell types were investigated: healthy MCF-10 breast cells, MCF-7 breast cancer cells, and MCF-7 breast cancer cells treated with a 5 µM aspirin solution. Atomic Force Microscopy (AFM) was used to determine the mechanical properties of the cells. Cell deformation was analyzed in all groups, and Young's modulus was calculated using the Hertz model.

RESULT

According to the obtained data, cancer cells deformed at a rate half that of healthy cells. Nonetheless, when aspirin was used, cancer cells deformed similarly to healthy cells. Additionally, healthy cells' Young's modulus was calculated to be approximately three times that of cancer cells, which was placed closer to that of healthy cells by adding aspirin to Young's modulus.

CONCLUSION

Cell strength appears to have increased due to aspirin's intervention on actin filaments and cytoskeletons, and the mechanical properties of breast cancer cells have become more similar to those of normal cells. The likelihood of cell migration and metastasis decreases as cell strength increases.

Structural Analysis of Social Behavior: Using Cluster Analysis to Examine Intrapsychic Personality Traits Associated With Depression in Women With Breast Cancer

Background

This study aimed to investigate personality traits associated with depression in breast cancer women (BCW).

Methods

Sample: 236 BCW recently diagnosed (early stages). Tests: SASB-Structural-Analysis of Social-Behavior; IPAT-CDQ-Depression. Statistical analysis: cluster K-Means analysis to explore SASB personality-traits considering the 8 SASB clusters (Cl); CDQ scores dichotomized by 50th percentile cutoff (high/low); Pearson’s chi square test to compare CDQ levels and SASB traits.

Results

Cluster analysis results supported two distinguishable SASB personality traits (for all SASB Cl-Scales P < .001) classified as “Love and Autonomy” (62.2%) and “Control and Hate” (37.8%). Patients with Love/Autonomy traits are spontaneous, accept their deepest feelings and desire to be close to other people (Cl1, Cl2, Cl3, Cl4). They show a medium value of self-control and a low tendency to self-abusive and self-critical behaviors (Cl5, Cl6). They pay attention to themselves and to their needs at emotional and physical levels also if may be occasionally engaged in self-destructive behaviors (Cl7, Cl8). Women with Control/Hate traits are not spontaneous and do not always express emotions (C1, Cl2, Cl3, Cl4) and flexibility in their relationship with others (Cl5, Cl6). In stressful situations, they may ignore the option of choices for self-growth and neglect their needs and those of others (Cl7, Cl8). BCWs with Control/Hate traits scored higher in depression (P <.001) than those with the Love/Autonomy profile.

Conclusions

Healthcare professionals should be aware of these personality traits and their association with depression to identify the psychologically most vulnerable BCW and improve the care they provide them. The psychotherapeutic intervention should be planned to face on the personality problems.

Prediction of the Invasiveness of Ground-Glass Nodules in Lung Adenocarcinoma by Radiomics Analysis Using High-Resolution Computed Tomography Imaging

Background

Pure ground-glass nodules (pGGNs) have been considered inert tumors due to their biological behavior; however, their prognosis is not completely consistent because of differences in internal pathological component. The aim of this study was to explore whether radiomics can be used to identify the invasiveness of pGGNs.

Methods

The retrospective study received the relevant ethical approval. After postoperative pathological confirmation, sixty-five patients with lung adenocarcinoma pGGNs (≤30 mm) were enrolled in this study from January 2015 to October 2018. All the cases were randomly divided into training and test groups in a 7:3 ratio. In total, 385 radiomics features were obtained from HRCT images, and then least absolute shrinkage and selection operator (LASSO) logistic regression was applied to the training group to obtain optimal features to distinguish the invasion degree of lesions. The diagnostic efficiency of the radiomics model was estimated by the area under the curve (AUC) of the receiver operating curve (ROC), and verified by the test group.

Results

The optimal features (“GLCMEntropy_angle135_offset1” and “Sphericity”) were selected after applying the LASSO regression to develop the proposed radiomics model. This prediction model exhibited good differentiation between pre-invasive and invasive lesions. The AUC for the test group was 0.824 (95%CI: 0.599-1.000), indicating that the radiomics model has some prediction ability.

Conclusion

The HRCT radiomics features can discriminate pre-invasive from invasive lung adenocarcinoma pGGNs. This non-invasive method can provide more information for surgeons before operation, and can also predict the prognosis of patients to some extent.

Cancer Rehabilitation Provided by Designated Cancer Hospitals in Japan: The Current State of Outpatient Setting and Coordination after Discharge

Objectives:

The aim of the present study was to clarify the current state of outpatient cancer rehabilitation and coordination systems provided by designated cancer hospitals in Japan.

Methods:

A questionnaire was sent to 427 designated cancer hospitals in Japan to investigate the status of outpatient cancer rehabilitation and whether it was sufficiently conducted. The status of regional coordination with post-discharge rehabilitation facilities was surveyed.

Results:

Responses were received from 235/427 facilities (55.0%). Outpatient cancer rehabilitation was implemented in 92 (39.1% of responding facilities), and of these facilities, 83.7% answered that the provision of rehabilitation was insufficient. The reasons were ineligibility for reimbursement of medical fees, a lack of human resources, a lack of awareness of the need, and a lack of education. Regional coordination was conducted by 39.1% of responding facilities, yet a regional alliance path had been established in only 9.8% of centers. The absence of coordination was associated with large facility size, the absence of physiatrists, and few rehabilitation professionals who had completed the training program; an insufficient framework for regional coordination was also given as a reason.

Conclusions:

To provide adequate outpatient cancer rehabilitation, sufficient human resources, the reimbursement of medical fees in the outpatient setting, and education and a framework to promote regional coordination are necessary.

Pharmacological Modulation of Apoptosis and Autophagy in Pancreatic Cancer Treatment

BACKGROUND

Pancreatic cancer is a fatal malignant neoplasm with infrequent signs and symptoms until a progressive stage. In 2020, GLOBOCAN reported that pancreatic cancer accounts for 4.7% of all cancer deaths. Despite the availability of standard chemotherapy regimens for treatment, the survival benefits are not guaranteed because tumor cells become chemoresistant even due to the development of chemoresistance in tumor cells even with a short treatment course, where apoptosis and autophagy play critical roles.

OBJECTIVE

This review compiled essential information on the regulatory mechanisms and roles of apoptosis and autophagy in pancreatic cancer, as well as drug-like molecules that target different pathways in pancreatic cancer eradication, with an aim to provide ideas to the scientific communities in discovering novel and specific drugs to treat pancreatic cancer, specifically PDAC.

METHOD

Electronic databases that were searched for research articles for this review were Scopus, Science Direct, PubMed, Springer Link, and Google Scholar. The published studies were identified and retrieved using selected keywords.

DISCUSSION/CONCLUSION

Many small-molecule anticancer agents have been developed to regulate autophagy and apoptosis associated with pancreatic cancer treatment, where most of them target apoptosis directly through EGFR/Ras/Raf/MAPK and PI3K/Akt/mTOR pathways. The cancer drugs that regulate autophagy in treating cancer can be categorized into three groups: i) direct autophagy inducers (e.g., rapamycin), ii) indirect autophagy inducers (e.g., resveratrol), and iii) autophagy inhibitors. Resveratrol persuades both apoptosis and autophagy with a cytoprotective effect, while autophagy inhibitors (e.g., 3-methyladenine, chloroquine) can turn off the protective autophagic effect for therapeutic benefits. Several studies showed that autophagy inhibition resulted in a synergistic effect with chemotherapy (e.g., a combination of metformin with gemcitabine/ 5FU). Such drugs possess a unique clinical value in treating pancreatic cancer as well as other autophagy-dependent carcinomas.

Risk for relapse and death after adjuvant chemotherapy associated with SNPs in patients with breast cancer - A retrospective study

For the women breast cancer (BC) patients included in this retrospective study, the first line of systemic treatment in adjuvant modality for breast cancer (BC) after surgery was fluorouracil, epirubicin and cyclophosphamide (FEC). The aim of our investigation was to analyze the prognostic biomarkers for relapse and death of patients eight to ten years after chemotherapy in association with nausea and vomiting.

METHOD

This retrospective study included 114 patients treated between 2010 and 2013. Blood samples for Single Nucleotide Polymorphism (SNP) analysis before the chemotherapy treatment were collected. The medical records were used to determine relapses and death.

RESULTS

Sixteen percent relapsed and 9 % died during the follow-up period. SNPs located in the genes ESR and CASP9 were associated with both relapse and death.

CONCLUSIONS

Relapse and death were at a relative moderate level and consistent with other studies. Two SNPs in the Estrogen hormone receptor gene ESR1 and the apoptosis execution gene Caspases 9 (Casp9) were found to be associated with a higher risk of relapse and death. These findings suggest the possible value of blood biomarkers in the selection of individual treatments in the clinical setting.

Resveratrol-Loaded TPGS-Resveratrol-Solid Lipid Nanoparticles for Multidrug-Resistant Therapy of Breast Cancer: In Vivo and In Vitro Study

Multidrug resistance (MDR) is a serious problem during cancer therapy. The purpose of the present study was to formulate D-α-Tocopheryl polyethylene glycol 1000 succinate-resveratrol-solid lipid nanoparticles (TPGS-Res-SLNs) to improve its therapeutic efficacy against breast cancer. In this study, the solvent injection method was used to prepare the TPGS-Res-SLNs. It was found that the TPGS-Res-SLNs exhibited zeta potential and drug-loading of -25.6 ± 1.3 mV and 32.4 ± 2.6%, respectively. Therefore, it was evident that the TPGS-Res-SLNs can increase cellular uptake of chemotherapeutic drugs, induce mitochondrial dysfunction, and augment tumor treatment efficiency by inducing apoptosis. Moreover, it was found that SKBR3/PR cells treated with TPGS-Res-SLNs exhibited significant inhibition of cell migration and invasion, as compared with free resveratrol. In addition, results from in vivo SKBR3/PR xenograft tumor models revealed that TPGS-Res-SLNs has better efficacy in promoting apoptosis of tumor cells owing to high therapeutic outcomes on tumors when compared with the efficacy of free resveratrol. In conclusion, the findings of the present study indicate significant potential for use of TPGS-Res-SLNs as an efficient drug delivery vehicle to overcome drug resistance in breast cancer therapy.