The global breast cancer burden: variations in epidemiology and survival

Effectiveness of combined targeted and hormonal therapies for post-menopausal women with hormone receptor-positive and HER2-negative advanced breast cancer: A systematic review and meta-analysis of RCTs

OBJECTIVE

we aim to synthesize available evidence on the effectiveness of hormonal plus targeted therapies for post-menopausal women with hormone receptor-positive and HER2-negative advanced breast cancer.

DATA SOURCES AND METHODS

We searched the following databases: Medline, PubMed, Cochrane Library, CINAHL, Web of Science, Scopus, and African Journal. Only studies that investigated the effectiveness of hormonal therapy combined with targeted therapy for HR+/HER2- advanced breast cancer treatment were included. The outcomes were progression-free survival (PFS), overall survival (OS) and objective response rate (ORR). A random-effect meta-analysis model was employed. Statistical analysis was performed using Comprehensive Meta-analysis version 3.

RESULTS

24 studies were included in the meta-analysis with an overall sample size of 7635. Median PFS, OS and ORR were found to be significantly increased in the combination group compared to hormonal monotherapy [SMD = 6.072 (95% CI = 3.785-8.360), p < 0.001], [SMD = 1.614 (95% CI = 0.139-3.089), p = 0.032] and [OR = 1.584 (CI 1.134-2.213), p = 0.007] respectively. Subgroup analysis showed a significant difference in PFS and ORR between patients who received "hormonal therapy + CDK4/6 inhibitors" vs hormonal therapy only [SMD = 6.015 (CI 3.069-8.960), p < 0.001], (OR = 1.828 (CI 1.030-3.243), p = 0.039] respectively.

CONCLUSION

Compared with hormonal monotherapy, targeted plus hormonal therapy significantly improves PFS, OS and ORR in postmenopausal women with HR+/HER2- advanced breast cancer.

Socioeconomic Disparities in Diagnosis-to-Treatment Time Among Patients Diagnosed With Breast Cancer in Saudi Arabia: A Cross-Sectional Study in a Tertiary Care Center

Introduction Despite Saudi Arabia's' free healthcare system, breast cancer (BC) has a major impact on affected individuals. Previous studies have shown that socioeconomic variables could contribute to inequities in receiving treatment. Although early detection and treatment are essential, delays are frequently influenced by either insurance status or other socioeconomic variables. Assessing characteristics that influence the duration of BC treatment for Saudi women will aid in improving health equity and lowering system costs. Methods This was a cross-sectional study that included all female patients who were diagnosed with BC between 2016 and 2023 at a tertiary care center. All patients were contacted by phone calls to fill out a questionnaire. Results A total of 113 females were included; the mean age at the time of diagnosis with BC was 48.88±10.97 years, and the majority were Saudis (58.4%). Additionally, the median duration for treatment initiation was 28 (15.50-45.50) days from the date of diagnosis. Factors influencing the time for initiating the treatment included nationality, as non-Saudis took longer to receive their treatment (27.00 (13.00-39.25) days vs. 30.00 (18.00-59.00) days, p = 0.176). Moreover, patients living further from the hospital demonstrated a delay in receiving treatment compared to those living near the hospital. However, the relation was not statistically significant. Conclusion Our study investigated the demographic disparities among BC patients. Our results showed that some variables contributed to a delay in treatment initiation, including nationality and distance from the hospital, which suggest further areas for investigation. We recommend further studies be conducted with a larger sample size to improve accessibility and reduce treatment delays for BC patients.

Combined influence of nutritional and inflammatory status and breast cancer: findings from the NHANES

BACKGROUND

Previous studies have hinted at the benefits of following an anti-inflammatory diet for potentially reducing breast cancer prevalence. However, the combined influence of diet and inflammation on breast cancer remains unclear.

METHODS

The advanced lung cancer inflammation index (ALI) was used to assess inflammation and nutritional status. Statistical methods, such as multivariable logistic regression, eXtreme Gradient Boosting (XGBoost) model, and subgroup analysis, were employed to analyze the impact of ALI on prevalence of BC. Additionally, a two-piece-wise logistic regression model with smoothing was used to determine the ALI threshold for BC prevalence. The study aimed to understand the mechanistic association between ALI levels and BC development.

RESULTS

The mean (SD) age of the study population was 50.0 (17.7) years, with 40.0% of individuals classified as obese. Comparing ALI tertiles to the lowest tertile, the odds ratios (95% CI) for breast cancer (BC) were 0.78 (0.62, 0.98) and 0.68 (0.52, 0.87) for T2-T3. The XGBoost machine learning model was employed to assess the importance of selected factors, revealing ALI as one of the top five variables influencing BC. Subgroup analysis identified a correlation between ALI, alcohol consumption, and menopausal status. Additionally, ALI levels were associated with decreased estradiol (E2) levels, increased total testosterone (TT)/E2 ratio, and TT/sex hormone-binding globulin (SHBG) ratio.

CONCLUSION

This study indicates a potential protective effect of ALI levels against breast cancer, possibly related to sex hormone disruption. The findings support the use of optimal therapeutic strategies for preventing breast cancer.

Dialyl-sulfide with trans-chalcone prevent breast cancer prohibiting SULT1E1 malregulations and oxidant-stress induced HIF1a-MMPs induction

BACKGROUND

In some breast cancers, altered estrogen-sulfotransferase (SULT1E1) and its inactivation by oxidative-stress modifies E2 levels. Parallelly, hypoxia-inducible tissue-damaging factors (HIF1α) are induced. The proteins/genes expressions of these factors were verified in human-breast-cancer tissues. SULT1E1 inducing-drugs combinations were tested for their possible protective effects.

METHODS

Matrix-metalloproteases (MMP2/9) activity and SULT1E1-HIF1α protein/gene expression (Western-blot/RTPCR) were assessed in breast-cancers versus adjacent-tissues. Oxidant-stress neutralizer, chalcone (trans-1,3-diaryl-2-propen-1-ones) and SULT1E1-inducer pure dialyl-sulfide (garlic; Allium sativum) were tested to prevent cancer causing factors in rat, in-vitro and in-vivo. The antioxidant-enzymes SOD1/catalase/GPx/LDH and matrix-degenerating MMP2/9 activities were assessed (gel-zymogram). Histoarchitecture (HE-staining) and tissue SULT1E1-localization (immuno-histochemistry) were screened. Extensive statistical-analysis were performed.

RESULTS

Human cancer-tissue expresses higher SULT1E1, HIF1α protein/mRNA and lower LDH activity. Increase of MMP2/9 activities commenced tissue damage. However, chalcone and DAS significantly induced SULT1E1 gene/protein, suppressed HIF1α expression, MMP2/9 activities in rat tissues. Correlation and group statistics of t-test suggest significant link of oxidative-stress (MDA) with SULT1E1 (p = 0.006), HIF1α (p = 0.006) protein-expression. The non-protein-thiols showed negative correlation (p = 0.001) with HIF1α. These proteins and SULT1E1-mRNA expressions were significantly higher in tumor (p < 0.05). Correlation data suggest, SULT1E1 is correlated with non-protein-thiols.

CONCLUSIONS

Breast cancers associate with SULT1E1, HIF1α and MMPs deregulations. For the first time, we are revealing that advanced cancer tissue with elevated SULT1E1-protein may reactivate in a reducing-state initiated by chalcone, but remain dormant in an oxidative environment. Furthermore, increased SULT1E1 protein synthesis is caused by DAS-induced mRNA expression. The combined effects of the drugs might decrease MMPs and HIF1α expressions. Further studies are necessary.

Cancer, metastasis, and the epigenome

Cancer is the second leading cause of death worldwide and disease burden is expected to increase globally throughout the next several decades, with the majority of cancer-related deaths occurring in metastatic disease. Cancers exhibit known hallmarks that endow them with increased survival and proliferative capacities, frequently as a result of de-stabilizing mutations. However, the genomic features that resolve metastatic clones from primary tumors are not yet well-characterized, as no mutational landscape has been identified as predictive of metastasis. Further, many cancers exhibit no known mutation signature. This suggests a larger role for non-mutational genome re-organization in promoting cancer evolution and dissemination. In this review, we highlight current critical needs for understanding cell state transitions and clonal selection advantages for metastatic cancer cells. We examine links between epigenetic states, genome structure, and misregulation of tumor suppressors and oncogenes, and discuss how recent technologies for understanding domain-scale regulation have been leveraged for a more complete picture of oncogenic and metastatic potential.

Phenotypic Expansion of Autosomal Dominant LZTR1-Related Disorders with Special Emphasis on Adult-Onset Features

Leucine zipper-like transcription regulator 1 (LZTR1) acts as a negative factor that suppresses RAS function and MAPK signaling; mutations in this protein may dysregulate RAS ubiquitination and lead to impaired degradation of RAS superfamily proteins. Germline LZTR1 variants are reported in Noonan syndrome, either autosomal dominant or autosomal recessive, and in susceptibility to schwannomatosis. This article explores the genetic and phenotypic diversity of the autosomal dominant LZTR1-related disorders, compiling a cohort of previously published patients (51 with the Noonan phenotype and 123 with schwannomatosis) and presenting two additional adult-onset cases: a male with schwannomatosis and Parkinson's disease and a female with Noonan syndrome, generalized joint hypermobility, and breast cancer. This review confirms that autosomal dominant LZTR1-related disorders exhibit an extreme phenotypic variability, ranging from relatively mild manifestations to severe and multi-systemic involvement, and offers updated frequences of each clinical feature. The aim is to precisely define the clinical spectrum of LZTR1-related diseases, using also two new emblematic clinical cases. Gaining insight into the mechanisms underneath this variability is crucial to achieve precision diagnostics and the development of therapeutic interventions.

Multidrug Resistant Enteric Bacteria from Cancer Patients Admitted in Douala Laquintinie Hospital, Littoral Region of Cameroon

Patients with cancer have weakened immune systems, making them more vulnerable to infections. This study was carried out to determine the bacterial origins of enteric disorders in cancer patients and noncancer patients at the Oncology Department of Laquintinie Hospital in Douala. A cross-sectional study was conducted from October 2021 to March 2023. Stool samples from 307 cancer patients with enteric disorders and 200 noncancer patients with enteric disorders were examined to diagnose the presence of bacteria using various techniques. Among all participants in this study, 62.13% were female and 37.87% were male. The average age of the participants was 46.38 ± 15.81 years, with a minimum age of 10 years and a maximum age of 84 years. The average age of participants was significantly higher (p < 0.000) in cancer patients (49.54 ± 14.65 years) compared to noncancer patients (41.53 ± 16.33 years). Proteus mirabilis, Proteus vulgaris, Salmonella typhi, Enterobacter cloacae, Klebsiella pneumoniae, Yersinia intemedia, and Klebsiella oxytoca were more frequently isolated in cancer patients than in noncancer patients, with the respective percentages of 56.25% versus 43.75%, 50.00% versus 50.00%, 61.66% versus 38.34%, 66.66% versus 33.34%, 72.22% versus 27.78%, 80.00 versus 20.00%, and 100% versus 0.00%. Most isolates were sensitive to imipenem (IMP), gentamicin (GEN), and amikacin (AMK). Proteus vulgaris, the most prevalent isolate, showed significantly high resistance (with p < 0.05) in cancer patients compared to noncancer patients at amoxicillin/clavuranic acid (AMC) (89.13% versus 41.30%), ceftriaxone (CTR) (63.04% versus 39.13%), ciprofloxacin (CIP) (65.22% versus 34.18%), and tetracycline (TET) (93.48% versus 63.04%). Multidrug resistance was observed in cancer patients compared to noncancer patients for Klebsiella pneumoniae (85.00% versus 60.00%), Salmonella typhi (84.62% versus 60.00%), and Klebsiella oxytoca (86.49% versus 43.48%). The increase in the number of Gram-negative infections among cancer patients, as shown in the present study, highlights the need for broad-spectrum therapy and effective planning of control programs to reduce bacterial diseases among cancer patients.

Measurement properties of the Iranian version of the breast cancer perception scale (BCPS) according to the COSMIN checklist

BACKGROUND

Breast cancer is a prevalent cancer characterized by its aggressive nature and potential to cause mortality among women. The rising mortality rates and women's inadequate perception of the disease's severity in developing countries highlight the importance of screening using conventional methods and reliable scales. Since the validity and reliability of the breast cancer perception scale (BCPS) have not been established in the Iranian context. Therefore, this study aimed to determine the measurement properties of the BCPS in women residing in Tabriz, Iran.

METHODS

The present study comprised a cross-sectional design, encompassing a sample of 372 Iranian women. The participants were selected through a multi-stage cluster random sampling technique conducted over a period spanning from November 2022 to February 2023. The measurement properties of the Iranian version of BCPS were assessed following the guidelines outlined in the COSMIN checklist. This involved conducting various steps, including the translation process, reliability testing (internal consistency, test-retest reliability, and measurement error), and methodological tests for validity (content validity, face validity, construct validity, and hypothesis testing). The study also investigated the factors of responsiveness and interpretability. The presence of floor and ceiling effects was assessed.

RESULTS

The internal consistency of the scale was assessed using Cronbach's alpha, yielding a satisfactory value of 0.68. Additionally, McDonald's omega (95% CI) was computed, resulting in a value of 0.70 (0.66 to 0.74). Furthermore, the test-retest reliability was evaluated, revealing a high intraclass correlation coefficient (ICC) of 0.97 (95% CI: 0.94 to 0.99). The CVI, CVR, and impact scores of the BCPS were determined to be 0.98, 0.95, and 3.70, respectively, indicating favorable levels of content and face validity. To assess construct validity, an examination of the Exploratory Factor Analysis (EFA) was conducted on a set of 24 items. This analysis revealed the presence of six distinct factors, which collectively accounted for 52% of the cumulative variance. The fit indices of the validity model (CFI = 0.91, NFI = 0.96, RFI = 0.94, TLI = 0.90, χ2/df = 2.03, RMSEA = 0.055 and SRMR = 0.055) were confirmed during the confirmatory factor analysis (CFA). The overall score of BCPS exhibited a ceiling effect of 0.3%. The floor effect observed in the overall score (BCPS) was found to be 0.5%. Concerning the validation of the hypothesis, Spearman's correlation coefficient of 0.55 was obtained between the BCPS and the QLICP-BR V2.0. This correlation value signifies a statistically significant association. Furthermore, it is worth noting that the minimum important change (MIC) of 3.92 exhibited a higher value compared to the smallest detectable change (SDC) of 3.70, thus suggesting a satisfactory level of response.

CONCLUSIONS

The obtained findings suggest that the Iranian version of the BCPS demonstrates satisfactory psychometric properties for assessing the perception of breast cancer among Iranian women. Furthermore, it exhibits favorable responsiveness to clinical variations. Consequently, it can serve as a screening instrument for healthcare professionals to comprehend breast cancer and as a reliable tool in research endeavors.

Cancer population norms using a new value set for the SF-6Dv2 based on the preferences of patients with breast or colorectal cancer in Quebec

BACKGROUND

Because health resources are limited, health programs should be compared to allow the most efficient ones to emerge. To that aim, health utility instruments have been developed to allow the calculation of quality-adjusted life-year (QALY). However, generic instruments, which can be used by any individual regardless of their health profile, typically consider the preferences of the general population when developing their value set. Consequently, they are often criticized for lacking sensitivity in certain domains, such as cancer. In response, the latest version of the Short Form 6-Dimension (SF-6Dv2) has been adapted to suit the preferences of patients with breast or colorectal cancer in the Canadian province of Quebec. By extension, our study's aim was to determine cancer population norms of utility among patients with breast or colorectal cancer in Quebec using the SF-6Dv2.

METHOD

To determine the cancer population norms, we exploited the data that were used in the development of a new value set for the SF-6Dv2. This value set was developed considering the preferences of patients with breast or colorectal cancer. Stratification by time of data collection (i.e., T1 and T2), sociodemographic variables (i.e., age, sex, body mass index, and self-reported health problems affecting quality of life), and clinical aspects (i.e., cancer site, histopathological classification, cancer stage at diagnosis, modality, and treatment characteristics) was performed.

RESULTS

In 353 observations, patients were more likely to have negative utility scores at T1 than at T2. Males had higher mean utility scores than females considering type of cancer and comorbidities. Considering the SF-6Dv2's dimensions, more females than males reported having health issues, most which concerned physical functioning. Significant differences by sex surfaced for all dimensions except "Role Limitation" and "Mental health." Patients with multifocal cancer had the highest mean and median utility values in all cancer sites considered.

CONCLUSION

Cancer population norms can serve as a baseline for interpreting the scores obtained by a given population in comparison to the situation of another group. In this way, our results can assist in comparing utility scores among cancer patients with different sociodemographic groups to other patients/populations groups. To our knowledge, our identified utility norms are the first for patients with breast or colorectal cancer from Quebec.

Status of breast cancer detection in young women and potential of liquid biopsy

Young onset breast cancer (YOBC) is an increasing demographic with unique biology, limited screening, and poor outcomes. Further, women with postpartum breast cancers (PPBCs), cancers occurring up to 10 years after childbirth, have worse outcomes than other young breast cancer patients matched for tumor stage and subtype. Early-stage detection of YOBC is critical for improving outcomes. However, most young women (under 45) do not meet current age guidelines for routine mammographic screening and are thus an underserved population. Other challenges to early detection in this population include reduced performance of standard of care mammography and reduced awareness. Women often face significant barriers in accessing health care during the postpartum period and disadvantaged communities face compounding barriers due to systemic health care inequities. Blood tests and liquid biopsies targeting early detection may provide an attractive option to help address these challenges. Test development in this area includes understanding of the unique biology involved in YOBC and in particular PPBCs that tend to be more aggressive and deadly. In this review, we will present the status of breast cancer screening and detection in young women, provide a summary of some unique biological features of YOBC, and discuss the potential for blood tests and liquid biopsy platforms to address current shortcomings in timely, equitable detection.

The role of transcription factor FOXA1/C2/M1/O3/P1/Q1 in breast cancer

Breast cancer is a common malignancy with the highest mortality rate among women worldwide. Its incidence is on the rise year after year, accounting for more than one-tenth of new cancers worldwide. Increasing evidence suggests that forkhead box (FOX) transcription factors play an important role in the occurrence and development of breast cancer. However, little is known about the relationship between the expression, prognostic value, function, and immune infiltration of FOX transcription factors in tumor microenvironment. We used bioinformatics to investigate expression and function of FOX factor in breast cancer. Our results revealed the expression levels of FOXA1 and FOXM1 were significantly higher in breast cancer tissues than in normal tissues. The high expression of mRNA in FOXA1 (P < .05), FOXM1 (P < .01), and FOXP1 (P < .05) groups was related to tumor stage. Survival analysis results showed that increased FOXP1 mRNA levels were significantly associated with overall survival (OS), recurrence-free survival (RFS), and distant metastasis-free survival (DMFS) in all patients with breast cancer (P < .05). Patients with the FOXA1 high-expression group had better RFS and DMFS than the low-expression group (P < .05), while patients with FOXM1 high-expression group had worse RFS, OS, and DMFS than the low-expression group (P < .05). Meanwhile, mutation analysis showed that genetic alterations in FOX transcription factors were significantly associated with shorter OS and progression-free survival (P < .05), but not with disease-free survival (P = .710) in patients with breast cancer. FOXP1, FOXA1, and FOXM1 may be used as potential biomarkers to predict the prognosis of patients with breast cancer. Functional enrichment indicated that FOX was mainly involved in cell division, cell senescence, cell cycle, and prolactin signaling pathway. In patients with breast cancer, FOXC2 expression was negatively correlated with the infiltration of B cells and positively correlated with the infiltration of neutrophils and dendritic cells. However, FOXM1 was negatively correlated with the infiltration of CD8 + T cells and macrophages and positively correlated with the infiltration of neutrophils and dendritic cells. These findings provided novel insights into the screening of prognostic biomarkers of the FOX family in breast cancer and laid a foundation for further research on the immune infiltration of the FOX transcription factor family members in tumors.

Effect of perceived injustice-targeted pain neuroscience education compared with biomedically focused education in breast cancer survivors: a study protocol for a multicentre randomised controlled trial (BCS-PI trial)

INTRODUCTION

Current treatments for pain in breast cancer survivors (BCSs) are mostly biomedically focused rather than biopsychosocially driven. However, 22% of BCSs with pain are experiencing perceived injustice, which is a known predictor for adverse pain outcomes and opioid prescription due to increased maladaptive pain behaviour. Educational interventions such as pain neuroscience education (PNE) are suggested to target perceived injustice. In addition, motivational interviewing can be an effective behavioural change technique. This trial aims to examine whether perceived injustice-targeted PNE with the integration of motivational interviewing is superior to biomedically focused pain education in reducing pain after 12 months in BCS with perceived injustice and pain. In addition, improvements in quality of life, perceived injustice and opioid use are evaluated, and a cost-effectiveness analysis will finally result in a recommendation concerning the use of perceived injustice-targeted PNE in BCSs with perceived injustice and pain.

METHODS AND ANALYSIS

This two-arm multicentre randomised controlled trial will recruit female BCS (n=156) with pain and perceived injustice. Participants will be randomly assigned to perceived injustice-targeted PNE or biomedically focused pain education in each centre. Both interventions include an online session, an information leaflet and three one-to-one sessions. The primary outcome (pain), secondary outcomes (quality of life, perceived injustice and outcomes for cost-effectiveness analysis) and explanatory outcomes (pain phenotyping, sleep, fatigue and cognitive-emotional factors) will be assessed at baseline and at 0, 6, 12 and 24 months postintervention using self-reported questionnaires online. Treatment effects over time will be evaluated using linear mixed model analyses. Additionally, a cost-utility analysis will be done from a healthcare payer and societal perspective.

ETHICS AND DISSEMINATION

The ethical agreement was obtained from the Main Ethics Committee (B.U.N.1432020000068) at the University Hospital Brussels and all other participating hospitals. Study results will be disseminated through presentations, conferences, social media, press and journals.

TRIAL REGISTRATION NUMBER

NCT04730154.

Alkaloids as Additional Weapons in the Fight against Breast Cancer: A Review

Breast carcinoma is among the most frequent cancerous tumour in females around the globe. The major modalities now employed in the therapeutic management of breast cancer include surgeries, chemotherapy, and specialized medicines. Despite their potential to help individuals' problems, they are also associated with many negative impacts. As a result, natural products are increasingly regarded to be a preferable alternative. Alkaloids are essential biochemical substances that can be used to develop new drugs. Numerous alkaloids that originate from natural plants have been shown in vitro and in vivo to have anti-proliferation and anti-metastasis actions on different kinds of carcinoma. According to the data collected in this study, the utilization of alkaloids as anti-tumor medicines appears to be extremely potent; nevertheless, extensive studies and clinical trials are required before utilizing individual alkaloids. In this overview, we provide a detailed and vital exploration of pre-existing alkaloids possessing anti-tumor activities due to bioactive compounds. This study also includes an overview of synthesized analogues and pharmacological characteristics that will be beneficial to scientists working on alkaloids for medicinal purposes. In a recent survey of the literature, alkaloids are an important component of plantderived antitumor medicines that hold great potential for the future development of cancer therapy and preventive therapies. We have also discussed structural analysis relationship (SAR) studies. Moreover, it covers clinical trial medications and FDA-approved medicines from the last five years that will be useful in further research.

Saliency of breast lesions in breast cancer detection using artificial intelligence

The analysis of mammograms using artificial intelligence (AI) has shown great potential for assisting breast cancer screening. We use saliency maps to study the role of breast lesions in the decision-making process of AI systems for breast cancer detection in screening mammograms. We retrospectively collected mammograms from 191 women with screen-detected breast cancer and 191 healthy controls matched by age and mammographic system. Two radiologists manually segmented the breast lesions in the mammograms from CC and MLO views. We estimated the detection performance of four deep learning-based AI systems using the area under the ROC curve (AUC) with a 95% confidence interval (CI). We used automatic thresholding on saliency maps from the AI systems to identify the areas of interest on the mammograms. Finally, we measured the overlap between these areas of interest and the segmented breast lesions using Dice's similarity coefficient (DSC). The detection performance of the AI systems ranged from low to moderate (AUCs from 0.525 to 0.694). The overlap between the areas of interest and the breast lesions was low for all the studied methods (median DSC from 4.2% to 38.0%). The AI system with the highest cancer detection performance (AUC = 0.694, CI 0.662-0.726) showed the lowest overlap (DSC = 4.2%) with breast lesions. The areas of interest found by saliency analysis of the AI systems showed poor overlap with breast lesions. These results suggest that AI systems with the highest performance do not solely rely on localized breast lesions for their decision-making in cancer detection; rather, they incorporate information from large image regions. This work contributes to the understanding of the role of breast lesions in cancer detection using AI.

Gemcitabine-associated digital necrosis in metastatic breast cancer

INTRODUCTION

Gemcitabine is a nucleoside analog antimetabolite used in various malignancies, including metastatic breast cancer. Objective response rates in its use as a single agent in the treatment of metastatic breast cancer are not to be underestimated. Cutaneous, hematological, pulmonary, and vascular side effects are well-known side effects. Venous thromboembolism may occur with antineoplastics, such as platinum compounds. Arterial thromboembolism is rare in cancer, almost rare with chemotherapy. Here, we present a metastatic breast cancer patient who had digital necrosis due to arterial occlusion with gemcitabine monotherapy.

CASE REPORT

A 54-year-old metastatic breast cancer female patient had digital ischemia and necrosis in the left hand's fifth finger after the second course of single-agent gemcitabine as the fourth line setting. Gemcitabine was discontinued, and medical treatment was started. Thrombus was detected in the left subclavian artery digital angiography. Balloon angioplasty and stenting were applied. However, digital amputation had to be performed since tissue necrosis had not regressed despite radiological interventions and medical treatment.

MANAGEMENT AND OUTCOME

Gemcitabine was discontinued. Low molecular weight heparin and acetylsalicylic acid were started. The distal phalanx was amputated due to necrosis during follow-up. Gemcitabine was permanently stopped.

DISCUSSION

Gemcitabine-related vascular events, including arterial thrombosis, may also occur in cancer patients, especially those with higher tumor burden. Therefore, predisposing factors for hypercoagulability and vascular occlusion should be questioned in more detail even before starting antineoplastics which are known to have a lower risk for thrombosis, such as gemcitabine monotherapy.

Global burden of female breast cancer and its association with socioeconomic development status, 1990-2044

BACKGROUND

Breast cancer is a widespread disease in women worldwide.

AIM

We aimed to explore the global epidemiological trends of female breast cancer (FBC) between 1990 and 2044.

METHODS AND RESULTS

Disease burden, population, and socio-demographic index (SDI) data were obtained from the Global Health Data Exchange (GHDx) database. We analyzed temporal trends, age differences, risk factors, and geographic patterns of FBC disease burden globally and explored the association between age-standardized incidence rate (ASIR) of FBC and SDI. Bayesian age-period-cohort model was also performed to predict the changes in FBC incidence worldwide from 2020 to 2044. First, the global ASIR of FBC increased by 14.31% from 1990 to 2019 (95% Uncertainty Interval 4.75% to 23.98%). The death rate presented a falling trend. Second, alcohol use is the most-highlighted risk factor for FBC in some high-income regions such as Europe. A high fasting plasma glucose levels is the most prominent risk factor for FBC in Latin America and Africa. Third, the ASIR of the FBC increases with the SDI. Fourth, the incidence is expected to increase faster among women aged 35-60 years and fastest for those aged 50-54 years from 2020 to 2044. Countries with a high incidence of FBC that is expected to increase significantly include Barbados, Burkina Faso, Senegal, Monaco, Lebanon, Togo, and Uganda.

CONCLUSION

The disease burden of FBC varies worldwide; the findings suggest attaching importance to the control of middle and low-middle SDI regions. Public health as well as cancer prevention experts should pay more attention to regions and populations at an increased risk of developing FBC, focusing on their prevention and rehabilitation while conducting further epidemiological studies to investigate the risk factors of their increase.

Second Version of the Short Form 6-Dimension Value Set Elicited From Patients With Breast and Colorectal Cancer: A Hybrid Approach

BACKGROUND

Quality-adjusted life-year instruments help comparison among programs by capturing their effects in terms of utility. Generic instruments are applicable to everyone, and for this reason, they are known to lack sensitivity when measuring gains in some domains. Specific instruments tend to fill this gap but, in domains like cancer, existing instruments are either nonpreferences-based or based on the general population's preferences.

PATIENTS AND METHODS

This study describes the development of a new value set for a well-known and highly used generic instrument, the Second Version of the Short Form 6-Dimension, to better consider the preferences of patients with cancer. In this aim, a hybrid approach combining the time trade-off and the discrete choice experiment was used. The population of interest was the Quebec population, Canada, with breast or colorectal cancer. Their preferences were elicited in 2 periods: before (T1) and 8 days after the beginning of a chemotherapy procedure (T2).

RESULTS

A total of 2808 observations for the time trade-off and 2520 observations for the discrete choice experiment were used. The parsimonious model encompassing the 2 periods was the preferred model. The new value set allows a greater utility range than the EQ-5D-5L and the Second Version of the Short Form 6-Dimension reference value sets and helps in better considering patients experiencing severe health situations. A good correlation between these 2 instruments and other specific cancer instruments (ie, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, QLU-C10D, and Functional Assessment of Cancer Therapy-General) was observed. Significative differences in utility values were also noted within periods and types of cancer.

A Cross-Sectional Study on the Epidemiology of Newly Diagnosed Breast Cancer Patients Attending Tertiary Care Hospitals in a Tribal Preponderant State of India: Regression Analysis

INTRODUCTION

Breast cancer (BC) is globally prevalent and the leading cause of death due to cancer in females. Due to changes in risk factor profiles, improved cancer registration, and cancer detection, its incidence and death rates have risen over the past three decades. Both modifiable and immutable risk factors for BC make up a sizable portion of the total risk factors.  Methodology: This was a hospital-based cross-sectional study carried out in the Department of Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi. Consecutive sampling was done with a complete enumeration of all newly diagnosed cases of breast cancer >15 years old. Those who consented to participate and those who were extremely ill, deaf, or dumb were excluded from the study.

RESULTS

A total of 88 patients were included. Maximum patients diagnosed with breast cancer belonged to the age group of 40-50 years (37.5%), Hindu by religion (76.1%), non-tribal (80.68%), illiterate (89.8%), married (98.9%), housewives (92%), and of class IV socio-economic status (SES) (65.9%).

CONCLUSION

Regular training of Sahiya (the local name of Accredited Social Health Activist (ASHA) in Jharkhand), empowerment of screening clinics for cancer, and upgraded diagnostic facilities for timely referral should be stressed upon.

Socio-economic variations of breast cancer treatment and discontinuation: a study from a public tertiary cancer hospital in Mumbai, India

BACKGROUND

The study examined the socio-economic variation of breast cancer treatment and treatment discontinuation due to deaths and financial crisis.

METHODS

We used primary data of 500 patients with breast cancer sought treatment at India's one of the largest cancer hospital in Mumbai, between June 2019 and March 2022. This study is registered on the Clinical Trial Registry of India (CTRI/2019/07/020142). Kaplan-Meier method and Cox-hazard regression model were used to calculate the probability of treatment discontinuation.

RESULTS

Of the 500 patients, three-fifths were under 50 years, with the median age being 46 years. More than half of the patients were from outside of the state and had travelled an average distance of 1,044 kms to get treatment. The majority of the patients were poor with an average household income of INR15,551. A total of 71 (14%) patients out of 500 had discontinued their treatment. About 5.2% of the patients died and 4.8% of them discontinued treatment due to financial crisis. Over one-fourth of all deaths were reported among stage IV patients (25%). Patients who did not have any health insurance, never attended school, cancer stage IV had a higher percentage of treatment discontinuation due to financial crisis. Hazard of discontinuation was lower for patients with secondary (HR:0.48; 95% CI: 0.27-0.84) and higher secondary education (HR: 0.42; 95% CI: 0.19-0.92), patients from rural area (HR: 0.79; 95% CI: 0.42-1.50), treated under general or non-chargeable category (HR: 0.60; 95% CI:0.22-1.60) while it was higher for the stage IV patients (HR: 3.61; 95% CI: 1.58-8.29).

CONCLUSION

Integrating breast cancer screening in maternal and child health programme can reduce delay in diagnosis and premature mortality. Provisioning of free treatment for poor patients may reduce discontinuation of treatment.

"I'm Hooked on e-cycling, I Can Finally Be Active Again": Perceptions of e-cycling as a Physical Activity Intervention during Breast Cancer Treatment

Electrically-assisted bicycles (e-bikes) are a means through which to increase individual physical activity (PA) and overcome some commonly reported barriers to engaging in conventional cycling. Fatigue is a common side effect to breast cancer treatment, and the rate of PA engagement drops significantly following a breast cancer diagnosis. The aim of this qualitative study was to examine perceptions of e-cycling as a means of increasing PA in this population. Twenty-four participants (mean age = 57.88 (standard deviation 10.8), 100% female) who have had a breast cancer diagnosis, completed two semi-structured interviews via Zoom. One interview was conducted prior to an e-bike taster session and a second, after the session. Taster sessions were conducted by certified cycling instructors in the community. Interviews were conducted between December 2021 and May 2022. Data were transcribed verbatim and analyzed thematically using NVivo 12 software. An inductive and deductive approach to analysis was adopted. Five themes were generated: (1) Perceived role of e-bikes during treatment, (2) The relationship between e-bikes and fatigue, (3) Cancer-specific considerations, (4) Is e-cycling 'enough'?, and (5) Optimizing the intervention. Negative perceptions of e-bikes noted before the taster session were altered following riding an e-bike. The multiple levels of assistance made cycling manageable and less impacted by fatigue, thereby enabling individuals to re-establish previous cycling habits. E-cycling may be a suitable option to increase PA behavior amongst individuals being treated for breast cancer, with the potential to overcome many of the barriers of conventional cycling. Enabling this population to trial an e-bike elicits positive physical and psychological responses that may help to promote future engagement.

Dietary Inflammatory Index and risk of breast cancer: evidence from a prospective cohort of 67,879 women followed for 20 years in France

BACKGROUND

Inflammation is implicated in breast cancer development, and diet is one of the modifiable risk factors involved in the regulation of chronic inflammation. Previous studies on the association between breast cancer risk and Dietary Inflammatory Indexes (DII) derived from food frequency questionnaires and data on inflammatory potential of dietary components have reported inconsistent results.

OBJECTIVE

To investigate the association between the DII and the risk of breast cancer using data from a large population-based cohort study.

DESIGN

A total of 67,879 women from the E3N cohort were followed from 1993 to 2014. A total of 5686 breast cancer cases were diagnosed during the follow-up. The food frequency questionnaire administered at baseline in 1993 was used to calculate an adapted DII. Cox proportional hazard models using age as the time scale were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Spline regression was used to determine any dose-response relationship. We also evaluated effect modification by menopausal status, body mass index, smoking status and alcohol consumption.

RESULTS

The median DII score of the study population was slightly pro-inflammatory (DII = + 0.39); ranged from - 4.68 in the lowest quintile to + 4.29 in the highest quintile. The HR increased linearly with the DII (HR per 1SD = 1.04 [95% CI: 1.01, 1.07]), and reached 1.13 [95% CI: 1.04, 1.23] in the 5th quintile group as compared to the first. A positive linear dose-response relationship was also observed when modeling DII with spline functions. Slightly higher HRs were observed in non-smokers (HR _{for 1-SD increase} 1.06 [95% CI: 1.02, 1.10]; p trend = 0.001) and in low-alcohol consumers (≤ 1 glass/day) (HR _{for 1-SD increase} 1.05 [95% CI: 1.01, 1.08]; p trend = 0.002).

CONCLUSION

Our results suggest a positive association between DII and breast cancer risk. Consequently, the promotion of anti-inflammatory diet may contribute to breast cancer prevention.

Recent Advances in Mesoporous Silica Nanoparticle-Mediated Drug Delivery for Breast Cancer Treatment

Breast cancer (BC) currently occupies the second rank in cancer-related global female deaths. Although consistent awareness and improved diagnosis have reduced mortality in recent years, late diagnosis and resistant response still limit the therapeutic efficacy of chemotherapeutic drugs (CDs), leading to relapse with consequent invasion and metastasis. Treatment with CDs is indeed well-versed but it is badly curtailed with accompanying side effects and inadequacies of site-specific drug delivery. As a result, drug carriers ensuring stealth delivery and sustained drug release with improved pharmacokinetics and biodistribution are urgently needed. Core-shell mesoporous silica nanoparticles (MSNPs) have recently been a cornerstone in this context, attributed to their high surface area, low density, robust functionalization, high drug loading capacity, size-shape-controlled functioning, and homogeneous shell architecture, enabling stealth drug delivery. Recent interest in using MSNPs as drug delivery vehicles has been due to their functionalization and size-shape-driven versatilities. With such insights, this article focuses on the preparation methods and drug delivery mechanisms of MSNPs, before discussing their emerging utility in BC treatment. The information compiled herein could consolidate the database for using inorganic nanoparticles (NPs) as BC drug delivery vehicles in terms of design, application and resolving post-therapy complications.

Relapse-free survival in Sudanese women with non-metastatic breast cancer

Background

Breast cancer (BC) is the most frequently diagnosed cancer and a major cause of cancer mortality in Sudan. However, there is lack of data related to BC relapse. Therefore, this study was undertaken to estimate the 5-year relapse free survival (RFS) rate and factors related to BC relapse in Sudanese women with non-metastatic BC.

Methods

Data of BC women with BC diagnosed and treated at the National Cancer Institute-University of Gezira during 2012 were retrieved from medical records. The cases were followed-up through hospital records and telephone contact. Survival functions were calculated using Kaplan-Meier method and compared by log-rank test. The prognostic factors were tested using univariate and multivariable Cox regression analyses.

Results

We included 168 women with median age of 45 years (range, 22-83 years). 53.5%of women had stage III at time of diagnosis, whereas 4.2% and 42.3% of women presented with stage I and stage II, respectively. At the end of 5 years follow-up, with median follow-up period of 64 months, 94 (56.0%) women were alive in remission, 11 (6.5%) were alive with BC relapse, 49 (29.2%) were dead, and survival status was unknown in 14 (8.3%) women. Most of the occurred relapses were distant relapses. The 5-year RFS was 59%. The independent predictors of relapse were: larger primary tumor size (HR:1.84, 95% CI: 1.54-5.48, p=0.018); involved axillary lymph nodes with tumour (HR:  2.91, 95% CI:  1.53-7.91, p=0.001); not receiving adjuvant radiotherapy (HR: 2.2, 95% CI: 1.22-3.95, p=0.009); and not receiving hormone therapy (HR: 1.67, 95% CI: 1.01-2.76, p= 0.046).

Conclusion

We found a high risk of BC relapse in our resource-constrained settings. Advanced stages, not receiving adjuvant radiotherapy, and not receiving adjuvant hormone therapy were independent predictors associated with worse 5-year RFS. Therefore, enhancing the early diagnosis of BC and improving timely access to appropriate treatments represent key approaches to achieving better treatment outcomes.

Anticancer potential of poly(2-aminobenzoic acid)-blend-Aloe vera against the human breast cancer cell line MDA-MB-231

Breast cancer in women is amongst the most significant concerns from time immemorial in the field of oncology. This study proposes an anticancerous polymeric material based on an electroactive substituted polyaniline blend, poly(2-aminobenzoic acid)-blend-Aloe vera (PABA/AV) synthesized by the emulsion polymerization method. The structural, thermal, and morphological characteristics determined using FT-IR and UV-Visible Spectroscopy, XRD, TGA, DTA, and SEM-EDX validated the thermally stable, semi-crystalline, emeraldine salt structure. The material is semi-conducting, and the electrical conductivity measured is 1.86 × 10−3 S/cm. It shows bactericidal efficacy against Enterococcus faecalis at a minimum inhibitory and minimum bactericidal concentration of 50 μg/mL. The radical cations in the emeraldine polymer chain reduce the 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical and exhibit a significant % of DPPH scavenging (89.85%) at 20 μL. The polymer blend is active against the human breast cancer cell line MDA-MB-231 and causes 78.65% cytotoxicity at a concentration of 125 μg/mL. The synergistic effect of the ancient healing Aloe vera plant and the electroactive biocompatible poly(2-aminobenzoic acid) certainly opens up new developments in the field of cancer therapy.

Expression and Signaling Pathways of Nerve Growth Factor (NGF) and Pro-NGF in Breast Cancer: A Systematic Review

Breast cancer represents the most common type of cancer and is the leading cause of death due to cancer among women. Thus, the prevention and early diagnosis of breast cancer is of primary urgency, as well as the development of new treatments able to improve its prognosis. Nerve Growth Factor (NGF) is a neurotrophic factor involved in the regulation of neuronal functions through the binding of the Tropomyosin receptor kinase A (TrkA) and the Nerve Growth Factor receptor or Pan-Neurotrophin Receptor 75 (NGFR/p75NTR). In addition, its precursor (pro-NGF) can extert biological activity by forming a trimeric complex with NGFR/p75NTR and sortilin, or by binding to TrkA receptors with low affinity. Several examples of in vitro and in vivo evidence show that NGF is both synthesized and released by breast cancer cells, and has mitogen, antiapoptotic and angiogenic effects on these cells through the activation of different signaling cascades that involve TrkA and NGFR/p75NTR receptors. Conversely, pro-NGF signaling has been related to breast cancer invasion and metastasis. Other studies suggested that NGF and its receptors could represent a good diagnostic and prognostic tool, as well as promising therapeutic targets for breast cancer. In this paper, we comprehensively summarize and systematically review the current experimental evidence on this topic. INPLASY ID: INPLASY2022100017.

Predicting Breast Cancer from Risk Factors Using SVM and Extra-Trees-Based Feature Selection Method

Developing a prediction model from risk factors can provide an efficient method to recognize breast cancer. Machine learning (ML) algorithms have been applied to increase the efficiency of diagnosis at the early stage. This paper studies a support vector machine (SVM) combined with an extremely randomized trees classifier (extra-trees) to provide a diagnosis of breast cancer at the early stage based on risk factors. The extra-trees classifier was used to remove irrelevant features, while SVM was utilized to diagnose the breast cancer status. A breast cancer dataset consisting of 116 subjects was utilized by machine learning models to predict breast cancer, while the stratified 10-fold cross-validation was employed for the model evaluation. Our proposed combined SVM and extra-trees model reached the highest accuracy up to 80.23%, which was significantly better than the other ML model. The experimental results demonstrated that by applying extra-trees-based feature selection, the average ML prediction accuracy was improved by up to 7.29% as contrasted to ML without the feature selection method. Our proposed model is expected to increase the efficiency of breast cancer diagnosis based on risk factors. In addition, we presented the proposed prediction model that could be employed for web-based breast cancer prediction. The proposed model is expected to improve diagnostic decision-support systems by predicting breast cancer disease accurately.

Work Ability after Breast Cancer: Study of Healthcare Personnel Operating in a Hospital of South Italy

Breast cancer (BrC) treatment can produce disabilities that often impact the quality of daily life and impact the social and working relationships of the patient. This paper looked into the remaining work ability in a group of female healthcare personnel (HCPs) with BrC in Southern Italy. Each HCP was subjected to a medical check, routine blood tests, and a questionnaire on the work ability index (WAI). Of 980 (100%) HCWs undergoing health control, 6% (n = 54) had experienced BRC, and only 66.6% (n = 36) agreed to take part in the study. A total of 28 (78%) were on night shifts. The WAI score was quite low in 5 (13.8%) cases, moderate in 10 (27.7%) cases, good in 14 (38.8%) cases, and excellent in 7 (19.5%) HCWs. Among all health figures, in nurses as well as technical staff, lower WAI scores were observed. HCWs reported various comorbidities, which affected WAI score, such as limited mobility in the upper limbs, arm/shoulder pain, numbness, and lymphoedema. The main complication that negatively affects any work activity is the morbidity in the upper limbs. This seems to affect the ability to perform tasks, and the re-entry to work is highlighted on sick leave days.

Biosynthesis of Silver Nanoparticles Using Azadirachta indica and Their Antioxidant and Anticancer Effects in Cell Lines

In the present study, silver nanoparticles (Ag-NPs) were synthesized using Azadirachta indica extract and evaluated for their in vitro antioxidant activity and cytotoxicity efficacy against MCF-7 and HeLa cells. The silver nanoparticles (Ag-NPs) were formed within 40 min and after preliminary confirmation by UV-visible spectroscopy (peak observed at 375 nm), they were characterized using a transmission electron microscope (TEM) and dynamic light scattering (DLS). The TEM images showed the spherical shape of the biosynthesized Ag-NPs with particle sizes in the range of 10 to 60 nm, and compositional analysis was carried out. The cytotoxicity and antioxidant activity of various concentrations of biosynthesized silver nanoparticles, Azadirachta indica extract, and a standard ranging from 0.2 to 1.0 mg/mL were evaluated. The 2,2-Diphenyl-1-picrylhydrazyl (DPPH) activity of the biosynthesized Ag-NPs and aqueous leaf extract increased in a dose-dependent manner, with average IC₅₀ values of the biosynthesized Ag-NPs, aqueous leaf extract, and ascorbic acid (standard) of 0.70 ± 0.07, 1.63 ± 0.09, and 0.25 ± 0.09 mg/mL, respectively. Furthermore, higher cytotoxicity was exhibited in both the MCF-7 and HeLa cell lines in a dose-dependent manner. The average IC₅₀ values of the biosynthesized Ag-NPs, aqueous leaf extract, and cisplatin (standard) were 0.90 ± 0.07, 1.85 ± 0.01, and 0.56 ± 0.08 mg/mL, respectively, with MCF-7 cell lines and 0.85 ± 0.01, 1.76 ± 0.08, 0.45 ± 0.10 mg/mL, respectively, with HeLa cell lines. Hence, this study resulted in an efficient green reductant for producing silver nanoparticles that possess cytotoxicity and antioxidant activity against MCF-7 and HeLa cells.

Microtubule-affinity regulating kinase 4: A potential drug target for cancer therapy

The human genome encodes more than 500 protein kinases that work by transferring the γ-phosphate group from ATP to serine, threonine, or tyrosine (Ser/Thr/Tyr) residues. Various kinases are associated with the onset of cancer and its further progression. The recent advancements in developing small-molecule kinase inhibitors to treat different cancer types have shown noticeable results in clinical therapies. Microtubule-affinity regulating kinase 4 (MARK-4) is a Ser/Thr protein kinase that relates structurally to AMPK/Snf1 subfamily of the CaMK kinases. The protein kinase modulates major signalling pathways such as NF-κB, mTOR and the Hippo-signalling pathway. MARK4 is associated with various cancer types due to its important role in regulating microtubule dynamics and subsequent cell division. Aberrant expression of MARK4 is linked with several pathologies such as cancer, Alzheimer's disease, obesity, etc. This review provides detailed information on structural aspects of MARK4 and its role in various signalling pathways related to cancer. Several therapeutic molecules were designed to inhibit the MARK4 activity from controlling associated diseases. The review further highlights kinase-targeted drug discovery and development in oncology and cancer therapies. Finally, we summarize the latest findings regarding the role of MARK4 in cancer, diabetes, and neurodegenerative disease path to provide a solid rationale for future investigation and therapeutic intervention.

Comparison of female breast cancer between Russia and Germany: A population-based study on time trends and stage at diagnosis

OBJECTIVES

While a mammography-screening program (MSP) is being offered systematically in Germany since 2009, the dispanserizatsiya has been implemented in Russia since 2013. This study examined trends of stage at breast cancer diagnosis in two Russian regions and compared the results with the development in Germany. In addition, we aimed to gain further insights into the early detection of breast cancer in Russia.

METHODS

Incidence data from two cancer registries in Russia and 12 population-based cancer registries in Germany were used to analyse breast cancer incidence rates among women above age 30 over time. Further, we calculated rate ratios to compare the age group-specific incidence rates after the implementation of MSP in Germany (2010-2014) with the period before implementation (2003-2005) separately for each tumour stage and all stages combined.

RESULTS

During the study period from 2003 to 2014, age-standardised rates for breast cancer were 54.6 and 116.7 per 100,000 for Russia and Germany, respectively. The proportion of the T1 stage at diagnosis among Russian women aged 50 + is half than that in Germany. Nevertheless, we observed an increasing trend of early-stage alongside the reduction of advanced-stage incidence rates of breast cancer in Russia.

CONCLUSIONS

The observed trend in Russia may reflect overall positive changes in early detection of breast cancer, with actual proportion of T1 stage still far behind Germany. Advances in breast cancer screening efforts through the dispanserizatsiya may help to further reduce the breast cancer burden.

Cyclic Peptides for the Treatment of Cancers: A Review

Cyclic peptides have been widely reported to have therapeutic abilities in the treatment of cancer. This has been proven through in vitro and in vivo studies against breast, lung, liver, colon, and prostate cancers, among others. The multitude of data available in the literature supports the potential of cyclic peptides as anticancer agents. This review summarizes the findings from previously reported studies and discusses the different cyclic peptide compounds, the sources, and their modes of action as anticancer agents. The prospects and future of cyclic peptides will also be described to give an overview on the direction of cyclic peptide development for clinical applications.

Increased morbidity evaluated on hospital contacts and prescriptions among 100,834 Danish breast cancer survivors

BACKGROUND

Cardiovascular disease competes with breast cancer (BC) as the leading cause of death for females diagnosed with breast cancer. Not much is known concerning morbidity and medicine use in the short and long term after a BC diagnosis.

AIM

The aim of this study was to determine acute and long-term morbidity in Danish women treated for BC.

METHOD

A nationwide registry-based cohort study of 100,834 BC patients identified in the clinical database of Danish Breast Cancer Cooperative Group (DBCG) and 1,100,320 (10 per patient) age-matched Danish women without BC, serving as controls. Morbidity was studied using complete data on hospital contacts and medicinal use.

RESULTS

The risk of hospital contacts was significantly increased in BC survivors compared with controls evaluated both by means of Cox regression and negative binomial regression analysis both during and after cessation of breast cancer treatment. Young age at breast cancer diagnosis was associated with the most pronounced increase in risk of hospital contacts, both during and after cessation of BC treatment. Medicinal use was significantly increased among BC patients compared to controls, both during (HR 1.27 (1.26-1.28), p < 0.0001) and after BC treatment (HR 1.18 (1.17-1.19), p < 0.0001, and present for all subgroups of medicine.

CONCLUSION

Overall, BC survivors have a pronounced increase in hospital contacts and medicinal use compared to women without BC. Premenopausal status at BC diagnosis was associated with an overall higher excess morbidity and a higher burden both during and after treatment.

Knowledge of breast cancer and breast self-examination practices and its barriers among university female students in Bangladesh: Findings from a cross-sectional study

Early diagnosis of breast cancer is the best approach towards its control that may result in alleviating related mortality and morbidity. This study aimed to evaluate knowledge about breast cancer and both practices and perceived barriers to breast self-examination among female university students in Bangladesh. A cross-sectional study was carried out with 400 female students of Jahangirnagar University, Bangladesh. Participants were sampled from female dormitories at the university from January to April 2020. Proportionate stratified random sampling was conducted to calculate the study sample from each dormitory. A validated semi-structured self-reported questionnaire was employed to collect data from participants during the survey periods. The questionnaire consisted of demographic variables, items about knowledge about breast cancer, breast self-examination practices and its barriers. We applied descriptive and inferential statistics and data were analyzed using the Statistical Package for the Social Sciences (SPSS). Participants were aged between 18–26 years and comprised university students of first year (20%), second year (24%), third year (22%), fourth year (21%) and Master’s (14%). 18% of them reported positive family history (mother, aunt, sister/cousin, grandmother) of breast cancer. The overall mean score of total knowledge items was 15 (SD = 3) out of 43, with an overall correct rate of 34%. The mean score of total knowledge items was significantly higher (p<0.001) among Master’s students and students with family members who have had breast cancer. Only one in five students (21%) ever practiced breast self-examination. The mean score of practice of breast self-examination was significantly higher (p<0.001) among participants who reported having family member of breast cancer. Total knowledge score about breast cancer and practice of breast self-examination were significantly correlated with each other (r = 0.54; p<0.001). About 33% participants reported ‘lack of knowledge’ as the main barrier to practicing breast self-examination followed by ‘I do not have the symptoms’ (22%), and ‘shyness/ uncomfortable feelings’ (17%). The study revealed low levels of knowledge about breast cancer and low breast self-examination practices. Our findings highlight the need to develop, implement and promote socially, culturally and demographically appropriate educational interventions programs aimed at breast cancer and breast self-examination awareness and practice in Bangladesh.

Expression of ERBB gene family in females with breast cancer and its correlation with clinicopathological characteristics of the disease

BACKGROUND

Breast cancer (BC) is the most prevalent and fatal cancer in women. Given that there are very few studies investigating the overexpression of four members of ERBB genes, we decided to investigate the correlation between these four genes with clinicopathological characteristics in breast cancer cases.

METHODS

Tumoural tissue of 50 patients with sporadic invasive ductal BC was recruited. Also, control samples were provided from adjacent non-cancerous tissues (ANCTs) of the same patients. The expression of four ERBB genes was evaluated by real-time PCR and its correlation with clinicopathological characteristics was assessed.

RESULTS

Only ERBB2 (HER2) was overexpressed in tumoural tissue compared with ANCTs. Our data showed a significant relationship between ERBB1 overexpression with triple-negative tumors, ER, and PR negativity (P < 0.05). Also, ERBB2 overexpression indicated a significant correlation with several pathological characteristics such as age < 50, tumor size larger than 2 cm, early and advanced stages, negative involved lymph nodes, luminal B, triple-negative, ERBB2-enrich, estrogen receptor (ER) and progesterone receptor (PR) negative tumors, Ki-67 mutation more than 15%, and finally HER2/neu immunohistochemistry (IHC) positive and intermediate (P < 0.05). Moreover, this study demonstrated that ERBB4 overexpression had a significant correlation with tumor size smaller than 2 cm, grade I and II tumors (early-stage tumors), luminal A, ER and PR positive tumors, HER-2/neu IHC intermediate, and tumors that had a Ki-67 mutation lower than 15% (P < 0.05). Besides, our analysis showed a significant correlation between the expression of ERBB1 with ERBB2 and ERBB3 with ERBB4 (P < 0.05).

CONCLUSIONS

Our findings showed a significant relationship between unfavorable clinicopathological characteristics with ERBB1 and ERBB2 overexpression, but overexpression of ERBB4 was correlated with favorable outcomes.

Breast Cancer Survival in Eastern Region of Ghana

Objective

Five-year overall survival rate of breast cancer in low-income countries (LICs) is significantly lower than in high-resource countries. This study explored clinical and pathological factors influencing mortality in the Eastern region of Ghana.

Methods

We performed a retrospective medical chart review for patients undergoing surgery and chemotherapy for breast cancer at a regional hospital in Ghana from January 2014 to January 2017. Descriptive and survival analysis was done.

Results

One hundred and twenty-nine patients were included in the study. The median age at presentation was 51 years. Sixty percent of patients presented with poorly differential histological grade III. The most common histological type was invasive ductal carcinoma (83%). Based on stage assessment using only tumor size and lymph node status, 60% presented at stage 3. Only 25% were tested for hormone receptor proteins and HER2 status. Of these, 57% had triple-negative breast cancer (TNBC). The 3-year overall survival rate was only 52%.

Conclusion

The cumulative 3-year survival was 52%. Despite success in reducing cancer mortality in northern Africa, survival in sub-Saharan Africa remains poor. A significantly higher percentage of GIII and TNBC is found in breast cancers seen in Ghana. When combined with limited capacity for accurate diagnosis, cancer subtype analysis, adequate therapy, and follow-up, late-stage presentation leads to poor outcomes. Future studies should emphasize the identification of barriers to care and opportunities for cost-effective and sustainable improvements in diagnosing and treating breast cancer in LICs.

Body mass index, breast density, and the risk of breast cancer development in relation to the menopausal status; results from a population-based screening program in a native African-Arab country

Background

Risk factors are traits or behaviors that have an influence on the development of breast cancer (BC). Awareness of the prevalent risk factors can guide in developing prevention interventions.

Purpose

To evaluate the correlation between the breast density, body mass index, and the risk of breast cancer development in relation to the menopausal status in a native African-Arab population.

Material and methods

The study included 30,443 screened females who were classified into cancer and non-cancer groups and each group was further sub-classified into pre- and postmenopausal groups. The breast density (BD) was reported and subjectively classified according to the 2013 ACR BI-RADS breast density classification. The weight and height were measured, and the body mass index (BMI) was calculated and classified according to the WHO BMI classification.

Results

A statistically significant difference was calculated between the mean BMI in the cancer and non-cancer groups (p: .027) as well as between the pre- and postmenopausal groups (p < .001). A positive statistically insignificant correlation was calculated between the breast density and the risk of breast cancer in the premenopausal group (OR: 1.062, p: .919) and a negative highly significant correlation was calculated in the postmenopausal group (OR: 0.234, p < .001).

Conclusion

BMI and BD are inversely associated with each other. The current studied population presented unique ethnic characteristics, where a decreased BD and an increased BMI were found to be independent risk factors for developing breast cancer.

New oxovanadium(IV) complexes overcame drug resistance and increased in vitro cytotoxicity by an apoptotic pathway in breast cancer cells

In order to examine the anticancer potential of oxovanadium(IV) complexes with thiosemicarbazone, two new complexes were prepared starting from 2-thenoyltrifluoroacetone-S-methylthiosemicarbazone. The complexes with tetradentate thiosemicarbazone ligand were characterized by elemental analysis, IR, ESI MS, and single-crystal X-ray diffraction analysis. Cytotoxicity on breast cancer cells, MDA-MB-231 and MCF-7, was determined by MTT assay. Cisplatin was positive control and the results were compared with those of the normal cells, HUVEC and 3T3. The complexes exhibited greater activity on cancer cells than cisplatin, but they were cytotoxic at several times higher concentrations in the healthy cells. In our study, the presence of thiophene and fluoro groups in the oxovanadium(IV) complexes with thiosemicarbazone increased greatly the cytotoxic activity of the complexes on breast cancer cells. Moreover, the complexes induced apoptosis-mediated cell death and also reduced the expression of MDR-1 or P-glycoprotein and ABCG2. As a result, the findings indicated that the complexes have selective cytotoxicity on breast cancer cells and can overcome multidrug resistance. These properties of the complexes make it possible to be a potential anticancer drug candidate for breast cancer treatment.

Volatile Organic Compounds Analysis as a Potential Novel Screening Tool for Breast Cancer: A Systematic Review

Introduction

An early diagnosis is crucial in reducing mortality among people who have breast cancer (BC). There is a shortfall of characteristic early clinical symptoms in BC patients, highlighting the importance of investigating new methods for its early detection. A promising novel approach is the analysis of volatile organic compounds (VOCs) produced and emitted through the metabolism of cancer cells.

Methods

The purpose of this systematic review is to outline the published research regarding BC-associated VOCs. For this, headspace analysis of VOCs was explored in patient-derived body fluids, animal model-derived fluids, and BC cell lines to identify BC-specific VOCs. A systematic search in PubMed and Web of Science databases was conducted according to the PRISMA guidelines.

Results

Thirty-two studies met the criteria for inclusion in this review. Results highlight that VOC analysis can be promising as a potential novel screening tool. However, results of in vivo, in vitro and case-control studies have delivered inconsistent results leading to a lack of inter-matrix consensus between different VOC sampling methods.

Discussion

Discrepant VOC results among BC studies have been obtained, highly due to methodological discrepancies. Therefore, methodological issues leading to disparities have been reviewed and recommendations have been made on the standardisation of VOC collection and analysis methods for BC screening, thereby improving future VOC clinical validation studies.

Notch signaling in female cancers: a multifaceted node to overcome drug resistance

Drug resistance is one of the main challenges in cancer therapy, including in the treatment of female-specific malignancies, which account for more than 60% of cancer cases among women. Therefore, elucidating the underlying molecular mechanisms is an urgent need in gynecological cancers to foster novel therapeutic approaches. Notably, Notch signaling, including either receptors or ligands, has emerged as a promising candidate given its multifaceted role in almost all of the hallmarks of cancer. Concerning the connection between Notch pathway and drug resistance in the afore-mentioned tumor contexts, several studies focused on the Notch-dependent regulation of the cancer stem cell (CSC) subpopulation or the induction of the epithelial-to-mesenchymal transition (EMT), both features implicated in either intrinsic or acquired resistance. Indeed, the present review provides an up-to-date overview of the published results on Notch signaling and EMT- or CSC-driven drug resistance. Moreover, other drug resistance-related mechanisms are examined such as the involvement of the Notch pathway in drug efflux and tumor microenvironment. Collectively, there is a long way to go before every facet will be fully understood; nevertheless, some small pieces are falling neatly into place. Overall, the main aim of this review is to provide strong evidence in support of Notch signaling inhibition as an effective strategy to evade or reverse resistance in female-specific cancers.

Breast Cancer Knowledge, Attitudes and Practices amongst Women in Qatar

This cross-sectional study examines knowledge, attitudes, and practices surrounding breast cancer awareness and screening among women residents in Qatar. Females, >18 years old, registered with the Primary Health Care Corporation were invited to complete an Arabic or English online survey using a modified version of the Breast Cancer Awareness Module. Of the 9008 participants, 69% report awareness of breast cancer warning signs, but the results did not substantiate these claims. There remains a disconnect between participants’ perceived awareness of their ability to detect breast cancer and their actual recognition of individual signs and symptoms. Nearly half (45.4%) report rarely or never checking their breasts for abnormalities (44.6%). Breast self-examination (BSE) and Breast Cancer Screening (BCS) uptake is low and many are unaware of the starting age for invitation to Qatar’s BCS program. While only 18% of women report receiving an invitation, 94% attended, indicating that the BCS invitation is a remarkably effective means of improving screening uptake. Policymakers should capitalize on early recognition, which is possible in the youthful population. Broadening awareness campaigns and interventions targeting a broader audience including males, community and religious leaders and healthcare professionals may prove more effective in Arab communities.

Breast Cancer Treatment Delay in SafetyNet Health Systems, Houston Versus Southeast Brazil

Background

Breast cancer outcomes among patients who use safety-net hospitals in the highly populated Harris County, Texas and Southeast Brazil are poor. It is unknown whether treatment delay contributes to these outcomes.

Methods

We conducted a retrospective cohort analysis of patients with non-metastatic breast cancer diagnosed between January 1, 2009 and December 31, 2011 at Harris Health Texas and Unicamp’s Women’s Hospital, Barretos Hospital, and Brazilian National Institute of Cancer, Brazil. We used Cox proportional hazards regression to evaluate association of time to treatment and risk of recurrence (ROR) or death.

Results

One thousand one hundred ninety-one patients were included. Women in Brazil were more frequently diagnosed with stage III disease (32.3% vs. 21.1% Texas; P = .002). Majority of patients in both populations had symptom-detected disease (63% in Brazil vs. 59% in Texas). Recurrence within 5 years from diagnosis was similar 21% versus 23%. Median time from diagnosis to first treatment defined as either systemic therapy (chemotherapy or endocrine therapy) or surgery, were comparable, 9.9 weeks versus 9.4 weeks. Treatment delay was not associated with increased ROR or death. Higher stage at diagnosis was associated with both increased ROR and death.

Conclusion

Time from symptoms to treatment was considerably long in both populations. Treatment delay did not affect outcomes.

Impact

Access to timely screening and diagnosis of breast cancer are priorities in these populations.

CCDC134 as a Prognostic-Related Biomarker in Breast Cancer Correlating With Immune Infiltrates

Background

The expression of Coiled-Coil Domain Containing 134(CCDC134) is up-regulated in different pan-cancer species. However, its prognostic value and correlation with immune infiltration in breast cancer are unclear. Therefore, we evaluated the prognostic role of CCDC134 in breast cancer and its correlation with immune invasion.

Methods

We downloaded the transcription profile of CCDC134 between breast cancer and normal tissues from the Cancer Genome Atlas (TCGA). CCDC134 protein expression was assessed by the Clinical Proteomic Cancer Analysis Consortium (CPTAC) and the Human Protein Atlas. Gene set enrichment analysis (GSEA) was also used for pathway analysis. Receiver operating characteristic (ROC) curve was used to differentiate breast cancer from adjacent normal tissues. Kaplan-Meier method was used to evaluate the effect of CCDC134 on survival rate. The protein-protein interaction (PPI) network is built from STRING. Function expansion analysis is performed using the ClusterProfiler package. Through tumor Immune Estimation Resource (TIMER) and tumor Immune System Interaction database (TISIDB) to determine the relationship between CCDC134 expression level and immune infiltration. CTD database is used to predict drugs that inhibit CCDC134 and PubChem database is used to determine the molecular structure of identified drugs.

Results

The expression of CCDC134 in breast cancer tissues was significantly higher than that of CCDC134 mRNA expression in adjacent normal tissues. ROC curve analysis showed that the AUC value of CCDC134 was 0.663. Kaplan-meier survival analysis showed that patients with high CCDC134 had a lower prognosis (57.27 months vs 36.96 months, P = 2.0E-6). Correlation analysis showed that CCDC134 mRNA expression was associated with tumor purity immune invasion. In addition, CTD database analysis identified abrine, Benzo (A) Pyrene, bisphenol A, Soman, Sunitinib, Tetrachloroethylene, Valproic Acid as seven targeted therapy drugs that may be effective treatments for seven targeted therapeutics. It may be an effective treatment for inhibiting CCDC134.

Conclusion

In breast cancer, upregulated CCDC134 is significantly associated with lower survival and immune infiltrates invasion. Our study suggests that CCDC134 can serve as a biomarker of poor prognosis and a potential immunotherapy target in breast cancer. Seven drugs with significant potential to inhibit CCDC134 were identified.

The association between migraine and breast cancer risk: A systematic review and meta-analysis

Background

Migraines is likely to play a protective role in the risk of breast cancer. Some studies have shown that there is an inverse relationship between migraine and breast cancer, and some studies have not found an association; therefore, results from previous studies have been inconclusive and we conducted a meta-analysis to evaluate association between migraine and breast cancer.

Methods

PubMed, EMBASE, Scopus and Web of Science were searched to identify studies on the association between migraine and breast cancer from January 1, 2000 through March 12, 2021. The pooled relative risk (RR) and the 95% confidence intervals (CI) was used to measure this relationship by assuming a random effects meta-analytic model.

Results

A total of 10 studies were included. Our study revealed that there was statistically significant inverse relationship between migraine and breast cancer in case-control studies 0.68 [95% CI: 0.56, 0.82], but no significant relationship was found in cohort studies 0.98 [95% CI: 0.91, 1.06]. Also, migraine reduced the risk of ductal carcinoma 0.84 [95% CI: 0.73, 0.96], and lobular carcinoma 0.83 [95% CI: 0.73, 0.96]. With respect to ER_PR status no association between migraine and breast cancer was found. We found no evidence of publication bias.

Conclusion

Our analysis demonstrated a statistically significantly inverse relationship between migraine and total risk of breast cancer only in case-control studies. In summary, cohort studies do not support an inverse association between migraine and incident breast cancer. While in case-control studies, migraine has an inverse association with ductal carcinoma and lobular carcinoma of breast.

The effect of reproductive, hormonal, nutritional and lifestyle on breast cancer risk among black Tanzanian women: A case control study

Purpose

This study aimed to determine the effect of reproductive, hormonal, lifestyle and nutritional factors on breast cancer development among Tanzanian black women.

Methodology

We undertook a case-control study age-matched to ±5years in 2018 at Muhimbili National Hospital. The study recruited 105 BC patients and 190 controls giving it 80% power to detect an odds ratio of ≥2 at the alpha error of <5% for exposure with a prevalence of 30% in the control group with 95% confidence. Controls were recruited from in patients being treated for non-cancer related conditions. Information regarding hormonal, reproductive, nutritional and lifestyle risk for breast cancer and demography was collected by interviews using a predefined data set. Conditional multinomial logistic regression used to determine the adjusted odds ratio for variables that had significant p-value in the binomial logistic regression model with 5% allowed error at 95% confidence interval.

Results

The study recruited 105 cases and 190 controls. Only old age at menopause had a significant risk, a 2.6 fold increase. Adolescent obesity, family history of breast cancer, cigarette smoking and alcohol intake had increased odds for breast cancer but failed to reach significant levels. The rural residency had 61% reduced odds for developing breast cancer though it failed to reach significant levels.

Conclusion

Older age at menopause is a significant risk factor for the development of breast cancer among Tanzanian women. This study has shed light on the potential role of modifiable risk factors for breast cancer which need to be studied further for appropriate preventive strategies in similar settings.

Diagnostic Value of Nonacid Nucleic Blood Tumor Marker Panels in Early Diagnosing Breast Cancer: A Systematic Review and Network Meta-Analysis

This study is aimed at determining the best nonacid nucleic blood tumor marker panels in terms of sensitivity, specificity, and accuracy in order to detect breast cancer in early stages (I, II, and III) among eligible women for breast cancer screening. PubMed, Web of Science, Embase, Scopus, and Cochrane were systematically reviewed to assess nonacid nucleic blood tumor marker panels’ diagnostic value in women, both healthy and patient (before any anticancer treatment), for detecting breast cancer. A network meta-analysis was carried out using a Bayesian network meta-analysis to estimate combined odd ratio (OR) and 95% CI credible interval for presenting the results. Rankograms plot was drawn to rank the diagnostic value of different panels. Of the 2358 titles initially identified, 9 studies and 8 panels were included in the network meta-analysis. Panels A (MMP-9/TIMP-1) and K (TF1+TF2+TF3) had the highest sensitivity in early stages, as panel A with $\text{OR}=11.61$ and 95% CI (1.49-102.5) demonstrated a better function than mammography. Panels H (CA 15.3 + IL-18) and A (MMP-9/TIMP-1) had the highest specificity in early stages, but no significant difference with mammography. Panels A (MMP-9/TIMP-1) and H (CA 15.3 + IL-18) had the highest accuracy in early stages, as they significantly exhibited a higher function than mammography with $\text{OR}=6.87$ and 95% CI (2.07-31.35) as well as $\text{OR}=3.44$ and 95% CI (1.15-11.07), respectively. Panel A including MMP-9/TIMP-1 in early stages demonstrated a higher diagnostic value for breast cancer than the rest of the panels.