Assessing breast cancer risk

Physical Activity in Young BRCA Carriers and Reduced Risk of Breast Cancer

INTRODUCTION

A systematic literature review was conducted to determine whether physical activity levels during adolescent and young adult years were associated with a reduced lifetime risk of breast cancer among carriers of deleterious mutations in BRCA1 and BRCA2 genes.

METHODS

Ovid/MEDLINE, Embase, CENTRAL, WOS, and CINAHL were searched for articles including information about adolescent and young adult physical activity and breast cancer incidence among women carrying deleterious BRCA1 and BRCA2 gene mutations (search was initiated in October 2019; last update and full analyses were in March 2021). Independent reviewers screened articles at the title/abstract and full-text levels, resolving differences by consensus with lead authors. The NIH Quality Assessment Tools were used to assess sources of bias.

RESULTS

A total of 1,957 unique articles were identified; 5 met inclusion criteria. Samples size ranged from 68 to 1,185. All studies relied on self-reported adolescent and young adult physical activity. One study measured sports involvement; the others measured recreational activity. One large study was null, whereas 4 others showed a reduction in breast cancer incidence later in life with higher adolescent and young adult physical activity (p≤0.05). However, the protection was limited to premenopausal breast cancer in 1 of the studies (OR=0.62; 95% CI=0.40, 0.96; p-trend=0.01). In addition, adolescent and young adult physical activity was associated with older age at breast cancer diagnosis in 1 study (p=0.03).

CONCLUSIONS

A limited number of studies suggest that adolescent and young adult physical activity may reduce or delay the risk of breast cancer incidence among carriers of deleterious mutations in BRCA1 and BRCA2 genes.

Papillary lesions of the breast discovered on percutaneous large core and vacuum-assisted biopsies: reliability of clinical and pathological parameters in identifying benign lesions

BACKGROUND

A review of the literature reveals conflicting evidence on whether core biopsy, complemented with concordant imaging, is sufficient in differentiating benign from malignant papillary lesions. Our objective was to evaluate whether in our patient population, commonly used clinical and pathological parameters could predict benignity, thus eliminating the need to proceed with excision.

METHODS

A retrospective review of clinical variables and pathologic slides of 39 patients in whom both core biopsy and excisional biopsy were available for evaluation.

RESULTS

Excision revealed malignancy in 44%. Risk factors for malignancy, palpability, size, or Breast Imaging Reporting and Data System (American College of Radiology, Reston, VA) did not help differentiate benign from malignant disease. Younger age and core biopsies revealing minimal or no atypia were predictive of benignity. However, 4 (25%) of 20 patients whose core biopsies were classified as probably benign were found to have malignancy on excision.

CONCLUSIONS

Caution should be used in recommending nonoperative management after a core biopsy revealing a papillary lesion.

Prognostic value of the apoptosis related genes BCL2 and BCL2L12 in breast cancer

Many members of BCL2 (Bcl-2) apoptosis-related genes were found to be differentially expressed in various malignancies and were proposed as prognostic cancer biomarkers. Recently, a new member of the BCL2 gene family, BCL2L12, was cloned and was found to be expressed in mammary gland. In the present study, 55 specimens from patients with, histologically confirmed, epithelial breast carcinoma were analyzed for BCL2 and BCL2L12 gene expression by RT-PCR. Increased expression of BCL2 gene was found in patients belonging to the age groups <45 or >55 years, as well as in estrogen receptors (ER)-positive patients and in BCL2L12-positive tumors. In addition, BCL2 or BCL2L12-positive patients were found to be almost four times less likely to relapse or die in comparison to BCL2 or BCL2L12-negative patients, respectively. Multivariate analysis revealed that BCL2 and BCL2L12 might be used as independent prognostic biomarkers in breast cancer.

Missed opportunities: family history and behavioral risk factors in breast cancer risk assessment among a multiethnic group of women

BACKGROUND

Clinician's knowledge of a woman's cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care.

OBJECTIVE

To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception or worry with clinician's behavior.

DESIGN

Cross-sectional population-based telephone survey.

PARTICIPANTS

Multiethnic sample; 1,700 women from San Francisco Mammography Registry with a screening mammogram in 2001-2002.

PREDICTORS

well visit in prior year, self-perception of 10-year breast cancer risk, worry scale.

OUTCOMES

Patient report of clinician asking about CFH in prior year, or ever counseling about HRB in relation to breast cancer risk. Multivariate models included age, ethnicity, education, language of interview, insurance/mammography facility, well visit, ever having a breast biopsy/follow-up mammography, Gail-Model risk, Jewish heritage, and body mass index.

RESULTS

58% reported clinicians asked about CFH; 33% reported clinicians ever discussed HRB. In multivariate analysis, regardless of actual risk, perceived risk, or level of worry, having had a well visit in prior year was associated with increased odds (OR = 2.3; 95% CI 1.6, 3.3) that a clinician asked about CFH. Regardless of actual risk of breast cancer, a higher level of worry (OR = 1.9; 95% CI 1.4, 2.6) was associated with increased odds that a clinician ever discussed HRB.

CONCLUSIONS

Clinicians are missing opportunities to elicit family cancer histories and counsel about health-related behaviors and breast cancer risk. Preventive health visits offer opportunities for clinicians to address family history, risk behaviors, and patients' worries about breast cancer.

Family Systems Genetic Illness Model—Breast Cancer

Mrs. R and others like her are having prophylactic surgery to prevent breast cancer based primarily on their family history, personal history, and environmental risks. Although the clinical application of genetics medical research is in its infancy, its relevance to breast cancer already is making significant I advances toward more accurate prognosis and treatment options for women and their families. Illness and death from breast cancer continue to limit human existence, whereas new information and medical treatments increase the complexity of healthcare decisions and family life. Rolland and Williams' (2005) FSGI Model helps nurses and advanced practice nurses understand how illnesses such as breast cancer likely will affect patients' lives and families, well before any biologic markers are detectable. Considering the complexity of medical information that currently is available and the risks involved in genetic testing for breast cancer, the best recommendation at this time for people with a family history of breast cancer is to see a genetics counselor. Nurses can help individuals and families prepare for counselors by giving them a list of helpful questions and recommending that they bring a trusted family member or confidant to the meeting. For women who decide to have prophylactic breast surgery, nurses play a significant role in helping them prepare for the emotional and physiologic ramifications. The FSGI Model anticipates the time when families will have an overall genetic risk profile, which can guide them in their prevention efforts and truly give them informed consent.

Identification of risk factors for breast cancer for women in istanbul

BACKGROUND

Breast cancer is the most common cancer type seen in women, accounts for 18% of all cancer types in women and the risk of a woman to get breast cancer during her life is 11%. These notified rates enable breast cancer to be defined as a preventable and if pre-diagnosed, a treatable cancer type, despite it was regarded as a terrifying type of cancer in the past.

OBJECTIVE

The aim of the study was to determine the lifestyle pattern of women without breast cancer in Istanbul.

METHOD

The study was carried out as a descriptive and cross-sectional study with 1000 women.

RESULTS

The majority of the women (29.7%) were in the 35-44 year old age group. Out of these 93.1% gave birth before the age of 30, 29.5% breastfed for 7-12 months, 65.8% started menarche between 13-15 years of age (mean of 13.3 years), 15.5% were in menopause and had entered menopause at a mean age of 46.5 years. Their mean body mass index was 24.3kg/m(2) and 24.5% of them preferred foods containing high fat content. The majority of the women (85.4%) did not participate in sports regularly. One third (30.3%) of the women had underwent Breast Self Examination. There was a positive family history of breast cancer for 12.1% of the women.

CONCLUSION

Sedentary lifestyles, lower Breast Self Examination and routine mammography rates and family histories of breast cancer were the risk factors that needed to be given priority for further action.

Co-occurrence analysis for discovery of novel breast cancer pathology patterns

To discover novel patterns in pathology co-occurrence, we have developed algorithms to analyze and visualize pathology co-occurrence. With access to a database of pathology reports, collected under a single protocol and reviewed by a single pathologist, we can conduct an analysis greater in its scope than previous studies looking at breast pathology co-occurrence. Because this data set is unique, specialized methods for pathology co-occurrence analysis and visualization are developed. Primary analysis is through a co-occurrence score based on the Jaccard coefficient. Density maps are used to visualize global co-occurrence. When our co-occurrence analysis is applied to a population stratified by menopausal status, we can successfully identify statistically significant differences in pathology co-occurrence patterns between premenopausal and postmenopausal women. Genomic and proteomic experiments are planned to discover biological mechanisms that may underpin differences seen in pathology patterns between populations.