The Menstrual Cycle and Risk of Breast Cancer: A Review

Systematic Review on Gender-Affirming Testosterone Therapy and the Risk of Breast Cancer: A Challenge for Physicians Treating Patients from Transgender and Gender-Diverse Populations

Conflicting evidence exists about the risk of breast cancer in transgender and gender-diverse (TGD) patients treated with testosterone. This review aimed to summarize current knowledge regarding the risk of breast cancer associated with gender-affirming testosterone treatment (GATT). A systematic literature search using the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist was conducted in January 2023 through Ovid, Scopus, and Web of Science databases. English-language, peer-reviewed articles evaluating breast cancer in TGD patients after GATT that met the inclusion criteria were included. This review included 22 articles, with 14 case reports, 4 case series, and 4 retrospective cohort studies. The review identified 26 TGD patients who developed breast cancer post-GATT therapy, with inconclusive evidence on the relationship between testosterone and the risk of breast cancer in TGD patients. This uncertainty in part arises from the mechanisms governing testosterone's effects within breast tissue, with contrasting theories proposing both proliferative and antiproliferative impacts. Considering this ambiguity, it is imperative for healthcare providers to engage in informed discussions with patients prior to initiating hormone therapy to discuss potential adverse effects, including the possibility of breast cancer development in TGD individuals. Patient education and shared decision-making are essential components of responsible care in this context.

Menstrual and reproductive factors associated with risk of breast cancer among Indian women: a cross sectional study from National Family Health Survey, 2019-21

BACKGROUND

The breast cancer is common cancer in women globally. The risk of breast cancer is strongly associated with women's menstrual and reproductive factors that have been established in different countries. Therefore present study was aim to explore the association between menstrual and reproductive factors and the risk of breast cancer screening in Indian women.

METHODS

The present study data has been used fifth round of the National Family Health Survey (NFHS-V) with 724,115 women in aged 15-49 in 2019-21. The self-reported ever screened of breast cancer for women aged 30-49 was the main outcome variable of the study. Logistic regression models were used to estimate odds ratios and 95% confidence intervals for breast cancer by menstrual and reproductive factors adjusted for potential confounders.

RESULTS

Late menarche (OR = 2.20, 95% CI: 1.48-3.28), irregular menstrual cycle (OR = 1.29, 95% CI: 1.08-3.53)), delay age at first birth (OR = 1.93, 95% CI: 1.11-3.04) and contraceptive pill used (OR = 1.11, 95% CI: 0.74-2.10) were significantly associated to increases the uptake of screening breast cancer. While, a higher number of birth (OR = 0.52, 95% CI: 0.10-1.03), and long duration of breast-feeding practice (OR = 0.75, 95% CI: 0.63-0.91) were reduced to participate for screening breast cancer.

CONCLUSION

The results of the study confirm the role of menstrual and reproductive factors in breast cancer in Indian women. Therefore, our findings are imperative for developing breast cancer prevention strategies and better preparedness. Creating awareness and providing knowledge on cancer could be key strategies for the reduction of breast cancer in Indian reproductive age group women.

Breast cancer: Epidemiology, risk factors and screening

Breast cancer is a global health concern with a significant impact on the well-being of women. Worldwide, the past several decades have witnessed changes in the incidence and mortality of breast cancer. Additionally, epidemiological data reveal distinct geographic and demographic disparities globally. A range of modifiable and non-modifiable risk factors are established as being associated with an increased risk of developing breast cancer. This review discusses genetic, hormonal, behavioral, environmental, and breast-related risk factors. Screening plays a critical role in the effective management of breast cancer. Various screening modalities, including mammography, ultrasound, magnetic resonance imaging (MRI), and physical examination, have different applications, and a combination of these modalities is applied in practice. Current screening recommendations are based on factors including age and risk, with a significant emphasis on minimizing potential harms to achieve an optimal benefits-to-harms ratio. This review provides a comprehensive insight into the epidemiology, risk factors, and screening of breast cancer. Understanding these elements is crucial for improving breast cancer management and reducing its burden on affected individuals and healthcare systems.

Nanostrategy of Targeting at Embryonic Trophoblast Cells Using CuO Nanoparticles for Female Contraception

Effective contraceptives have been comprehensively adopted by women to prevent the negative consequences of unintended pregnancy for women, families, and societies. With great contributions of traditional hormonal drugs and intrauterine devices (IUDs) to effective female contraception by inhibiting ovulation and deactivating sperm, their long-standing side effects on hormonal homeostasis and reproductive organs for females remain concerns. Herein, we proposed a nanostrategy for female contraceptives, inducing embryonic trophoblast cell death using nanoparticles to prevent embryo implantation. Cupric oxide nanoparticles (CuO NPs) were adopted in this work to verify the feasibility of the nanostrategy and its contraceptive efficacy. We carried out the in vitro assessment on the interaction of CuO NPs with trophoblast cells using the HTR8/SVneo cell line. The results showed that the CuO NPs were able to be preferably uptaken into cells and induced cell damage via a variety of pathways including oxidative stress, mitochondrial damage, DNA damage, and cell cycle arrest to induce cell death of apoptosis, ferroptosis, and cuproptosis. Moreover, the key regulatory processes and the key genes for cell damage and cell death caused by CuO NPs were revealed by RNA-Seq. We also conducted in vivo experiments using a rat model to examine the contraceptive efficacy of both the bare CuO NPs and the CuO/thermosensitive hydrogel nanocomposite. The results demonstrated that the CuO NPs were highly effective for contraception. There was no sign of disrupting the homeostasis of copper and hormone, or causing inflammation and organ damage in vivo. In all, this nanostrategy exhibited huge potential for contraceptive development with high biosafety, efficacy, clinical translation, nonhormonal style, and on-demand for women.

Protooncogenic Role of ARHGAP11A and ARHGAP11B in Invasive Ductal Carcinoma: Two Promising Breast Cancer Biomarkers

Invasive duct carcinoma (IDC) is one of the most common types of breast cancer (BC) in women worldwide, with a high risk of malignancy, metastasis, recurrence, and death. So far, molecular patterns among IDC cases have not been fully defined. However, extensive evidence has shown that dysregulated Rho family small GTPases (Rho GTPases) including Rho GTPase activating proteins (RhoGAPs) have important roles in the invasive features of IDCs. In the current study, we analyzed the expression levels of two RhoGAP genes, ARHGAP11A and ARHGAP11B, in The Cancer Genome Atlas (TCGA) breast cancer (BRCA) and also our 51 IDC tumors compared to their matched normal tissues using quantitative polymerase chain reaction (qPCR). Our TCGA data analysis revealed higher expression of ARHGAP11A and ARHGAP11B in various cancers comprising BCs. Also, we found correlations between these genes and other genes in TCGA-BRCA. Moreover, our methylation analysis showed that their promotor methylation had a negative correlation with their overexpression. QPCR revealed their significant upregulation in our tumor samples. Furthermore, we found that the expression level of ARHGAP11A was considerably lower in women who were breastfeeding. Moreover, it had overexpression in cases who had regular menstrual cycles and early age (younger than 14) at menarche. However, ARHGAP11B had a higher expression in HER2-positive tumors versus HER2-positive and ER-positive tumors. Our study found possible protooncogenic roles for these genes and their involvement in IDC pathogenesis and malignancy. Therefore, they can be considered novel prognostic and diagnostic biomarkers for IDC.

Determinants of breast cancer in Ethiopia: a systematic review and meta-analysis

Background

Breast cancer (BC) is the first leading cancer sharing about 25% of the cancer burden among women globally. This study aimed to identify the determinants of BC in Ethiopia.

Methods

We comprehensively searched primary studies conducted in Ethiopia on associated factors of BC in PubMed, Cochrane Library, Hinari, Google, and Google Scholar) and available online until 2 June 2023. The necessary data were extracted from relevant studies and exported to STATA version 15 for analysis. The pooled odds ratio with its 95% confidence interval (CI) was estimated using a random effect model. The finding was reported following preferred reporting items for systematic reviews and meta-analyses guidelines.

Results

Five studies with 1,819 participants (792 cases and 1,027 controls) were included. The significant determinants of BC were age at menarche <12 years (adjusted odds ratio (AOR) = 3.36, 95% CI: 1.68-5.04), post-menopause (AOR = 2.37, 95% CI: 1.67-3.06), ever breastfeeding (AOR = 0.28, 95% CI: 0.15-0.42), and family history of cancer (AOR = 2.39, 95% CI: 1.29-3.44).

Conclusion

In Ethiopia, the significant determinants of BC among women were age at menarche <12 years, post-menopause, Ever breastfeeding, and family history of cancer. We recommend that the concerned organizations consider the aforementioned factors in addressing the problem of BC in Ethiopia by increasing community awareness, promoting breast self-examination, and developing programs to reduce the increasing burden of BC in the study setting.

Estrogens and the risk of breast cancer: A narrative review of literature

In female mammals, the development and regulation of the reproductive system and non-reproductive system are significantly influenced by estrogens (oestrogens). In addition, lipid metabolism is another physiological role of estrogens. Estrogens act through different types of receptors to introduce signals to the target cell by affecting many estrogen response elements. Breast cancer is considered mostly a hormone-dependent disease. Approximately 70% of breast cancers express progesterone receptors and/or estrogen receptors, and they are a good marker for cancer prognosis. This review will discuss estrogen metabolism and the interaction of estrogen metabolites with breast cancer. The carcinogenic role of estrogen is discussed in light of both conventional and atypical cancers susceptible to hormones, such as prostate, endometrial, and lung cancer, as we examine how estrogen contributes to the formation and activation of breast cancer. In addition, this review will discuss other factors that can be associated with estrogen-driven breast cancer.

Associations of chronotype and insomnia with menstrual problems in newly employed nurses at university hospitals in the Republic of Korea

Background

Dysmenorrhea and menstrual cycle changes occur in women working shifts. Circadian rhythm disruption and sleep disturbances associated with shift work leads to health problems. We identified chronotypes and the occurrence of insomnia among newly employed university hospital nurses and investigated the association of these factors with menstrual problems.

Methods

We conducted pre-placement health examinations for shift workers using self-reported questionnaires between 2018 and 2020. A total of 463 nurses were included in the study. Sociodemographic data, shift work experience, and information on insomnia were collected from health examination data. In addition, details regarding chronotype, dysmenorrhea, irregular and abnormal menstrual cycles, amenorrhea, and contraceptive use were obtained from the questionnaire. Multiple logistic regression analysis was performed to study the association between chronotype, insomnia, and menstrual problems after controlling for age, body mass index, contraceptive use, amenorrhea, and prior shift work.

Results

The prevalence rates of dysmenorrhea, irregular menstrual cycles, and longer menstrual cycles were 23.8%, 14.9%, and 4.1%, respectively. The risk of dysmenorrhea increased in the evening-type (odds ratio [OR]: 3.209; 95% confidence interval [CI]: 1.685-6.113) and those with insomnia (OR: 1.871; 95% CI: 1.074-3.261). Additionally, the risk of an irregular menstrual cycle (OR: 2.698; 95% CI: 1.167-6.237) increased in the evening-type, and the risk of a longer menstrual cycle (OR: 4.008; 95% CI: 1.354-11.864) increased in individuals with insomnia.

Conclusions

Our findings suggest that dysmenorrhea is promoted in the evening-type and insomnia individuals. There may be an increased risk of irregular menstrual cycles among evening-type nurses and an increased risk of longer menstrual cycles among those with insomnia. Therefore, factors such as evening-type and insomnia should be considered for the prevention of menstrual problems in women performing shift work.

Association between breast nodules, anxiety, depression and metabolic risk factors in a Chinese cohort

Background

The relationship between anxiety, depression, and metabolic parameters and the incidence of breast nodules is unclear. This study aims to investigate the association between female breast nodules and anxiety, depression and metabolic factors.

Methods

This cross-sectional study recruited 857 individuals with biological indicators and breast ultrasound data from the Daping hospital from April 2021 to February 2022. Serum samples were used to measure fasting blood glucose, uric acid, triglycerides, total cholesterol, urea nitrogen, alanine transaminase, aspartate transaminase, albumin, high-density lipoprotein, low-density lipoprotein. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the level of anxiety and depression.

Result

The positive rate of breast nodules in women aged 40 to 49 years old was significantly higher than that of other age women. The proportion of participants aged 40-49 years old in the group with breast nodules was significantly higher than that in the group without breast nodules (34.6% vs. 16.9%, p<0.001). Breast nodules in postmenopausal women were significantly lower than those in premenopausal women (26.4% vs. 73.6%, p = 0.026). The SAS scores of women with breast nodules were higher than those of the no-nodules group (40.99 ± 8.45 vs. 38.94 ± 6.89, p<0.001), same as the SDS scores (41.97 ± 10.33 vs. 38.91 ± 7.60, p < 0.001). The number of women suffering from anxiety in the group of breast nodules was significantly higher than that in control (13.8% vs. 4.5%, p < 0.001), and the number of depression in the group of breast nodules was also significantly higher than that of in control (14.4% vs. 4.5%, p < 0.001). Women with breast nodules showed a slightly lower uric acid level than those without breast nodules (290.11 ± 65.32 vs. 301.43 ± 65.93 umol/L, p = 0.016). Multivariable logistic regression analysis showed that age, menopausal status, anxiety and depression status were significantly associated with the presence of breast nodules, but there was no significant difference in uric acid.

Conclusion

Our findings offer insight into the occurrence of depression and anxiety in the breast nodules of Chinese women. Anxiety and depression status, age and menopausal status may be the independent risk factors for the occurrence of breast nodules.

Epigenetic investigation into circulating microRNA 197-3p in sera from patients affected by malignant pleural mesothelioma and workers ex-exposed to asbestos

The epigenetic role of microRNAs is established at both physiological and pathological levels. Dysregulated miRNAs and their targets appear to be a promising approach for innovative anticancer therapies. In our previous study, circulating miR-197-3p tested dysregulated in workers ex-exposed to asbestos (WEA). Herein, an epigenetic investigation on this circulating miRNA was carried out in sera from malignant pleural mesothelioma (MPM) patients. MiR-197-3p was quantified in MPM (n = 75) sera and comparatively analyzed to WEA (n = 75) and healthy subject (n = 75) sera, using ddPCR and RT-qPCR techniques. Clinicopathological characteristics, occupational, non-occupational information and overall survival (OS) were evaluated in correlation studies. MiR-197-3p levels, analyzed by ddPCR, were significantly higher in MPM than in WEA cohort, with a mean copies/µl of 981.7 and 525.01, respectively. Consistently, RT-qPCR showed higher miR-197-3p levels in sera from MPM with a mean copies/µl of 603.7, compared to WEA with 336.1 copies/µl. OS data were significantly associated with histologic subtype and pleurectomy. Circulating miR-197-3p is proposed as a new potential biomarker for an early diagnosis of the MPM onset. Indeed, miR-197-3p epigenetic investigations along with chest X-ray, computed tomography scan and spirometry could provide relevant information useful to reach an early and effective diagnosis for MPM.

Impact of risk factors on early cancer evolution

Recent identification of oncogenic cells within healthy tissues and the prevalence of indolent cancers found incidentally at autopsies reveal a greater complexity in tumor initiation than previously appreciated. The human body contains roughly 40 trillion cells of 200 different types that are organized within a complex three-dimensional matrix, necessitating exquisite mechanisms to restrain aberrant outgrowth of malignant cells that have the capacity to kill the host. Understanding how this defense is overcome to trigger tumorigenesis and why cancer is so extraordinarily rare at the cellular level is vital to future prevention therapies. In this review, we discuss how early initiated cells are protected from further tumorigenesis and the non-mutagenic pathways by which cancer risk factors promote tumor growth. By nature, the absence of permanent genomic alterations potentially renders these tumor-promoting mechanisms clinically targetable. Finally, we consider existing strategies for early cancer interception with perspectives on the next steps for molecular cancer prevention.

Do Aging and Parity Affect VEGF-A/VEGFR Content and Signaling in the Ovary?-A Mouse Model Study

In this study, the effects of aging and parity on VEGF-A/VEGFR protein content and signaling in the mice ovaries were determined. The research group consisted of nulliparous (virgins, V) and multiparous (M) mice during late-reproductive (L, 9-12 months) and post-reproductive (P, 15-18 months) stages. Whilst ovarian VEGFR1 and VEGFR2 remained unchanged in all the experimental groups (LM, LV, PM, PV), protein content of VEGF-A and phosphorylated VEGFR2 significantly decreased only in PM ovaries. VEGF-A/VEGFR2-dependent activation of ERK1/2, p38, as well as protein content of cyclin D1, cyclin E1, and Cdc25A were then assessed. In ovaries of LV and LM, all of these downstream effectors were maintained at a comparable low/undetectable level. Conversely, the decrease recorded in PM ovaries did not occur in the PV group, in which the significant increase of kinases and cyclins, as well phosphorylation levels mirrored the trend of the pro-angiogenic markers. Altogether, the present results demonstrated that, in mice, ovarian VEGF-A/VEGFR2 protein content and downstream signaling can be modulated in an age- and parity-dependent manner. Moreover, the lowest levels of pro-angiogenic and cell cycle progression markers detected in PM mouse ovaries sustains the hypothesis that parity could exert a protective role by downregulating the protein content of key mediators of pathological angiogenesis.

Association of hypertension, hyperlipidemia, obesity, and demographic risk factors with breast cancer in Bangladeshi women

In recent years, breast cancer incidences and related deaths have been rising among Bangladeshi women and will be a major threat by 2040. So, conducting more population-based studies is crucial. This case-control study was designed to quantitatively evaluate potential risk factors for breast cancer. In this population-based case-control study, 52 random breast cancer cases and 59 matched healthy controls, aged between 25 and 70 years, were included. The breast cancer patient samples were collected from the National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh, from December 2021 to February 2022. The study was conducted fully following the Declaration of Helsinki guidelines. The collected socio-demographic data and blood samples of the study participants were analyzed. Chi-square analysis was used to compare study characteristics between cases and controls, Odds ratios (ORs) with 95% confidence intervals (CIs) were derived by univariate-logistic regression, and models were adjusted where necessary for study characteristics. Summary demographic characteristics of the 111 study participants suggested that higher age: (≥45): [OR 4.38, 95% CI (1.94-9.89), P value <.001], height: (<1.5 m): [OR 3.01, 95% CI (1.12-8.12), P value .029], low-incomes: [OR 6.83, 95% CI (2.11-22.05), P value .001], and illiteracy: [OR 12.65, 95% CI (3.49-45.79), P value .0001] showed significant correlations with breast cancer. The patient's body mass index (BMI) (≥30) indicated an association with breast cancer: [OR 3.91, 95% CI (1.00-15.31), P value .05]. The lipid profile: [triglycerides (TG): OR = 3.20, 95% CI (1.36-7.53), P value .008; TG/high-density lipid (HDL): OR = 8.82, 95% CI (2.81-27.68), P value <.001; and a lowered HDL: OR = 3.32, 95% CI (1.38-7.98), P value .007], hypertension: [systolic: OR 4.32, 95% CI (1.71-10.93), P value .002; and diastolic: OR 7.32, 95% CI (2.51-21.34), P value <.001], and gastric issues: [OR 6.07, 95% CI (2.00-18.37), P value .001], all showed significant association with breast cancer. The ER- breast cancer subtype was significantly associated with the overweight (OW) group (P value .046) whereas the PR-patients were significantly higher in the normal BMI group (P value .013). Results from this study might aid in the prevention, management, and raising of awareness against the specific risk factors among Bangladeshi women in near future.

Breast Self-Examination: Knowledge, Practice, and Beliefs Among Females in Jordan

Introduction

Worldwide, breast cancer is one of the most common types of cancer. It is the leading cause of cancer-related deaths among females in Jordan.

Objectives

The current study aimed to evaluate breast cancer knowledge levels and practice and assess health beliefs regarding the model supporting self-breast examination (BSE) in a group of females aged between 20 and 60 in Jordan.

Methods

Descriptive, cross-sectional, correlational design was used; Two hundred females participated in the study, employing convenient sampling. The adjusted version of the Champion's Health Belief Model Scale (CHBMS) was utilized to collect the data.

Results

Most participants were married (F = 128, 64%), and the mean of the participants' age was (36.18, SD = 10.87). About 73 participants (36.5%) don't practice BSE; however, 53 participants (26.5%) plan to practice BSE in the future monthly. The logistic regression model showed that the impact of confidence as positive predictive value on practicing BSE in the last year (B = 0.141, p < .001) and this year (B = 0.130, p < .001) was statistically significant.

Conclusion

Implications for practice include identifying culturally specific barriers and improving health education programs to trigger breast self-examination utilization.

The health effects of soy: A reference guide for health professionals

Soy is a hotly debated and widely discussed topic in the field of nutrition. However, health practitioners may be ill-equipped to counsel clients and patients about the use of soyfoods because of the enormous, and often contradictory, amount of research that has been published over the past 30 years. As interest in plant-based diets increases, there will be increased pressure for practitioners to gain a working knowledge of this area. The purpose of this review is to provide concise literature summaries (400-500 words) along with a short perspective on the current state of knowledge of a wide range of topics related to soy, from the cholesterol-lowering effects of soy protein to the impact of isoflavones on breast cancer risk. In addition to the literature summaries, general background information on soyfoods, soy protein, and isoflavones is provided. This analysis can serve as a tool for health professionals to be used when discussing soyfoods with their clients and patients.

Plasma perfluoroalkyl substance exposure and incidence risk of breast cancer: A case-cohort study in the Dongfeng-Tongji cohort

Experimental studies have suggested perfluoroalkyl substances (PFASs) as mammary toxicants, but few studies evaluated the prospective associations of PFASs with breast cancer risk. We performed a case-cohort study within the Dongfeng-Tongji cohort, including incident breast cancer cases (n = 226) and a random sub-cohort (n = 990). Baseline plasma concentrations of four perfluorinated carboxylic acids (PFCAs) [perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroheptanoic acid (PFHpA)] and two perfluorinated sulfonic acids (PFSAs) [perfluorooctane sulfonic acid (PFOS) and perfluorohexane sulfonic acid (PFHxS)] were measured. Barlow-weighted Cox regression models revealed that each 1-unit increase in ln-transformed PFOA and PFHpA was associated with a separate 35% and 20% elevated incident risk of breast cancer [HR(95%CI) = 1.35(1.03, 1.78) and 1.20(1.02, 1.40), respectively], which were also significant among postmenopausal females [HR(95%CI) = 1.34(1.01, 1.77) and 1.23 (1.02, 1.48), respectively]. Quantile g-computation analysis observed a 19% increased incident risk of breast cancer along with each simultaneous quartile increase in all ln-transformed PFCA concentrations [HR(95%CI) = 1.19(1.01, 1.41)], with PFOA accounting for 56% of the positive effect. Our findings firstly revealed the impact of short-chain PFHpA on increased incident risk of breast cancer, suggested exposure to PFASs as a risk factor for breast cancer, and shed light on breast cancer prevention by regulating PFASs as a chemical class.

Jalil MA. Knowledge Level on Breast Cancer and Breast Self-Examination (BSE) Practice Among Female University Students

Introduction: Breast cancer is the most common cancer affecting women in Malaysia and therefore, it is important to recognize the early signs and symptoms of breast cancer. In addition, breast self?examination (BSE) also has been suggested as a valuable technique for the early diagnosis of breast cancer. Therefore, this study aimed to assess the level of knowledge on breast cancer and breast self-examination (BSE); and determine the practice of BSE among female student in International Islamic University Malaysia (IIUM), Kuantan, Pahang. Methods: A quantitative cross-sectional study with stratified random sampling method was conducted among 245 female students in IIUM Kuantan Campus, from April to May 2021. Data were gathered by using Google Forms platform which was available in English Language and were distributed to female undergraduate students. The questionnaire was adapted from three sets of questionnaires, Nimir et al., (2014), Erdem and Toktas (2016) and Tewabe and Mekuria (2019). Data analysis was done by using SPSS version 23.0. Results: Majority of the participants (98.0%) have high knowledge regarding the knowledge on risk factors, signs and symptoms of breast cancer and breast self-examination (BSE). The result also showed that 31.0% participants never performed BSE. Most of them reported that the reasons that they do not perform BSE are due to lack of knowledge (35.1%), forgetfulness (33.9%) and negligence (21.6%). Around 36.3% participants reported that they do not know the technique that use to perform BSE.Conclusion: Participants having high knowledge on breast cancer and BSE; however, the practice of BSE is still lacking. Therefore, BSE need to be more educate and promote its practice among young women for early detection of breast cancer and its prevention.

Obesity and Breast Cancer Risk: The Oncogenic Implications of Metabolic Dysregulation

CONTEXT

Breast cancer is increasing in prevalence in parallel with rising rates of obesity worldwide. Obesity is recognized as a leading modifiable risk factor for the development of breast cancer; however, this association varies considerably by clinicopathologic features, and the underlying mechanisms are complex.

EVIDENCE ACQUISITION

Pubmed literature search using combinations of "obesity," "breast cancer risk," "diet," "exercise," "weight gain," "weight loss," "adipose tissue inflammation," "crown-like structure," "immune markers," "metformin," "gliflozins," "SGLT-2i," "GLP1-RA," and related terms.

EVIDENCE SYNTHESIS

Elevated body mass index and weight gain are associated with increased risk of postmenopausal, hormone receptor-positive breast cancer. Emerging evidence suggests that adverse measures of body composition in individuals of any weight can also confer increased breast cancer risk. Mechanistically, various factors including altered adipokine balance, dysfunctional adipose tissue, dysregulated insulin signaling, and chronic inflammation contribute to tumorigenesis. Weight loss and more specifically fat mass loss through lifestyle and pharmacologic interventions improve serum metabolic and inflammatory markers, sex hormone levels, and measures of breast density, suggesting a link to decreased breast cancer risk.

CONCLUSION

Incorporating markers of metabolic health and body composition measures with body mass index can capture breast cancer risk more comprehensively. Further studies of interventions targeting body fat levels are needed to curb the growing prevalence of obesity-related cancer.

Delineation of Pathogenomic Insights of Breast Cancer in Young Women

The prognosis of breast cancer (BC) in young women (BCYW) aged ≤40 years tends to be poorer than that in older patients due to aggressive phenotypes, late diagnosis, distinct biologic, and poorly understood genomic features of BCYW. Considering the estimated predisposition of only approximately 15% of the BC population to BC-promoting genes, the underlying reasons for an increased occurrence of BCYW, at large, cannot be completely explained based on general risk factors for BC. This underscores the need for the development of next-generation of tissue- and body fluid-based prognostic and predictive biomarkers for BCYW. Here, we identified the genes associated with BCYW with a particular focus on the age, intrinsic BC subtypes, matched normal or normal breast tissues, and BC laterality. In young women with BC, we observed dysregulation of age-associated cancer-relevant gene sets in both cancer and normal breast tissues, sub-sets of which substantially affected the overall survival (OS) or relapse-free survival (RFS) of patients with BC and exhibited statically significant correlations with several gene modules associated with cellular processes such as the stroma, immune responses, mitotic progression, early response, and steroid responses. For example, high expression of COL1A2, COL5A2, COL5A1, NPY1R, and KIAA1644 mRNAs in the BC and normal breast tissues from young women correlated with a substantial reduction in the OS and RFS of BC patients with increased levels of these exemplified genes. Many of the genes upregulated in BCYW were overexpressed or underexpressed in normal breast tissues, which might provide clues regarding the potential involvement of such genes in the development of BC later in life. Many of BCYW-associated gene products were also found in the extracellular microvesicles/exosomes secreted from breast and other cancer cell-types as well as in body fluids such as urine, saliva, breast milk, and plasma, raising the possibility of using such approaches in the development of non-invasive, predictive and prognostic biomarkers. In conclusion, the findings of this study delineated the pathogenomics of BCYW, providing clues for future exploration of the potential predictive and prognostic importance of candidate BCYW molecules and research strategies as well as a rationale to undertake a prospective clinical study to examine some of testable hypotheses presented here. In addition, the results presented here provide a framework to bring out the importance of geographical disparities, to overcome the current bottlenecks in BCYW, and to make the next quantum leap for sporadic BCYW research and treatment.

Oncobiology and treatment of breast cancer in young women

Female breast cancer emerged as the leading cancer type in terms of incidence globally in 2020. Although mortality due to breast cancer has improved during the past three decades in many countries, this trend has reversed in women less than 40 years since the past decade. From the biological standpoint, there is consensus among experts regarding the clinically relevant definition of breast cancer in young women (BCYW), with an age cut-off of 40 years. The idea that breast cancer is an aging disease has apparently broken in the case of BCYW due to the young onset and an overall poor outcome of BCYW patients. In general, younger patients exhibit a worse prognosis than older pre- and postmenopausal patients due to the aggressive nature of cancer subtypes, a high percentage of cases with advanced stages at diagnosis, and a high risk of relapse and death in younger patients. Because of clinically and biologically unique features of BCYW, it is suspected to represent a distinct biologic entity. It is unclear why BCYW is more aggressive and has an inferior prognosis with factors that contribute to increased incidence. However, unique developmental features, adiposity and immune components of the mammary gland, hormonal interplay and crosstalk with growth factors, and a host of intrinsic and extrinsic risk factors and cellular regulatory interactions are considered to be the major contributing factors. In the present article, we discuss the status of BCYW oncobiology, therapeutic interventions and considerations, current limitations in fully understanding the basis and underlying cause(s) of BCYW, understudied areas of BCYW research, and postulated advances in the coming years for the field.

Mapping of Female Breast Cancer Incidence and Mortality Rates to Socioeconomic Factors Cohort: Path Diagram Analysis

OBJECTIVES

Breast cancer is the leading cause of death in women around the world. Its occurrence and development have been linked to genetic factors, living habits, health conditions, and socioeconomic factors. Comparisons of incidence and mortality rates of female breast cancer are useful approaches to define cancer-related socioeconomic disparities.

METHODS

This was a retrospective observational cohort study on breast cancer of women in several developed countries over 30 years. Effects of socioeconomic factors were analyzed using a path diagram method.

RESULTS

We found a positive, significant association of public wealth on incidence and mortality of breast cancer, and the path coefficients in the structural equations are -0.51 and -0.39, respectively. The unemployment rate (UR) is critical and the path coefficients are all 0.2. The path coefficients of individual economic wealth to the rates of breast cancer are 0.18 and 0.27, respectively.

CONCLUSION

The influence of social pressure on the incidence and mortality of breast cancer was not typical monotonous. The survival rate of breast cancer determined by the ratio of mortality rate to incidence rate showed a similar pattern with socioeconomic factors.

Epidemiological and anatomopathological profile of breast cancer in the region of North-West of Tunisia

INTRODUCTION

Breast cancer is a common and serious disease. It represents the first cause of mortality and morbidity from cancer of Tunisian women and worldwide.

AIM

To analyze the clinico-pathological and evolutionary characteristics of the patients followed at the carcinology's pole in the region of the North-West of Tunisia.

METHODS

We conducted a retrospective descriptive study of 114 patients, who were diagnosed with non metastatic breast cancers over a 6-year period, from January 2011 to December 2016.

RESULTS

Among the 289 patients treated in the medical carcinology department of the Jendouba regional hospital for invasive breast carcinoma over a period of 6 years, 114 patients had localized breast carcinoma, they were the subject of our study. The average age was 51 years. Nonspecific invasive cancer was the most frequent histological type (95.6%). The mean histological size was 29.3 mm. SBR grade II was most prevalent. Histological lymph node involvement was observed in 50.9%. Lymphovascular invasion was detected in 23.9% of cases and perineural sheaths was detected in 21.9% of cases. The most common molecular subtype was Luminal B. After discussion in a multidisciplinary concertation meeting, the patients received locoregional treatment: surgery, radiotherapy and systemic treatment: chemotherapy, endocrine hormone therapy. After a median follow-up of 45 months, OS and PFS at 5 years were 85.6% and 79.2% respectively.

CONCLUSION

In the region of the North-West of Tunisia, breast cancer is characterized by its occurrence at a young age, the importance of tumor size, the importance of lymph node involvement, the frequency of inflammatory breast carcinoma and especially by the predominance of the molecular groups Luminal B and HER2 neu.

Effect of the Intake of Isoflavones on Risk Factors of Breast Cancer-A Systematic Review of Randomized Controlled Intervention Studies

Epidemiological studies suggest that high intake of soy isoflavones may protect against breast cancer, but causal relationships can only be established by experimental trials. Thus, we aimed to provide a systematic review of randomized controlled trials (RCTs) on the effect of an isoflavone intake on risk factors of breast cancer in healthy subjects. After a systematic literature search in PubMed, 18 different RCTs with pre- and/or postmenopausal women were included and investigated for details according to the PRISMA guideline. In these studies, isoflavones were provided by soy food or supplements in amounts between 36.5-235 mg/d for a period of 1-36 months. Breast density, estrogens including precursors, metabolites, estrogen response such as length of menstrual cycle, and markers of proliferation and inflammation were considered. However, in most studies, differences were not detectable between isoflavone and control/placebo treatment despite a good adherence to isoflavone treatment, irrespective of the kind of intervention, the dose of isoflavones used, and the duration of isoflavone treatment. However, the lack of significant changes in most studies does not prove the lack of effects as a sample size calculation was often missing. Taking into account the risk of bias and methodological limitations, there is little evidence that isoflavone treatment modulates risk factors of breast cancer in pre- and postmenopausal women. Future studies should calculate the sample size to detect possible effects and consider methodological details to improve the study quality.

The Physiology of Reproduction - Quo vadis?

The reproductive system in males and females reflects a highly dynamic underlying physiology. Yet our current understanding of this system is still largely based upon relatively simplistic snapshots of individual component cells and tissues. Gamete production as well as gonadal hormone synthesis and its influence are the manifestations of dynamic and redundant informational networks and processes, whose qualitative and quantitative dimensions, especially through development from embryo through puberty and adulthood into ageing, are still largely uncharted. Whilst the recent huge advances in molecular science have helped to describe the components of the reproductive system in ever greater detail, how these interact and function in space and time dimensions is still largely obscure. Recent developments in microfluidics, stem cell biology, and the integration of single-cell transcriptomics with tissue dynamics are offering possible methodological solutions to this issue. Such knowledge is essential if we are to understand not only the normal healthy functioning of this system, but also how and why it is affected in disease or by external impacts such as those from environmental endocrine disruptors, or in ageing. Moreover, operating within a complex network of other physiological systems, its integrational capacity is much more than the generation of male and female gametes and their roles in fertility and infertility; rather, it represents the underpinning support for health and well-being across the lifespan, through pregnancy, puberty, and adulthood, into old age.

Coffee Intake Interacted with the Bcl-2 rs1944420, rs7236090, and rs2849382 Haplotype to Influence Breast Cancer Risk in Middle-Aged Women

We hypothesized that the haplotype of Bcl-2 genetic variants increases breast cancer risk and interacts with lifestyles in Korean women. We identified single nucleotide polymorphism (SNPs) of Bcl-2 associated with breast cancer risk after adjusting for covariates in 390 breast cancer patients and 36,726 women without any cancer that participated in the Korean Genomic Epidemiology Study (KoGES). An allelic genetic model showed that three SNPs (rs1944420, rs7236090, and rs2849382) in the Bcl-2 gene were significantly associated with breast cancer (ORs = 1.28, 0.84, and 0.79, respectively). The participants with the minor allele of the haplotype with three SNPs had 1.65-fold higher breast cancer risk than those with the major allele, after adjusting for covariates. Serum C-reactive protein concentration had a positive association with breast cancer risk. A significant interaction was also observed between the minor allele of the Bcl-2 haplotype and coffee intake (P = 0.03). A low coffee intake in women with the minor allele presented a higher breast cancer risk than a low coffee intake in those with the major allele. In conclusion, the risk of breast cancer risk was higher in post-menopausal women with the minor allele of the Bcl-2 haplotype, and consuming more than 1 cup of coffee per day reduced the risk. The results of this study could be applied to reduce the risk of breast cancer.

Nonhuman primate model in mammary gland biology and neoplasia research

Research on breast cancer pathogenesis, prevention and drug development remains an important field as this disease is still one of the leading causes of cancer death worldwide. Nonhuman primates, particularly macaque species, may serve as a highly translational animal model in breast cancer studies due to their similarity with humans in genetics, anatomy, reproductive and endocrine physiology including mammary gland development profile. The use of nonhuman primates in biomedical research, however, requires high ethical standards and an increasing expectation to improve strategies to replace, reduce and refine their use. Here, we discuss some key features of nonhuman primate mammary gland biology relevant to their strengths and limitations as models in studies of breast development and cancer risk.

Breast cancer in Trinidad and Tobago: Etiopathogenesis, histopathology and receptor study

Background:

Breast Carcinoma (BCa) is the leading cause of cancer among females in Trinidad and Tobago (TnT). This twin-island has a diversified population of 1.3 million individuals that display and are exposed to a variety of lifestyle choices that have been linked to the development of BCa. Therefore, this study aimed to identify the risk factors that influence the development of BCa, analyze the common histopathological details, and categorize BCa based on receptor study.

Methods:

Cancer information for 120 BCa cases at Eric Williams Medical Sciences Complex from 2012 to 2019 was retrieved, analyzed, and statistically estimated. The clinical details were categorized based on data tabulations, and histological assessment was performed to identify specific features. The receptor analysis was classified based on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor-2 (HER-2neu) staining intensity. A descriptive data analysis and comparison were statistically evaluated in all these cases.

Results:

Epidemiological factors influencing the development of BCa were age with a peak of 56–65 years 27.5% (n = 33), ethnicity predominated in Indo-Trinidadians 48.33% (n = 58), and marital status primarily in unmarried/single/widowed patients 55% (n = 66). Infiltrating ductal carcinoma was the principal histopathological type 91.66% (n = 110). Receptor analysis revealed ER/PR + HER-2neu as the most common type 40% (n = 18) for therapeutic surveillance.

Conclusion:

This study highlights various epidemiological factors that influence the development of BCa among females in TnT. Histopathological analysis and receptor studies would provide a useful link between the tumor behavior and its prognosis.

The Influence of Age at Menarche on the Menstrual Pattern of Polish University Students

PURPOSE

The aim of the study was to examine the relationships between age at menarche and menstrual cycle characteristics in young female subjects.

METHODS

Anthropometric measurements were performed, and questionnaire data were collected from 1,323 women, aged 19-25 years.

RESULTS

No differences were found in terms of cycle duration or the number of days of bleeding between women with early, average, or late menarche. Each of those groups had a similar percentage of women who declared that their cycles last longer than 35 days, those who declared that their cycles are shorter than 21 days, and those who reported prolonged bleeding. Irregular cycles were associated with late age at menarche. Women with early age at menarche complained about menstrual cramps more frequently. The existence of a relationship between age at menarche and menstrual cycle disorders was confirmed by the results of logistic regression.

CONCLUSIONS

Both early and late age at menarche are associated with increased risk of menstrual cycle disorders.

Do malignant cells sleep at night?

Biological rhythms regulate the biology of most, if not all living creatures, from whole organisms to their constitutive cells, their microbiota, and also parasites. Here, we present the hypothesis that internal and external ecological variations induced by biological cycles also influence or are exploited by cancer cells, especially by circulating tumor cells, the key players in the metastatic cascade. We then discuss the possible clinical implications of the effect of biological cycles on cancer progression, and how they could be exploited to improve and standardize methods used in the liquid biopsy field.

Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening

BACKGROUND

Female-to-male (FtM) transsexuals may use testosterone therapy for masculinization, which potentially influences the risk of breast cancer development. Guided by our case report, we aimed to investigate the evidence regarding the risk of testosterone therapy on breast malignancy in female-to-male transsexuals and evaluate breast cancer screening in this subgroup.

METHODS

We conducted a systematic literature search according to the PRISMA checklist in June 2020 in PubMed/MEDLINE and Ovid/EMBASE. Reference lists of included articles were screened to find additional articles that met the inclusion criteria. All cohort studies and case reports evaluating breast cancer in FtM transsexuals after testosterone therapy were included.

RESULTS

We found 23 cases of FtM transsexuals who developed breast cancer after testosterone therapy, including our own case. Moreover, we evaluated ten retrospective cohort studies investigating breast malignancy in the transsexual population. The cohort studies showed no elevated risk in FtM transsexuals compared to natal women. Including our own case, nine cases were described in which breast malignancy was incidentally found during routine histological examination after mastectomy. High-level evidence for a correlation between testosterone therapy and breast malignancy is missing.

CONCLUSION

Few cases are described of FtM transsexuals with breast malignancy. However, cases such as these make physicians aware of the possibility of breast cancer in FtM transsexuals. Radiological screening of FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physicians should decide together with every individual FtM transsexual if screening is necessary.