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Peila R, Rohan TE. Circulating levels of biomarkers and risk of ductal carcinoma in situ of the breast in the UK Biobank study. Int J Cancer 2024; 154:1191-1203. [PMID: 38013398 DOI: 10.1002/ijc.34795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023]
Abstract
Observational studies have shown associations between circulating levels of various biomarkers (eg, total cholesterol [TC], low-density lipoprotein cholesterol [LDL], insulin-like growth factor-1 [IGF-1], C-reactive protein [CRP] and glycated hemoglobin-1c [HbA1c]) and the risk of invasive breast cancer (IBC). Ductal carcinoma in situ of the breast (DCIS) is a nonobligate precursor of IBC and shares several risk factors with it. However, the relationship between these biomarkers and DCIS risk remains unexplored. We studied the association between circulating levels of TC, LDL-C, high-density lipoprotein cholesterol (HDL-C), Lipoprotein (a) (Lp-(a)), IGF-1, CRP and HbA1c, with the risk of DCIS in 156801women aged 40 to 69 years and breast cancer-free at enrolment when blood samples and information on demographic and health-related factors were collected. Incident cases of DCIS were ascertained during the follow-up via linkage to the UK cancer registries Multivariable-adjusted Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of interest. In all, 969 DCIS incident cases were diagnosed during 11.4 years of follow-up. Total cholesterol was inversely associated with the risk of DCIS (HRquintile(Q)5vsQ1 = 0.47, 95% CI: 0.27-0.82, Ptrend = .008). Conversely, LDL-C was positively associated with DCIS risk (HRQ3vsQ1 = 1.43, 95% CI: 1.01-2.04, HRQ4vsQ1 = 1.60, 95% CI: 1.04-2.47, HRQ5vsQ1 = 2.29, 95% CI: 1.36-3.88, Ptrend = .004). In postmenopausal women, CRP had a weak positive association with DCIS risk, while HbA1c showed a nonlinear association with the risk. These results, in conjunction with those from previous studies on IBC, provide support for the association of several biomarkers with the risk of an early stage of breast cancer.
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Affiliation(s)
- Rita Peila
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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2
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Alaeikhanehshir S, Schmitz RSJM, van den Belt-Dusebout AW, van Duijnhoven FH, Verschuur E, van Seijen M, Schaapveld M, Lips EH, Wesseling J. The effects of contemporary treatment of DCIS on the risk of developing an ipsilateral invasive Breast cancer (iIBC) in the Dutch population. Breast Cancer Res Treat 2024; 204:61-68. [PMID: 37964135 PMCID: PMC10806034 DOI: 10.1007/s10549-023-07168-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE To assess the effects of contemporary treatment of ductal carcinoma in situ (DCIS) on the risk of developing an ipsilateral invasive breast cancer (iIBC) in the Dutch female population. METHODS Clinical data was obtained from the Netherlands Cancer Registry (NCR), a nationwide registry of all primary malignancies in the Netherlands integrated with the data from PALGA, the Dutch nationwide network and registry of histo- and cytopathology in the Netherlands, on all women in the Netherlands treated for primary DCIS from 2005 to 2015, resulting in a population-based cohort of 14.419 women. Cumulative iIBC incidence was assessed and associations of DCIS treatment type with subsequent iIBC risk were evaluated by multivariable Cox regression analyses. RESULTS Ten years after DCIS diagnosis, the cumulative incidence of iIBC was 3.1% (95% CI: 2.6-3.5%) in patients treated by breast conserving surgery (BCS) plus radiotherapy (RT), 7.1% (95% CI: 5.5-9.1) in patients treated by BCS alone, and 1.6% (95% CI: 1.3-2.1) in patients treated by mastectomy. BCS was associated with a significantly higher risk for iIBC compared to BCS + RT during the first 5 years after treatment (HR 2.80, 95% CI: 1.91-4.10%). After 5 years of follow-up, the iIBC risk declined in the BCS alone group but remained higher than the iIBC risk in the BCS + RT group (HR 1.73, 95% CI: 1.15-2.61). CONCLUSIONS Although absolute risks of iIBC were low in patients treated for DCIS with either BCS or BCS + RT, risks remained higher in the BCS alone group compared to patients treated with BCS + RT for at least 10 years after DCIS diagnosis.
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MESH Headings
- Female
- Humans
- Breast Neoplasms/epidemiology
- Breast Neoplasms/therapy
- Breast Neoplasms/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Mastectomy/methods
- Mastectomy, Segmental/methods
- Incidence
- Neoplasm Recurrence, Local/surgery
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Ductal, Breast/etiology
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Affiliation(s)
- Sena Alaeikhanehshir
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands
- Department of Surgical Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Renée S J M Schmitz
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands
| | - Alexandra W van den Belt-Dusebout
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Maartje van Seijen
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands
| | - Michael Schaapveld
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Esther H Lips
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands.
- Department of Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
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3
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Hsu DS, Jiang SF, Habel LA, Hoodfar E, Karlea A, Manace-Brenman L, Dzubnar JM, Shim VC. Germline Genetic Testing Among Women ≤ 45 Years of Age with Ductal Carcinoma In Situ Versus Invasive Breast Cancer in a Large Integrated Health Care System. Ann Surg Oncol 2023; 30:6454-6461. [PMID: 37386303 DOI: 10.1245/s10434-023-13745-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND We compared the results of hereditary cancer multigene panel testing among patients ≤ 45 years of age diagnosed with ductal carcinoma in situ (DCIS) versus invasive breast cancer (IBC) in a large integrated health care system. METHODS A retrospective cohort study of hereditary cancer gene testing among women ≤ 45 years of age diagnosed with DCIS or IBC at Kaiser Permanente Northern California between September 2019 and August 2020 was performed. During the study period, institutional guidelines recommended the above population be referred to genetic counselors for pretesting counseling and testing. RESULTS A total of 61 DCIS and 485 IBC patients were identified. Genetic counselors met with 95% of both groups, and 86.4% of DCIS patients and 93.9% of IBC patients (p = 0.0339) underwent gene testing. Testing differed by race/ethnicity (p = 0.0372). Among those tested, 11.76% (n = 6) of DCIS patients and 16.71% (n = 72) of IBC patients had a pathogenic variant (PV) or likely pathogenic variant (LPV) based on the 36-gene panel (p = 0.3650). Similar trends were seen in 13 breast cancer (BC)-related genes (p = 0.0553). Family history of cancer was significantly associated with both BC-related and non-BC-related PVs in IBC, but not DCIS. CONCLUSION In our study, 95% of patients were seen by a genetic counselor when age was used as an eligibility criterion for referral. While larger studies are needed to further compare the prevalence of PVs/LPVs among DCIS and IBC patients, our data suggest that even in younger patients, the prevalence of PVs/LPVs in BC-related genes is lower in DCIS patients.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/epidemiology
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Genetic Predisposition to Disease
- Retrospective Studies
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Genetic Testing
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Affiliation(s)
- Diana S Hsu
- University of California San Francisco, East Bay, Oakland, CA, USA
| | | | - Laurel A Habel
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | | - Audrey Karlea
- Department of Genetics, Kaiser Permanente, Oakland, CA, USA
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Williams AD, Chang C, Sigurdson ER, Wang CH, Aggon AA, Hill MV, Porpiglia A, Bleicher RJ. Neoadjuvant Endocrine Therapy and Delays in Surgery for Ductal Carcinoma in Situ: Implications for the Coronavirus Pandemic. Ann Surg Oncol 2022; 29:1683-1691. [PMID: 34635974 PMCID: PMC8504964 DOI: 10.1245/s10434-021-10883-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical delays are associated with invasive cancer for patients with ductal carcinoma in situ (DCIS). During the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic, neoadjuvant endocrine therapy (NET) was used as a bridge until postponed surgeries resumed. This study sought to determine the impact of NET on the rate of invasive cancer for patients with a diagnosis of DCIS who have a surgical delay compared with those not treated with NET. METHODS Using the National Cancer Database, the study identified women with hormone receptor-positive (HR+) DCIS. The presence of invasion on final pathology was evaluated after stratifying by receipt of NET and by intervals based on time from diagnosis to surgery (≤30, 31-60, 61-90, 91-120, or 121-365 days). RESULTS Of 109,990 women identified with HR+ DCIS, 276 (0.3%) underwent NET. The mean duration of NET was 74.4 days. The overall unadjusted rate of invasive cancer was similar between those who received NET ((15.6%) and those who did not (12.3%) (p = 0.10). In the multivariable analysis, neither the use nor the duration of NET were independently associated with invasion, but the trend across time-to-surgery categories demonstrated a higher rate of upgrade to invasive cancer in the no-NET group (p < 0.001), but not in the NET group (p = 0.97). CONCLUSIONS This analysis of a pre-COVID cohort showed evidence for a protective effect of NET in HR+ DCIS against the development of invasive cancer as the preoperative delay increased, although an appropriately powered prospective trial is needed for a definitive answer.
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MESH Headings
- Breast Neoplasms/drug therapy
- Breast Neoplasms/epidemiology
- Breast Neoplasms/surgery
- COVID-19
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/drug therapy
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- Neoadjuvant Therapy
- Pandemics
- Prospective Studies
- SARS-CoV-2
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Affiliation(s)
| | - Cecilia Chang
- Research Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Elin R Sigurdson
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Chih-Hsiung Wang
- Research Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Allison A Aggon
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Maureen V Hill
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Andrea Porpiglia
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Richard J Bleicher
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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Evans DG, van Veen EM, Byers H, Roberts E, Howell A, Howell SJ, Harkness EF, Brentnall A, Cuzick J, Newman WG. The importance of ethnicity: Are breast cancer polygenic risk scores ready for women who are not of White European origin? Int J Cancer 2022; 150:73-79. [PMID: 34460111 PMCID: PMC9290473 DOI: 10.1002/ijc.33782] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/08/2021] [Accepted: 08/02/2021] [Indexed: 11/07/2022]
Abstract
Polygenic risk scores (PRS) for disease risk stratification show great promise for application in general populations, but most are based on data from individuals of White European origin. We assessed two well validated PRS (SNP18, SNP143) in the Predicting-Risk-of-Cancer-At-Screening (PROCAS) study in North-West England for breast cancer prediction based on ethnicity. Overall, 9475 women without breast cancer at study entry, including 645 who subsequently developed invasive breast cancer or ductal carcinoma in situ provided DNA. All were genotyped for SNP18 and a subset of 1868 controls were genotyped for SNP143. For White Europeans both PRS discriminated well between individuals with and without cancer. For n = 395 Black (n = 112), Asian (n = 119), mixed (n = 44) or Jewish (n = 120) women without cancer both PRS overestimated breast cancer risk, being most marked for women of Black and Jewish origin (P < .001). SNP143 resulted in a potential mean 40% breast cancer risk overestimation in the combined group of non-White/non-European origin. SNP-PRS that has been normalized based on White European ethnicity for breast cancer should not be used to predict risk in women of other ethnicities. There is an urgent need to develop PRS specific for other ethnicities, in order to widen access of this technology.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/genetics
- Breast Density
- Breast Neoplasms/epidemiology
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Case-Control Studies
- England/epidemiology
- Ethnicity/genetics
- Female
- Follow-Up Studies
- Genetic Predisposition to Disease
- Humans
- Middle Aged
- Polymorphism, Single Nucleotide
- Prognosis
- Risk Factors
- White People/genetics
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Affiliation(s)
- D. Gareth Evans
- Nightingale/Prevent Breast Cancer Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
- Manchester Breast Centre, Manchester Cancer Research CentreThe Christie HospitalManchesterUK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester Academic Health Science CentreManchesterUK
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
| | - Elke M. van Veen
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
| | - Helen Byers
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
| | - Eleanor Roberts
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester Academic Health Science CentreManchesterUK
| | - Anthony Howell
- Nightingale/Prevent Breast Cancer Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
- Manchester Breast Centre, Manchester Cancer Research CentreThe Christie HospitalManchesterUK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester Academic Health Science CentreManchesterUK
| | - Sacha J. Howell
- Nightingale/Prevent Breast Cancer Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
- Manchester Breast Centre, Manchester Cancer Research CentreThe Christie HospitalManchesterUK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester Academic Health Science CentreManchesterUK
| | - Elaine F. Harkness
- Nightingale/Prevent Breast Cancer Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Adam Brentnall
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonUK
| | - Jack Cuzick
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonUK
| | - William G. Newman
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
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6
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Abstract
Ductal carcinoma in situ (DCIS) is thought to be a direct precursor of most cases of breast cancer and its incidence increases with age. However, the globally impressive rise of DCIS cases is probably an epidemiologic "artifact" that is mainly attributed to the establishment of screening mammography in developed countries. Furthermore, considering that usually there are no clinical findings of the disease, the initial detection of DCIS is a mammographic "event" in most cases. The risk factors for DCIS are similar to those for invasive cancer including, among others, deleterious mutations in the BRCA genes, family history of breast cancer, nulliparity, late age at first birth, increased breast density, personal history of benign breast disease, and postmenopausal obesity.
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7
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Giannakeas V, Lim DW, Narod SA. The risk of contralateral breast cancer: a SEER-based analysis. Br J Cancer 2021; 125:601-610. [PMID: 34040177 PMCID: PMC8368197 DOI: 10.1038/s41416-021-01417-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/26/2021] [Accepted: 04/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We sought to estimate the annual risk and 25-year cumulative risk of contralateral breast cancer among women with stage 0-III unilateral breast cancer. METHODS We identified 812,851 women with unilateral breast cancer diagnosed between 1990 and 2015 in the SEER database and followed them for contralateral breast cancer for up to 25 years. Women with a known bilateral mastectomy were excluded. We calculated the annual risk of contralateral breast cancer by age at diagnosis, by time since diagnosis and by current age. We compared risks by ductal carcinoma in situ (DCIS) versus invasive disease, by race and by oestrogen receptor (ER) status of the first cancer. RESULTS There were 25,958 cases of contralateral invasive breast cancer diagnosed (3.2% of all patients). The annual risk of contralateral breast cancer over the 25-year follow-up period was 0.37% and the 25-year actuarial risk of contralateral invasive breast cancer was 9.9%. The annual risk varied to a small degree by age of diagnosis, by time elapsed since diagnosis and by current age. The 25-year actuarial risk was similar for DCIS and invasive breast cancer patients (10.1 versus 9.9%). The 25-year actuarial risk was higher for black women (12.7%) than for white women (9.7%) and was lower for women with ER-positive breast cancer (9.5%) than for women with ER-negative breast cancer (11.2%). CONCLUSIONS Women with unilateral breast cancer experience an annual risk of contralateral breast cancer ~0.4% per year, which persists over the 25-year follow-up period.
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MESH Headings
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Female
- Humans
- Middle Aged
- Neoplasm Staging
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/metabolism
- Neoplasms, Second Primary/pathology
- Receptors, Estrogen/metabolism
- Risk Factors
- SEER Program
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Affiliation(s)
- Vasily Giannakeas
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - David W Lim
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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8
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Ahmed F, Adnan M, Malik A, Tariq S, Kamal F, Ijaz B. Perception of breast cancer risk factors: Dysregulation of TGF-β/miRNA axis in Pakistani females. PLoS One 2021; 16:e0255243. [PMID: 34297787 PMCID: PMC8301651 DOI: 10.1371/journal.pone.0255243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/12/2021] [Indexed: 01/10/2023] Open
Abstract
Breast cancer poses a serious health risk for women throughout the world. Among the Asian population, Pakistani women have the highest risk of developing breast cancer. One out of nine women is diagnosed with breast cancer in Pakistan. The etiology and the risk factor leading to breast cancer are largely unknown. In the current study the risk factors that are most pertinent to the Pakistani population, the etiology, molecular mechanisms of tumor progression, and therapeutic targets of breast cancer are studied. A correlative, cross-sectional, descriptive, and questionnaire-based study was designed to predict the risk factors in breast cancer patients. Invasive Ductal Carcinoma (90%) and grade-II tumor (73.2%) formation are more common in our patient’s data set. Clinical parameters such as mean age of 47.5 years (SD ± 11.17), disturbed menstrual cycle (> 2), cousin marriages (repeated), and lactation period (< 0.5 Y) along with stress, dietary and environmental factors have an essential role in the development of breast cancer. In addition to this in silico analysis was performed to screen the miRNA regulating the TGF-beta pathway using TargetScanHuman, and correlation was depicted through Mindjet Manager. The information thus obtained was observed in breast cancer clinical samples both in peripheral blood mononuclear cells, and biopsy through quantitative real-time PCR. There was a significant dysregulation (**P>0.001) of the TGF-β1 signaling pathway and the miRNAs (miR-29a, miR-140, and miR-148a) in patients’ biopsy in grade and stage specifically, correlated with expression in blood samples. miRNAs (miR-29a and miR-140, miR-148a) can be an effective diagnostic and prognostic marker as they regulate SMAD4 and SMAD2 expression respectively in breast cancer blood and biopsy samples. Therefore, proactive therapeutic strategies can be devised considering negatively regulated cascade genes and amalgamated miRNAs to control breast cancer better.
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Affiliation(s)
- Fayyaz Ahmed
- Laboratory of Applied and Functional Genomics, National Center of Excellence in Molecular Biology, University of the Punjab Lahore, Lahore, Pakistan
| | - Muhammad Adnan
- Laboratory of Applied and Functional Genomics, National Center of Excellence in Molecular Biology, University of the Punjab Lahore, Lahore, Pakistan
| | - Ayesha Malik
- Laboratory of Applied and Functional Genomics, National Center of Excellence in Molecular Biology, University of the Punjab Lahore, Lahore, Pakistan
| | - Somayya Tariq
- Laboratory of Applied and Functional Genomics, National Center of Excellence in Molecular Biology, University of the Punjab Lahore, Lahore, Pakistan
| | - Farukh Kamal
- Department of Pathology, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Bushra Ijaz
- Laboratory of Applied and Functional Genomics, National Center of Excellence in Molecular Biology, University of the Punjab Lahore, Lahore, Pakistan
- * E-mail:
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9
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Jia M, Wu Z, Vogtmann E, O'Brien KM, Weinberg CR, Sandler DP, Gierach GL. The Association Between Periodontal Disease and Breast Cancer in a Prospective Cohort Study. Cancer Prev Res (Phila) 2020; 13:1007-1016. [PMID: 32727823 PMCID: PMC7718282 DOI: 10.1158/1940-6207.capr-20-0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/27/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022]
Abstract
Periodontal disease may be associated with increased breast cancer risk, but studies have not considered invasive breast cancer and ductal carcinoma in situ (DCIS) separately in the same population. We assessed the relationship between periodontal disease and breast cancer in a large prospective cohort study. The Sister Study followed women without prior breast cancer ages 35 to 74 years from 2003 to 2017 (N = 49,968). Baseline periodontal disease was self-reported, and incident breast cancer was ascertained over a mean follow-up of 9.3 years. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazards regression, adjusting for multiple potential confounders, including smoking status. Heterogeneity in risk for invasive breast cancer versus DCIS was also estimated. About 22% of participants reported a history of periodontal disease at baseline. A total of 3,339 incident breast cancers (2,607 invasive breast cancer, 732 DCIS) were identified. There was no clear association between periodontal disease and overall breast cancer risk (HR = 1.02; 95% CI, 0.94-1.11). However, we observed a nonstatistically significant suggestive increased risk of invasive breast cancer (HR = 1.07; 95% CI, 0.97-1.17) and decreased risk of DCIS (HR = 0.86; 95% CI, 0.72-1.04) associated with periodontal disease, with evidence for heterogeneity in the risk associations (relative HR for invasive breast cancer versus DCIS = 1.24; 95% CI, 1.01-1.52). A case-only analysis for etiologic heterogeneity confirmed this difference. We observed no clear association between periodontal disease and overall breast cancer risk. The heterogeneity in risk associations for invasive breast cancer versus DCIS warrants further exploration.
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Affiliation(s)
- Mengmeng Jia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zeni Wu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Emily Vogtmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
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10
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Arthur RS, Wang T, Xue X, Kamensky V, Rohan TE. Genetic Factors, Adherence to Healthy Lifestyle Behavior, and Risk of Invasive Breast Cancer Among Women in the UK Biobank. J Natl Cancer Inst 2020; 112:893-901. [PMID: 31899501 PMCID: PMC7492765 DOI: 10.1093/jnci/djz241] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/01/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Breast cancer is considered to result from a combination of genetic and lifestyle-related factors, but the degree to which an overall healthy lifestyle may attenuate the impact of multiple genetic variants on invasive breast cancer risk remains equivocal. METHODS Using Cox proportional hazards regression models, we examined the association of a modified healthy lifestyle index (HLI) with risk of invasive breast cancer by genetic risk group among 146 326 women from the UK Biobank. We generated an HLI score based on a combination of diet, physical activity, smoking, alcohol consumption and anthropometry, and a polygenic risk score (PRS) using 304 breast cancer-associated genetic loci. RESULTS Among premenopausal and postmenopausal women, a favorable lifestyle (highest tertile) was associated with 22% and 31% reductions in invasive breast cancer risk, respectively (hazard ratio [HR]high vs low = 0.78, 95% confidence interval [CI] = 0.64 to 0.94; HRhigh vs low = 0.69, 95% CI = 0.63 to 0.77, respectively), whereas a high PRS (highest tertile) was associated with more than a doubling in the risk in both groups. For premenopausal women, the greatest risk reduction in association with the HLI was seen among those with a high PRS (HRhigh vs low = 0.73, 95% CI = 0.75 to 0.95). In postmenopausal women, those with a favorable lifestyle had 30%, 29%, and 32% reductions in risk of invasive breast cancer in the low, intermediate, and high PRS groups, respectively (HRhigh vs low = 0.70, 95% CI = 0.56 to 0.88; HRhigh vs low = 0.71, 95% CI = 0.59 to 0.84; and HRhigh vs low = 0.68, 95% CI = 0.59 to 0.78, respectively). There was an additive but not multiplicative interaction between the HLI score and PRS for postmenopausal and, to a lesser extent, premenopausal women. CONCLUSION Our findings support the view that an overall healthy lifestyle may attenuate the impact of genetic factors on invasive breast cancer risk among women of European ancestry.
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Affiliation(s)
| | - Tao Wang
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xiaonan Xue
- Albert Einstein College of Medicine, Bronx, NY, USA
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11
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Spreafico FS, Cardoso-Filho C, Cabello C, Sarian LO, Zeferino LC, Vale DB. Breast Cancer in Men: Clinical and Pathological Analysis of 817 Cases. Am J Mens Health 2020; 14:1557988320908109. [PMID: 32618495 PMCID: PMC7492861 DOI: 10.1177/1557988320908109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 11/15/2022] Open
Abstract
The objective of the current study was to describe breast cancer cases in men according to age, stage, and histology, calculating risks compared to women. It is a retrospective cross-sectional study of all breast cancer cases of the Hospital Cancer Registry of São Paulo state, Brazil, 2000-2015. Variables were age, sex, stage, and histology. Absolute numbers and proportions, Mann-Whitney test and prevalence ratio with 95% confidence interval were used. The study included 93,737 cases, of which 817 were males. The mean age at diagnosis was 60.3 years in men and 56.2 years in women (p < .001). Stage II was the most common in both sexes (33.9% in men and 36.5% in women). Men had a higher frequency of stage III than women (PR 1.18, 95% CI 1.01-1.37). Stage 0 was significantly more common in women (PR 0.69, 95% CI 0.51-0.94). Ductal carcinoma and its variants were the most common histological types in both sexes (88.7% in men and 89.0% in women). Men had a higher frequency of rarer histological types such as papillary (PR 2.17, 95% CI 1.36-3.44) and sarcomas (PR 4.10, 95% CI 1.86-9.01). In conclusion, in men, breast cancer diagnosis occurred in more advanced ages and stages. Invasive ductal carcinoma was the primary histological type observed, although rarer types were more frequent.
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Affiliation(s)
| | | | - Cesar Cabello
- Obstetrics and Gynecology Department,
State University of Campinas, Brazil
| | - Luis Otávio Sarian
- Obstetrics and Gynecology Department,
State University of Campinas, Brazil
| | | | - Diama Bhadra Vale
- Obstetrics and Gynecology Department,
State University of Campinas, Brazil
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12
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Lei YY, Ho SC, Cheng A, Kwok C, Cheung KL, He YQ, Lee R, Yeo W. The association between soy isoflavone intake and menopausal symptoms after breast cancer diagnosis: a prospective longitudinal cohort study on Chinese breast cancer patients. Breast Cancer Res Treat 2020; 181:167-180. [PMID: 32239423 DOI: 10.1007/s10549-020-05616-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/24/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE This study investigated the association between soy isoflavone intake and menopausal symptoms (MPS) among Chinese women with early stage breast cancer in a prospective cohort study. METHODS In an on-going prospective cohort study that involved 1462 Chinese women with early stage breast cancer, MPS were assessed at 18, 36 and 60 months after cancer diagnosis using the validated menopausal rating scale (MRS) questionnaire. Daily soy food intake for the previous 12 months was assessed at the same time using a validated food frequency questionnaire. The associations between MPS and soy isoflavone intake were evaluated in multivariable logistic regression analyses. RESULTS The prevalence of MPS was almost the same during the first 60 months after cancer diagnosis, which were 64.5%, 65.2%, and 63.9% at 18, 36, and 60 months, respectively. Patients with MPS tended to be younger than those without MPS. The intake of soy isoflavones was not associated with the total score of MRS at 18-month follow-up [highest vs lowest tertile, odds ratio (OR) = 1.00, 95% CI 0.75-1.34]. Similarly, no significant association was noted at 36-month (OR = 1.25, 95% CI 0.92-1.69) and 60-month (OR = 1.21, 95% CI 0.84-1.74) follow-up. With regards to specific domain within MRS, the risk of symptoms presenting in somatic domain was higher among breast cancer patients who were in the highest tertile of soy isoflavone intake at 36 months post-diagnosis (OR = 1.44, 95% CI 1.07-1.94, P-trend = 0.02), compared with the lowest tertile, where a stronger significant association was noted among patients who were younger than 60 years (OR = 1.52, 95% CI 1.05-2.20, P-trend = 0.03) and pre-menopausal (OR = 3.81, 95% CI 1.85-8.11, P-trend < 0.01). CONCLUSION The present study provided further evidence that soy isoflavone consumption was not associated with MPS among Chinese breast cancer patients. In fact, patients with higher intake of soy isoflavone have increased risk of experiencing somatic symptoms.
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Affiliation(s)
- Yuan-Yuan Lei
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, SAR, China
| | - Suzanne C Ho
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong, SAR, China
| | - Ashley Cheng
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - Carol Kwok
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - Ka Li Cheung
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, SAR, China
| | - Yi-Qian He
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, SAR, China
| | - Roselle Lee
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, SAR, China
| | - Winnie Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, SAR, China.
- Hong Kong Cancer Institute, State Key Laboratory in Oncology in South China, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, SAR, China.
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13
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Hoffman A, Ben Ishay O, Horesh N, Shabtai M, Forschmidt E, Rosin D, Gutman M, Ram E. Breast Cancer in Men: A Single Center Experience Over a Period of 22 years. Isr Med Assoc J 2020; 22:160-163. [PMID: 32147980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Male breast cancer (MBC) is a rare disease that is poorly understood. Treatment protocols are widely extrapolated from breast cancer in women. OBJECTIVES To review the experience with MBC of a single center in Israel over a period of 22 years. METHODS This single center retrospective study evaluated all patients diagnosed with MBC over a period of 22 years (1993-2015). Data were extracted from patient medical charts and included demographics, clinical, surgical, and oncological outcomes. RESULTS The study comprised 49 patients. Mean age at diagnosis was 64.1 ± 13.5 years. The majority were diagnosed at early stages (1A-2A) (54.4%), 30.6% were stage 3B mostly due to direct skin and nipple involvement, and 59.2% of the patients had node negative disease. All of the patients were diagnosed with invasive ductal carcinoma and 30.6% had concomitant ductal carcinoma in situ. Estrogen receptor (ER) status was predominantly positive and luminal B (HER2-) was the most common subtype. Of the patients, 18.4% were BRCA carriers. The majority of patients underwent mastectomy. Radiotherapy was delivered to 46.9% and hormonal therapy to 89.8%. Chemotherapy was administered to 42.9%. Overall survival was 79.6% with a median survival of 60.1 (2-178) months; 5- and 10-year survival was 93.9% and 79.6%, respectively. Progesterone receptor (PR)-negative patients had a significantly improved overall survival. CONCLUSIONS MBC has increasing incidence. PR-negative status was associated with better overall survival and disease-free interval. Indications to radiotherapy and hormonal therapy need standardization and will benefit from prospective randomized control trials.
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Affiliation(s)
- Aviad Hoffman
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofir Ben Ishay
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Shabtai
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Forschmidt
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Ram
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Chen L, Fu F, Huang M, Lv J, Zhang W, Wang C. The spectrum of BRCA1 and BRCA2 mutations and clinicopathological characteristics in Chinese women with early-onset breast cancer. Breast Cancer Res Treat 2020; 180:759-766. [PMID: 32072338 DOI: 10.1007/s10549-020-05573-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/07/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE BRCA1/2 mutations represent a high risk of breast cancer and are related to early-onset breast cancer. However, few studies have reported the relationship between BRCA1/2 mutations and their clinical characteristics in early-onset breast cancers. This study is the first article that characterizes the risk factor profiles in Chinese patients selected by the age of onset (≤ 40 years old). We found some differences in the prevalence of germline BRCA1/2 mutations between Asian and Western countries. METHODS A total of 1371 consecutive unselected Chinese early-onset breast cancer patients were enrolled from the Fujian Medical University Union Hospital, China, and screened for germline BRCA1/2 mutations. Full-exome sequencing in next-generation sequencing technology was performed in all patients to examine BRCA1/2 mutations. RESULTS In our study, 25 (1.8%) and 61 (4.4%) patients were identified with BRCA1 and BRCA2 mutations, respectively, among the unselected early-onset breast cancer patients. BRCA1 mutations were associated with pregnancies (p = 0.026), and BRCA1 carriers had a higher likelihood of being HR positive (p < 0.001), HER2 negative (p < 0.001), or high grade (p = 0.002) than noncarriers. Among BRCA2 mutations, the age of onset was younger in carriers than in noncarriers (p = 0.017), and BRCA2 carriers were more likely to have lymph node metastasis (p = 0.004). HR-positive or HER2-negative patients were likely to be positive for BRCA2 mutations (p < 0.001). Overall, 14 BRCA1 mutations and 8 BRCA2 mutations were first reported in our study CONCLUSION: This study provided some information about the spectrum of BRCA1/2 mutations and characterized the risk factors for early-onset breast cancer in China.
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Affiliation(s)
- Lili Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Fangmeng Fu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Meng Huang
- Fujian Center for Disease Control and Prevention, Fuzhou, China
| | - Jinxing Lv
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wenzhe Zhang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chuan Wang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
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15
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Sultana R, Kataki AC, Barthakur BB, Sarma A, Bose S. Clinicopathological and immunohistochemical characteristics of breast cancer patients from Northeast India with special reference to triple negative breast cancer: A prospective study. Curr Probl Cancer 2020; 44:100556. [PMID: 32044043 DOI: 10.1016/j.currproblcancer.2020.100556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/11/2020] [Accepted: 01/17/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Molecular pathogenesis of Triple-negative breast cancer (TNBC) is inconclusively documented from resource limited countries and hence there is a lack of available targeted therapy for clinical interventions. Compared to other breast cancer subtypes, TNBC is more aggressive, higher recurrence rate, and higher prevalence in younger premenopausal women. Sporadic literature indicates predominance of TNBC in all reported breast cancer cases from Northeast India. AIM This study was conducted to evaluate the candidature of panel of key molecular markers involved in the development and progression of TNBC for prognosis and futuristic tailored targeted therapy. MATERIALS AND METHODS We analyzed the clinicopathological characterized and immunohistochemically screened the differential expression of key molecular markers involved in the development and progression of in TNBC cases vis-a-vis non-TNBC and autopsy-based control samples. RESULTS TNBC tends to display at an early reproductive age and is more aggressive in nature. Further, the differential expression of 2 specific markers viz., epidermal growth factor receptor (EGFR) and FolR1 was higher in TNBC cases compared to controls and non-TNBC (both in terms of susceptibility and specificity), clinical staging in TNBC cases (severity) and mortality (outcome). Although Ki67 and vascular endothelial growth factor expression also correlated with severity and outcome of the disease but their differences in non-TNBC cases were not significantly differentiable compared to TNBC. CONCLUSIONS The study indicates that EGFR and FolR1 could serve as useful biomarkers to determine TNBC prognosis. Further studies will be needed to evaluate EGFR and Folate pathways in order to screen out the molecular targets which may be meaningfully used for clinical stratification, intervention, and treatment.
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MESH Headings
- Biomarkers, Tumor/metabolism
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- ErbB Receptors/metabolism
- Female
- Folate Receptor 1/metabolism
- Follow-Up Studies
- Humans
- India/epidemiology
- Middle Aged
- Prognosis
- Prospective Studies
- Survival Rate
- Triple Negative Breast Neoplasms/epidemiology
- Triple Negative Breast Neoplasms/metabolism
- Triple Negative Breast Neoplasms/pathology
- Triple Negative Breast Neoplasms/surgery
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Affiliation(s)
- Rizwana Sultana
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam, India; Multidisciplinary Research Unit, Department of Health Research, ICMR, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India
| | - Amal Ch Kataki
- Department of Gynecologic Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam, India
| | | | - Anupam Sarma
- Department of Pathology, Dr B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Sujoy Bose
- Department of Biotechnology, Gauhati University, Guwahati, Assam, India.
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16
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Li T, Zhang W, Lin SX. Steroid enzyme and receptor expression and regulations in breast tumor samples - A statistical evaluation of public data. J Steroid Biochem Mol Biol 2020; 196:105494. [PMID: 31610224 DOI: 10.1016/j.jsbmb.2019.105494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/20/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022]
Abstract
In spite of the significant progress of estrogen-dependent breast cancer (BC) treatment, aromatase inhibitor resistance is a major problem limiting the clinical benefit of this frontier endocrine-therapy. The aim of this study was to determine the differential expression of steroid-converting enzymes between tumor and adjacent normal tissues, as well as their correlation in modulating intratumoral steroid-hormone levels in post-menopausal estrogen-dependent BC. RNA sequencing dataset (n = 1097) of The-Cancer-Genome-Atlas (Breast Invasive Carcinoma) retrieved through the data portal of Genomic Data Commons was used for differential expressions and expression correlation analyses by Mann-Whitney U and Spearman's rank test, respectively. The results showed significant up-regulation of 17β-HSD7 (2.50-fold, p < 0.0001) in BC, supporting its effect in sex-hormone control. Besides, suppression of 11β-HSD1 expression (-8.29-fold, p < 0.0001) and elevation of 11β-HSD2 expression (2.04-fold, p < 0.0001) provide a low glucocorticoid environment diminishing BC anti-proliferation. Furthermore, 3α-HSDs were down-regulated (-1.59-fold, p < 0.01; -8.18-fold, p < 0.0001; -33.96-fold, p < 0.0001; -31.85-fold, p < 0.0001 for type 1-4, respectively), while 5α-reductases were up-regulated (1.41-fold, p < 0.0001; 2.85-fold, p < 0.0001; 1.70-fold, p < 0.0001 for type 1-3, respectively) in BC, reducing cell proliferation suppressers 4-pregnenes, increasing cell proliferation stimulators 5α-pregnanes. Expression analysis indicates significant correlations between 11β-HSD1 with 3α-HSD4 (r = 0.605, p < 0.0001) and 3α-HSD3 (r = 0.537, p < 0.0001). Significant expression correlations between 3α-HSDs were also observed. Our results systematically present the regulation of steroid-converting enzymes and their roles in modulating the intratumoral steroid-hormone levels in BC with a vivid 3D-schema, supporting novel therapy targeting the reductive 17β-HSD7 and proposing a new combined therapy targeting 11β-HSD2 and 17β-HSD7.
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MESH Headings
- 17-Hydroxysteroid Dehydrogenases/genetics
- 17-Hydroxysteroid Dehydrogenases/metabolism
- Breast Neoplasms/epidemiology
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Cohort Studies
- Cytochrome P-450 Enzyme System/genetics
- Cytochrome P-450 Enzyme System/metabolism
- Databases, Factual/statistics & numerical data
- Estradiol/pharmacology
- Female
- Gene Expression Regulation, Enzymologic/drug effects
- Gene Expression Regulation, Neoplastic/drug effects
- Gonadal Steroid Hormones/genetics
- Gonadal Steroid Hormones/metabolism
- Humans
- Public Sector/statistics & numerical data
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Cytoplasmic and Nuclear/metabolism
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Affiliation(s)
- Tang Li
- Axe Molecular Endocrinology and Nephrology, CHU Research Center and Department of Molecular Medicine, Laval University, 2705 Boulevard Laurier, Québec City, Québec G1V 4G2, Canada
| | - Wenfa Zhang
- Axe Molecular Endocrinology and Nephrology, CHU Research Center and Department of Molecular Medicine, Laval University, 2705 Boulevard Laurier, Québec City, Québec G1V 4G2, Canada
| | - Sheng-Xiang Lin
- Axe Molecular Endocrinology and Nephrology, CHU Research Center and Department of Molecular Medicine, Laval University, 2705 Boulevard Laurier, Québec City, Québec G1V 4G2, Canada.
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17
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Patricia Gallegos-Arreola M, Zúñiga González GM, Figuera LE, Puebla Pérez AM, Delgado Saucedo JI. Association of the IL-10 gene rs1800872 (-592 C>A) polymorphism with breast cancer in a Mexican population. J BUON 2019; 24:2369-2376. [PMID: 31983108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Interleukin 10 (IL-10) gene polymorphisms are associated with different types of cancer, but these associations are inconsistent. The purpose of this study was to determine the frequency and association of the rs1800872 IL-10 gene polymorphism in Mexican women with breast cancer (BC). METHODS The rs1800872 polymorphism was genotyped in 368 BC patients and 320 control women using the polymerase chain reaction (PCR). RESULTS The rs1800872 polymorphism was a risk factor for BC compared to controls and BC patients with genotypes CA (p=0.004) and AA, and in the recessive model (p=0.0002), dominant model (CA+AA; p=0.0001), and allele A ( p=0.0001). Additionally, differences were observed in BC patients with the CA and CAAA genotypes who had chemotherapy gastric and hematological toxicity (p=0.022) and tumor stage IV (p=0.013) as a risk factor. Genotypes were CA in breastfeeding (p=0.017), AA in gastric toxicity (p=0.048), and CAAA in tumor stage I-II (p=0.019) as protective risk factors. In BC carriers of: 1) CAAA genotype with tumor stage I-II and breast feeding (≥6 months), 2) CA genotype BC Luminal A with tumor stage I-II, 3) CA genotype BC Luminal B with breastfeeding (≥6 months), and 4) CAAA genotypes in BC HER2 with indices of cellular proliferation (Ki-67) that were elevated (≥20%), were considered to be protective factors in BC patients. CONCLUSION The IL-10 gene rs1800872 polymorphism was associated with BC susceptibility in this sample from the Mexican population.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/genetics
- Breast Neoplasms/epidemiology
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/pathology
- Case-Control Studies
- Female
- Follow-Up Studies
- Genetic Predisposition to Disease
- Genotype
- Humans
- Interleukin-10/genetics
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Polymorphism, Single Nucleotide
- Prognosis
- Receptor, ErbB-2/metabolism
- Risk Factors
- Young Adult
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Affiliation(s)
- Martha Patricia Gallegos-Arreola
- División de Genética, Centro de Investigación Biomédica de Occidente (CIBO), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México
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18
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Mokone-Fatunla DH, Koto MZ, Becker JHR, Bondo M, Mundawarara S. Laterality of breast cancer at Dr George Mukhari Academic Hospital. S AFR J SURG 2019; 57:56. [PMID: 31392868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The purpose of this descriptive study was to determine and compare the incidence of left-sided and rightsided breast cancer at Dr George Mukhari Academic Hospital from January 2000 to June 2016. It aimed to determine if there was a significant variation in laterality of breast cancer at our institution. METHOD A retrospective study. Medical records of breast cancer (BC) patients who were newly diagnosed from January 2000 to June 2016 were reviewed. Emphasis was on biopsy results (histology and/or cytology) and/or history of chemotherapy, and breast cancer laterality. RESULTS Out of 1482 patients, 1427 had unilateral BC and 55 (3.7%) bilateral cancer. A total of 789 (55.3%) patients had left-sided breast cancer (LSBC) and 638 (44.7%) had right BC. Left BC was 10.6% more common than right BC with a left to right laterality ratio (LRR) of 1.24. There was a statistically significant relationship between laterality and stage (p = 0.050), with the right breast having more advanced stage cancers (88.7%) compared to the left breast (85%). There was no statistically significant difference between age, site and histological type of BC and laterality (p = 0.740, p = 0.052, p = 0.394 respectively). CONCLUSION Left to right BC excess does exist in patients that were newly diagnosed at Dr George Mukhari Academic Hospital, South Africa, from January 2000 to June 2016.
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MESH Headings
- Academic Medical Centers
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Breast Neoplasms, Male/epidemiology
- Breast Neoplasms, Male/metabolism
- Breast Neoplasms, Male/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Female
- Humans
- Incidence
- Ki-67 Antigen/metabolism
- Male
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- South Africa/epidemiology
- Unilateral Breast Neoplasms/epidemiology
- Unilateral Breast Neoplasms/metabolism
- Unilateral Breast Neoplasms/pathology
- Young Adult
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Affiliation(s)
- D H Mokone-Fatunla
- Department of Surgery, Faculty of Health Sciences, School of Medicine, Sefako Makgatho Health Sciences University, South Africa
| | - M Z Koto
- Department of Surgery, Faculty of Health Sciences, School of Medicine, Sefako Makgatho Health Sciences University, South Africa
| | - J H R Becker
- Department of Surgery, Faculty of Health Sciences, School of Medicine, Sefako Makgatho Health Sciences University, South Africa
| | - M Bondo
- Department of Surgery, Faculty of Health Sciences, School of Medicine, Sefako Makgatho Health Sciences University, South Africa
| | - S Mundawarara
- Department of Surgery, Natalspruit Hospital, South Africa
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19
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Ebrahimi E, Sellars E, Shirkoohi R, Harirchi I, Ghiasvand R, Mohebbi E, Zendehdel K, Akbari MR. The NCCN Criterion "Young Age at Onset" Alone is Not an Indicator of Hereditary Breast Cancer in Iranian Population. Cancer Prev Res (Phila) 2019; 12:763-770. [PMID: 31451522 DOI: 10.1158/1940-6207.capr-19-0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/19/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022]
Abstract
Because the contribution of genetic factors to the burden of breast cancer is not well investigated in Iran, we aimed to examine the prevalence of mutations in breast cancer susceptibility genes, BRCA1/2 and PALB2, and to investigate the predictive potential of hereditary breast cancer risk criteria for genetic testing in Iranian population. Next-generation sequencing was conducted on a population consisting of 299 and 125 patients with breast cancer, with and without hereditary cancer risk criteria for genetic testing, respectively. The pathogenic mutation frequency rate was 10.7% in patients with hereditary cancer criteria versus 1.6% in no criteria group (P = 0.0017). None of the 107 tested patients with only young age at onset (<40) criterion had a pathogenic mutation. Patients who had only a single heritable risk criterion [OR, 6.15; 95% confidence interval (CI), 1.26-58.59; P = 0.009] and patients with multiple heritable risk criteria (OR, 22.5; 95% CI, 5.19-201.31; P < 0.0001) had higher probabilities of carrying a mutation compared with no criteria group. Our results showed that young age at onset alone is not an indicator of hereditary breast cancer at least in the Iranian population. This is while women with multiple hereditary breast cancer risk criteria were enriched for BRCA1/2 mutations. Given such high risk of identification of a disease-causing mutation, multiple hereditary criteria should be regarded as a strong predictor for a hereditary breast cancer syndrome. These findings are important concerning the optimization of genetic counseling and furthermore establishing criteria for BRCA1/2 testing of the Iranian population.
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MESH Headings
- Adult
- Age of Onset
- BRCA1 Protein/genetics
- BRCA2 Protein/genetics
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/genetics
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/genetics
- Fanconi Anemia Complementation Group N Protein/genetics
- Female
- Follow-Up Studies
- Genetic Predisposition to Disease
- Genetic Testing/methods
- Germ-Line Mutation
- High-Throughput Nucleotide Sequencing
- Humans
- Iran/epidemiology
- Middle Aged
- Mutation Rate
- Neoplastic Syndromes, Hereditary/diagnosis
- Neoplastic Syndromes, Hereditary/epidemiology
- Neoplastic Syndromes, Hereditary/genetics
- Prognosis
- Young Adult
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Affiliation(s)
- Elmira Ebrahimi
- Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Erin Sellars
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Reza Shirkoohi
- Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Harirchi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Elham Mohebbi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
- Breast Diseases Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad R Akbari
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
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20
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Ryser MD, Hendrix LH, Worni M, Liu Y, Hyslop T, Hwang ES. Incidence of Ductal Carcinoma In Situ in the United States, 2000-2014. Cancer Epidemiol Biomarkers Prev 2019; 28:1316-1323. [PMID: 31186262 PMCID: PMC6679771 DOI: 10.1158/1055-9965.epi-18-1262] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/01/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In absence of definitive molecular risk markers, clinical management of patients diagnosed with ductal carcinoma in situ (DCIS) remains largely guided by patient and tumor characteristics. In this study, we analyzed recent trends in DCIS incidence and compared them against trends in mammography use. METHODS The Surveillance, Epidemiology, and End Results registry was queried for patients diagnosed with DCIS from 2000 to 2014 (18 registries). Joinpoint regression analyses were used to compute age- and race-stratified trends in age-adjusted incidence of DCIS. The patterns of DCIS incidence were compared against mammography utilization data from the National Health Interview Survey. RESULTS Between 2000 and 2014, overall DCIS incidence in the U.S. population was stable (P = 0.24). Among age groups 20 to 44 years and 45 to 55 years, DCIS incidence increased by 1.3% (P = 0.001) and 0.6% (P = 0.02) per year, respectively. Although stable among white women, DCIS incidence increased among black women and women of other races by 1.6% (P < 0.001) and 1.0% (P = 0.002) per year, respectively. Mammography uptake correlated well with DCIS incidence, with the exception of women ages 40 to 49 years and black women who experienced an increase in DCIS incidence despite stagnating and decreasing mammography uptake, respectively. CONCLUSIONS Overall DCIS incidence rates have remained stable between 2000 and 2014. However, subgroup analyses revealed an increase in incidence among both younger women and black women. IMPACT DCIS incidence trends did not correlate with the mammography uptake patterns, suggesting that etiologic factors other than screening may be leading to an increased DCIS incidence in these groups.
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MESH Headings
- Adult
- Black or African American/statistics & numerical data
- Age Factors
- Aged
- Breast Neoplasms/epidemiology
- Breast Neoplasms/ethnology
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/ethnology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Female
- Humans
- Incidence
- Mammography/statistics & numerical data
- Middle Aged
- SEER Program
- United States/epidemiology
- White People/statistics & numerical data
- Young Adult
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Affiliation(s)
- Marc D Ryser
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina.
- Department of Mathematics, Duke University, Durham, North Carolina
| | - Laura H Hendrix
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Mathias Worni
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yiling Liu
- Duke Center for Applied Genomics & Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - Terry Hyslop
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Division of Advanced Oncologic and GI Surgery, Duke University Medical Center, Durham, North Carolina
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21
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Malik SS, Baig M, Khan MB, Masood N. Survival analysis of breast cancer patients with different treatments: a multicentric clinicopathological study. J PAK MED ASSOC 2019; 69:976-980. [PMID: 31308566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore and better understand clinic pathological details of breast cancer patients and analyse their survival rate among different treatment groups. METHODS The prospective cohort, multi-centric study was conducted from September, 2014, to February, 2018, at five hospitals in Rawalpindi and Islamabad, Pakistan, and comprised histo-pathologically confirmed breast cancer cases. Patient characteristics and medical history were collected using a detailed questionnaire. All the subjects were followed up, and information regarding their current health and treatment status was collected. Data was analysed using SPSS 24. RESULTS There were 347 subjects with a mean age of 44.3±12.2 years and body mass index of 27.9±4.0 kg/m2. Younger age, increased body mass index, consanguinity and family history were major contributing factors in breast cancer development (p<0.05). Overall, 267(77%) had invasive ductal carcinoma and Grade II tumour 234(67%) was more frequent. A total of 221(64%) cases had positive lymph nodes and 97(28%) had metastasis to different body organs. Overall survival analysis showed statistically significant role (p<0.0001) of all treatment options. CONCLUSIONS Combination of different treatments can provide more promising health outcomes in breast cancer cases.
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Affiliation(s)
| | - Mehreen Baig
- Surgical Unit, Fauji Foundation Hospital, Rawalpindi, Pakistan
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22
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Wang J, Xu R, Yuan H, Zhang Y, Cheng S. Single-cell RNA sequencing reveals novel gene expression signatures of trastuzumab treatment in HER2+ breast cancer: A pilot study. Medicine (Baltimore) 2019; 98:e15872. [PMID: 31261495 PMCID: PMC6617483 DOI: 10.1097/md.0000000000015872] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/16/2019] [Accepted: 05/07/2019] [Indexed: 12/13/2022] Open
Abstract
Human epidermal growth factor receptor 2-positive (HER2+) breast cancer accounts for ∼20% of invasive breast cancers and is associated with poor prognostics. The recent outcome of HER2+ breast cancer treatment has been vastly improved owing to the application of antibody-targeted therapies. Trastuzumab (Herceptin) is a monoclonal antibody designed to target HER2+ breast cancer cells. In addition to improved survival in the adjuvant treatment of HER2+ breast cancer, trastuzumab treatment has also been associated with cardiotoxicity side effect. However, the molecular mechanisms of trastuzumab action and trastuzumab-mediated cardiotoxicity are still not fully understood. Previous research utilized bulk transcriptomics analysis to study the underlining mechanisms, which relied on averaging molecular signals from bulk tumor samples and might have overlooked key expression features within breast cancer tumor. In contrast to previous research, we compared the single cancer cell level transcriptome profile between trastuzumab-treated and nontreated patients to reveal a more in-depth transcriptome profile. A total of 461 significantly differential expressed genes were identified, including previously defined and novel gene expression signatures. In addition, we found that trastuzumab-enhanced MGP gene expression could be used as prognostics marker for longer patient survival in breast invasive carcinoma patients, and validated our finding using TCGA (The Cancer Genome Atlas) breast cancer dataset. Moreover, our study revealed a 48-gene expression signature that is associated with cell death of cardiomyocytes, which could be used as early biomarkers for trastuzumab-mediated cardiotoxicity. This work is the first study to look at single cell level transcriptome profile of trastuzumab-treated patients, providing a new understanding of the molecular mechanism(s) of trastuzumab action and trastuzumab-induced cardiotoxicity side effects.
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MESH Headings
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/drug therapy
- Breast Neoplasms/epidemiology
- Breast Neoplasms/metabolism
- Calcium-Binding Proteins/metabolism
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/metabolism
- Extracellular Matrix Proteins/metabolism
- Female
- Gene Expression/drug effects
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Pilot Projects
- Prognosis
- RNA, Messenger/metabolism
- Receptor, ErbB-2/metabolism
- Sequence Analysis, RNA
- Single-Cell Analysis
- Survival Analysis
- Transcriptome/drug effects
- Trastuzumab/therapeutic use
- Matrix Gla Protein
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Affiliation(s)
- Jun Wang
- Taixing People's Hospital, Taixing City, Jiangsu Province, China
| | - Rengen Xu
- Taixing People's Hospital, Taixing City, Jiangsu Province, China
| | - Haiyan Yuan
- Taixing People's Hospital, Taixing City, Jiangsu Province, China
| | - Yunning Zhang
- Taixing People's Hospital, Taixing City, Jiangsu Province, China
| | - Sean Cheng
- School of Medicine, Saint Louis University, Saint Louis, MO
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23
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Arasu VA, Miglioretti DL, Sprague BL, Alsheik NH, Buist DS, Henderson LM, Herschorn SD, Lee JM, Onega T, Rauscher GH, Wernli KJ, Lehman CD, Kerlikowske K. Population-Based Assessment of the Association Between Magnetic Resonance Imaging Background Parenchymal Enhancement and Future Primary Breast Cancer Risk. J Clin Oncol 2019; 37:954-963. [PMID: 30625040 PMCID: PMC6494266 DOI: 10.1200/jco.18.00378] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To evaluate comparative associations of breast magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and mammographic breast density with subsequent breast cancer risk. PATIENTS AND METHODS We examined women undergoing breast MRI in the Breast Cancer Surveillance Consortium from 2005 to 2015 (with one exam in 2000) using qualitative BPE assessments of minimal, mild, moderate, or marked. Breast density was assessed on mammography performed within 5 years of MRI. Among women diagnosed with breast cancer, the first BPE assessment was included if it was more than 3 months before their first diagnosis. Breast cancer risk associated with BPE was estimated using Cox proportional hazards regression. RESULTS Among 4,247 women, 176 developed breast cancer (invasive, n = 129; ductal carcinoma in situ,n = 47) over a median follow-up time of 2.8 years. More women with cancer had mild, moderate, or marked BPE than women without cancer (80% v 66%, respectively). Compared with minimal BPE, increasing BPE levels were associated with significantly increased cancer risk (mild: hazard ratio [HR], 1.80; 95% CI, 1.12 to 2.87; moderate: HR, 2.42; 95% CI, 1.51 to 3.86; and marked: HR, 3.41; 95% CI, 2.05 to 5.66). Compared with women with minimal BPE and almost entirely fatty or scattered fibroglandular breast density, women with mild, moderate, or marked BPE demonstrated elevated cancer risk if they had almost entirely fatty or scattered fibroglandular breast density (HR, 2.30; 95% CI, 1.19 to 4.46) or heterogeneous or extremely dense breasts (HR, 2.61; 95% CI, 1.44 to 4.72), with no significant interaction (P = .82). Combined mild, moderate, and marked BPE demonstrated significantly increased risk of invasive cancer (HR, 2.73; 95% CI, 1.66 to 4.49) but not ductal carcinoma in situ (HR, 1.48; 95% CI, 0.72 to 3.05). CONCLUSION BPE is associated with future invasive breast cancer risk independent of breast density. BPE should be considered for risk prediction models for women undergoing breast MRI.
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Affiliation(s)
- Vignesh A. Arasu
- Kaiser Permanente Medical Center, Vallejo, CA
- University of California, San Francisco, San Francisco, CA
| | - Diana L. Miglioretti
- University of California, Davis, Davis, CA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Brian L. Sprague
- University of Vermont Cancer Center, University of Vermont, Burlington, VT
| | | | - Diana S.M. Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | | | - Sally D. Herschorn
- University of Vermont Cancer Center, University of Vermont, Burlington, VT
| | - Janie M. Lee
- University of Washington, and Seattle Cancer Care Alliance, Seattle, WA
| | - Tracy Onega
- Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Garth H. Rauscher
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
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24
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Grimm LJ, Saha A, Ghate SV, Kim C, Soo MS, Yoon SC, Mazurowski MA. Relationship between Background Parenchymal Enhancement on High-risk Screening MRI and Future Breast Cancer Risk. Acad Radiol 2019; 26:69-75. [PMID: 29602724 DOI: 10.1016/j.acra.2018.03.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/24/2018] [Accepted: 03/09/2018] [Indexed: 01/10/2023]
Abstract
RATIONALE AND OBJECTIVES To determine if background parenchymal enhancement (BPE) on screening breast magnetic resonance imaging (MRI) in high-risk women correlates with future cancer. MATERIALS AND METHODS All screening breast MRIs (n = 1039) in high-risk women at our institution from August 1, 2004, to July 30, 2013, were identified. Sixty-one patients who subsequently developed breast cancer were matched 1:2 by age and high-risk indication with patients who did not develop breast cancer (n = 122). Five fellowship-trained breast radiologists independently recorded the BPE. The median reader BPE for each case was calculated and compared between the cancer and control cohorts. RESULTS Cancer cohort patients were high-risk because of a history of radiation therapy (10%, 6 of 61), high-risk lesion (18%, 11 of 61), or breast cancer (30%, 18 of 61); BRCA mutation (18%, 11 of 61); or family history (25%, 15 of 61). Subsequent malignancies were invasive ductal carcinoma (64%, 39 of 61), ductal carcinoma in situ (30%, 18 of 61) and invasive lobular carcinoma (7%, 4of 61). BPE was significantly higher in the cancer cohort than in the control cohort (P = 0.01). Women with mild, moderate, or marked BPE were 2.5 times more likely to develop breast cancer than women with minimal BPE (odds ratio = 2.5, 95% confidence interval: 1.3-4.8, P = .005). There was fair interreader agreement (κ = 0.39). CONCLUSIONS High-risk women with greater than minimal BPE at screening MRI have increased risk of future breast cancer.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
| | - Ashirbani Saha
- Carl E. Ravin Advanced Imaging Laboratories, Duke University Hock Plaza, Durham, North Carolina
| | - Sujata V Ghate
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Connie Kim
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Mary Scott Soo
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Sora C Yoon
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Maciej A Mazurowski
- Carl E. Ravin Advanced Imaging Laboratories, Duke University Hock Plaza, Durham, North Carolina
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25
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Sun W, Shang J, Zhang J, Chen S, Hao M. Correlations of DKK1 with incidence and prognosis of breast cancer. J BUON 2019; 24:26-32. [PMID: 30941948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate the correlation between Dickkopf-related protein 1 (DKK1) expression and prognosis of breast cancer. METHODS The DKK1 expression in breast cancer cell lines was evaluated via reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. The DKK1 expression pattern in 85 cases of breast cancer was detected using the immunohistochemical method. Besides, the prognostic significance was evaluated via Kaplan-Meier analysis and Cox proportional hazards regression model. RESULTS DKK1 expression was confirmed in hormone-resistant breast cancer cell lines SK and MDA-MB231. DKK1 expression in breast cancer was associated with cytoplasm/nuclear β-catenin (p<0.01). Increased expressions of DKK1 and cytoplasm/nuclear β-catenin in breast cancer indicated adverse outcome of patients. DKK1 was also a bad prognostic factor for patients in early disease stage or without lymph node metastasis. CONCLUSION Both DKK1 and β-catenin may be important prognostic factors for breast cancer. DKK1 may be a valuable biomarker for predicting the prognosis of patients in early disease stage or with no lymph node metastasis. β-catenin will possibly serve as a potential therapeutic target for patients with triple-negative breast cancer through further understanding the role of Wnt/β-catenin pathway activation.
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Affiliation(s)
- Wenkai Sun
- Department of Thyroid and Breast Surgery, Dongying People's Hospital, Dongying, Shandong 257091, China
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26
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Ozturk A, Alco G, Sarsenov D, Ilgun S, Ordu C, Koksal U, Nur Pilanci K, Erdogan Z, Izci F, Elbuken F, Agacayak F, Aktepe F, Ozmen V. Synchronous and metachronous bilateral breast cancer: A long-term experience. J BUON 2018; 23:1591-1600. [PMID: 30610782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The objective of this study was to assess the demographic, pathologic and survival characteristics of patients who were diagnosed as having bilateral breast cancer. METHODS A review was conducted of the records pertaining to patients who presented to our clinic and were diagnosed as having breast cancer. Any second cancer diagnosed within 12 months of initial diagnosis was defined as synchronous bilateral breast cancer. Assessment included treatments administered to the patients and survival rates, as well as their demographic, reproductive and pathologic features. RESULTS The total number of patients who were diagnosed as having bilateral breast cancer in the context of the present study was 99. Among the patients with synchronous breast cancer, the median age at the time of initial diagnosis was found as 57 years. The median age of the discovery of first tumor among the patients with metachronous tumor was 52 years and the median age of second tumor detection was 59 years. Family history in metachronous tumor was significantly greater (p=0.041). The median time of metachronous cancer incidence was 96 months. The length of disease-free period among the patients with synchronous tumor was 126.3 months, whereas it was 243.7 months in those with metachronous tumor (p=0.041). CONCLUSION The incidence rate of synchronous breast tumors has been rising thanks to growing awareness and the leading-edge imaging methods. The fact that the second tumor developed after more than 5 years among the patients with metachronous cancer gave rise to the increased rate of survival.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Humans
- Incidence
- Middle Aged
- Neoplasm Invasiveness
- Neoplasms, Multiple Primary/epidemiology
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/surgery
- Prognosis
- Survival Rate
- Turkey/epidemiology
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Affiliation(s)
- Alper Ozturk
- Biruni University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
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27
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Ben Fatma L, Belaid I, Said N, Gahbiche S, Hochlef M, Chabchoub I, Ezzairi F, Ben Ahmed S. What could be the reasons of late diagnosis of breast cancer in Tunisia? Tunis Med 2018; 96:665-671. [PMID: 30746659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Breast cancer is often diagnosed at a late stage in Tunisia with long delay in time to consultation and to diagnosis. The aim of the study was to identify explanatory factors to delayed diagnosis. METHODS A case control analytical was performed from January 2013 to December 2014 in the department of Medical Oncology in FarhatHachedUniveristy Hospital.Patients with the diagnosis of ductal breast carcinoma were included in the study.Characteristics of a first group of 200 women with locally advanced or metastatic breast cancer (G1)were compared to a second group of 200 patients with early stage (G2). RESULTS Median delay in consultation and mean tumor size were significantly more important in group G1 (p<0,001).A low level of schooling, a rural origin, poor socio-economic conditions and no encouragement by the patient relatives do not allow an early diagnosis.Misinterpretation of clinical breast signs was the only explanatory factor related to the system. In multivariate study, a low level of schooling(adjusted OR=2.72; CI 95% [1,65-4,49]), no encouragement by the patient's relatives(adjusted OR=7.86; CI 95% [4,24-14,57])and more than three dependants(adjusted OR=2.49; CI 95% [1,58-3,93]) were the independent factors that could explain the delay in diagnosis. CONCLUSION Our study confirm the inverse relationship between socio-economic and scholar level and disease stage. Health education campaigns particularly among women with a low schooling level and of rural origin could reduce time for consultation. Promoting continuing medical education could avoid diagnostic errors.
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MESH Headings
- Adult
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Case-Control Studies
- Delayed Diagnosis/adverse effects
- Delayed Diagnosis/prevention & control
- Delayed Diagnosis/statistics & numerical data
- Female
- Health Knowledge, Attitudes, Practice
- Health Services Accessibility/statistics & numerical data
- Humans
- Middle Aged
- Patient Acceptance of Health Care
- Risk Factors
- Socioeconomic Factors
- Time Factors
- Time-to-Treatment/statistics & numerical data
- Tumor Burden
- Tunisia/epidemiology
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28
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Mariamidze A, Gogiashvili L, Khardzeishvili O, Javakhishvili T, Makaridze D, Jandieri K. DISTRIBUTION AND DEMOGRAPHIC CHARACTERISTICS OF DUCTAL INVASIVE BREAST CARCINOMA SUBTYPES IN GEORGIAN POPULATION. Georgian Med News 2018:129-133. [PMID: 30516508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The analysis of prevalence of each specific subtypes of the ductal invasive breast carcinoma according to age group categories showed that Luminal A subtype is observed in every age group as dominant subtype, although in different intensity: two peaks were demonstrated in group III and group IV, and in relatively less amount, in V group as well. Its considerable that Her2(+)/ER subtype was second most prevalent subtype in almost all age groups. It also must be noted that there was no direct correlation found between pre- or post-menopausal period and HER2+ state, except for group IV (60-69 year old range), where it was almost 2 times less frequently found than Basal-like subtype. The frequency of Her2(+)/ER tumor subtype was identical to Luminal A subtype frequency. In age group I (30-39 year old) and all others its frequency was found to be markedly decreasing along with the frequency of Luminal A subtype (if in age group I their frequency was 1.2, in the age group IV it accounted for 9.4, which means that Her2(+)/ER subtype prevalence decreases with increasing age until the age group V (70-79 year old), after which it increases again (age group V and VI demonstrated the frequency of 2.0 and 5.0 respectively). Basal-like tumor was not found in age groups I and VI, and its frequency was gradually increasing except for age group II, where it was approximately 1.5 less frequent than in other age group categories. Triple-negative subtype was not found in age groups I and VI, however, its frequency was gradually increasing with increasing age. The prevalence of triple-negative tumor in age group V was 4.5 times higher than in age group II. The frequency of Luminal B subtype tumor was almost 2 times decreased in age group III, while in age group V it was almost 3 times increased. However, it disappeared in age group VI completely. Consideration of the age-related specificities of ductal invasive breast carcinoma subtypes (phenotypes) is important both for diagnostic aspect and treatment strategy selection, as well as adequate planning of breast cancer screening programs. Thus, in all age groups of the studied population, IIIA and B stages of tumor were identified, with tumor sizes ranging between 2.8-4.7mm. There was no stable direct correlation between breast cancer and family history, as the presence of such data requires additional research with more focus on anamnesis details.
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Affiliation(s)
- A Mariamidze
- David Tvildiani Medical University; Iv. Javakhishvili Tbilisi State University, A. Natishvili Institute of Morphology; Pathology Research Center; Tbilisi State Medical University, Georgia
| | - L Gogiashvili
- David Tvildiani Medical University; Iv. Javakhishvili Tbilisi State University, A. Natishvili Institute of Morphology; Pathology Research Center; Tbilisi State Medical University, Georgia
| | - O Khardzeishvili
- David Tvildiani Medical University; Iv. Javakhishvili Tbilisi State University, A. Natishvili Institute of Morphology; Pathology Research Center; Tbilisi State Medical University, Georgia
| | - T Javakhishvili
- David Tvildiani Medical University; Iv. Javakhishvili Tbilisi State University, A. Natishvili Institute of Morphology; Pathology Research Center; Tbilisi State Medical University, Georgia
| | - D Makaridze
- David Tvildiani Medical University; Iv. Javakhishvili Tbilisi State University, A. Natishvili Institute of Morphology; Pathology Research Center; Tbilisi State Medical University, Georgia
| | - K Jandieri
- David Tvildiani Medical University; Iv. Javakhishvili Tbilisi State University, A. Natishvili Institute of Morphology; Pathology Research Center; Tbilisi State Medical University, Georgia
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Lee JM, Abraham L, Lam DL, Buist DS, Kerlikowske K, Miglioretti DL, Houssami N, Lehman CD, Henderson LM, Hubbard RA. Cumulative Risk Distribution for Interval Invasive Second Breast Cancers After Negative Surveillance Mammography. J Clin Oncol 2018; 36:2070-2077. [PMID: 29718790 PMCID: PMC6036621 DOI: 10.1200/jco.2017.76.8267] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose The aim of the current study was to characterize the risk of interval invasive second breast cancers within 5 years of primary breast cancer treatment. Methods We examined 65,084 surveillance mammograms from 18,366 women with a primary breast cancer diagnosis of unilateral ductal carcinoma in situ or stage I to III invasive breast carcinoma performed from 1996 to 2012 in the Breast Cancer Surveillance Consortium. Interval invasive breast cancer was defined as ipsilateral or contralateral cancer diagnosed within 1 year after a negative surveillance mammogram. Discrete-time survival models-adjusted for all covariates-were used to estimate the probability of interval invasive cancer, given the risk factors for each surveillance round, and aggregated across rounds to estimate the 5-year cumulative probability of interval invasive cancer. Results We observed 474 surveillance-detected cancers-334 invasive and 140 ductal carcinoma in situ-and 186 interval invasive cancers which yielded a cancer detection rate of 7.3 per 1,000 examinations (95% CI, 6.6 to 8.0) and an interval invasive cancer rate of 2.9 per 1,000 examinations (95% CI, 2.5 to 3.3). Median cumulative 5-year interval cancer risk was 1.4% (interquartile range, 0.8% to 2.3%; 10th to 90th percentile range, 0.5% to 3.7%), and 15% of women had ≥ 3% 5-year interval invasive cancer risk. Cumulative 5-year interval cancer risk was highest for women with estrogen receptor- and progesterone receptor-negative primary breast cancer (2.6%; 95% CI, 1.7% to 3.5%), interval cancer presentation at primary diagnosis (2.2%; 95% CI, 1.5% to 2.9%), and breast conservation without radiation (1.8%; 95% CI, 1.1% to 2.4%). Conclusion Risk of interval invasive second breast cancer varies across women and is influenced by characteristics that can be measured at initial diagnosis, treatment, and imaging. Risk prediction models that evaluate the risk of cancers not detected by surveillance mammography should be developed to inform discussions of tailored surveillance.
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Affiliation(s)
- Janie M. Lee
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Linn Abraham
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Diana L. Lam
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Diana S.M. Buist
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Karla Kerlikowske
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Diana L. Miglioretti
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Nehmat Houssami
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Constance D. Lehman
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Louise M. Henderson
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Rebecca A. Hubbard
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
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Schroeder MC, Rastogi P, Geyer CE, Miller LD, Thomas A. Early and Locally Advanced Metaplastic Breast Cancer: Presentation and Survival by Receptor Status in Surveillance, Epidemiology, and End Results (SEER) 2010-2014. Oncologist 2018; 23:481-488. [PMID: 29330212 PMCID: PMC5896714 DOI: 10.1634/theoncologist.2017-0398] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/07/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Metaplastic breast cancer (MBC) is a rare disease subtype characterized by an aggressive clinical course. MBC is commonly triple negative (TN), although hormone receptor (HR) positive and human epidermal growth receptor 2 (HER2) positive cases do occur. Previous studies have reported similar outcomes for MBC with regard to HR status. Less is known about outcomes for HER2 positive MBC. MATERIALS AND METHODS Surveillance, Epidemiology, and End Results Program data were used to identify women diagnosed 2010-2014 with MBC or invasive ductal carcinoma (IDC). Kaplan-Meier curves estimated overall survival (OS) and multivariate Cox models were fitted. For survival analyses, only first cancers were included, and 2014 diagnoses were excluded to allow for sufficient follow-up. RESULTS Our MBC sample included 1,516 women. Relative to women with IDC, women with MBC were more likely to be older (63 vs. 61 years), black (16.0% vs. 11.1%), and present with stage III disease (15.6% vs. 10.8%). HER2 positive and HER2 negative/HR positive MBC tumors represented 5.2% and 23.0% of cases. For MBC overall, 3-year OS was greatest for women with HER2 positive MBC (91.8%), relative to women with TN (75.4%) and HER2 negative/HR positive MBC (77.1%). This difference was more pronounced for stage III MBC, for which 3-year OS was 92.9%, 47.1%, and 42.2% for women with HER2 positive, TN, and HER2 negative/HR positive MBC, respectively. A multivariate Cox model of MBC demonstrated that HER2 positive tumors (relative to TN) were associated with improved survival (hazard ratio = 0.32, 95% confidence interval [CI] 0.13-0.79). In a second Cox model of exclusively HER2 positive tumors, OS did not differ between MBC and IDC disease subtypes (hazard ratio = 1.16, 95% CI 0.48-2.81). CONCLUSION In this contemporary, population-based study of women with MBC, HER2 but not HR status was associated with improved survival. Survival was similar between HER2 positive MBC and HER2 positive IDC. This suggests HER2 positive MBC is responsive to HER2-directed therapy, a finding that may offer insights for additional therapeutic approaches to MBC. IMPLICATIONS FOR PRACTICE This population-based study reports recent outcomes, by receptor status, for women with metaplastic breast cancer. Survival in metaplastic breast cancer is not impacted by hormone receptor status. To the authors' knowledge, this is the first report indicating that women with human epidermal growth receptor 2 (HER2) positive metaplastic breast cancer have survival superior to women with HER2 negative metaplastic breast cancer and survival similar to women with HER2 positive invasive ductal carcinoma. This information can be used for counseling patients diagnosed with metaplastic breast cancer. Further understanding of HER2 positive metaplastic breast cancer could offer insights for the development of therapeutic approaches to metaplastic breast cancer more broadly.
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MESH Headings
- Aged
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/epidemiology
- Breast Neoplasms/metabolism
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Female
- Humans
- Metaplasia
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- SEER Program/statistics & numerical data
- Survival Analysis
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Affiliation(s)
| | | | | | - Lance D Miller
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Alexandra Thomas
- Department of Internal Medicine, Winston-Salem, North Carolina, USA
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Syed A, Eleti S, Kumar V, Ahmad A, Thomas H. Validation of Memorial Sloan Kettering Cancer Center nomogram to detect non-sentinel lymph node metastases in a United Kingdom cohort. G Chir 2018; 39:12-19. [PMID: 29549676 DOI: 10.11138/gchir/2018.39.1.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIM Axillary lymph node dissection, although associated with long-term morbidity, has been the standard of treatment for all nodepositive breast cancer patients. We assessed the risk prediction ability (validity) of Memorial Sloan Kettering Cancer Center (MSKCC) nomogram for non-sentinel lymph node metastases and analysed the outcome of patients with sentinel node metastases. PATIENTS AND METHODS All operable early breast cancer patients with sentinel node macro metastases (size > 2mm) who underwent axillary dissection from April 2009 to March 2015 were considered eligible. The risk of non-sentinel lymph node metastases was calculated using an online MSKCC calculator, and accuracy was determined based on the area under the receiver-operating characteristic curve (AUC-ROC). Tumour characteristics and overall survival were also analysed as secondary end points. RESULTS Of 1745 patients who were diagnosed with operable breast cancer during the study period, 114 patients were considered eligible. The AUC-ROC was 0.66 suggestive of lesser accuracy in prediction and not statistically significant (p value = 0.7303). Seventysix (50.7%) of these patients did not have any non-sentinel node metastases. At a mean follow up of four years, the disease-free survival was 86.4% and overall survival rate was 88.4%. CONCLUSIONS The MSKCC nomogram was unable to accurately predict the risk in our cohort of patients with more than half of this cohort of patients not requiring axillary dissection. These findings are consistent with other European studies. This study thus highlights the need for modified prediction model for European cohorts.
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Williams LA, Nichols HB, Hoadley KA, Tse CK, Geradts J, Bell ME, Perou CM, Love MI, Olshan AF, Troester MA. Reproductive risk factor associations with lobular and ductal carcinoma in the Carolina Breast Cancer Study. Cancer Causes Control 2018; 29:25-32. [PMID: 29124544 PMCID: PMC5903274 DOI: 10.1007/s10552-017-0977-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/30/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Invasive lobular breast tumors display unique reproductive risk factor profiles. Lobular tumors are predominantly Luminal A subtype, and it is unclear whether reported risk factor associations are independent of molecular subtype. METHODS Polytomous logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the associations between risk factors and histologic subtype [ductal (n = 2,856), lobular (n = 326), and mixed ductal-lobular (n = 473)] in the Carolina Breast Cancer Study (1993-2013). Three-marker immunohistochemical clinical subtypes were defined as Luminal A (ER+ or PR+/HER2-), Luminal B (ER+ or PR+/HER2+), Triple Negative (ER-/PR-/HER2-), and HER2+ (ER-/PR-/HER2+). RESULTS In case-case analyses compared to ductal, lobular tumors were significantly associated with lactation duration > 12 months [OR 1.86, 95% CI (1.33-2.60)], age at first birth ≥ 26 years [OR: 1.35, 95% CI: (1.03-1.78)], and current oral contraceptive use [OR: 1.86, 95% CI: (1.08-3.20)]. Differences in risk factor associations between ductal and lobular tumors persisted after restricting to Luminal A subtype. CONCLUSIONS Lobular tumors were associated with older age at first birth, increased lactation duration, and current oral contraceptive use. Etiologic heterogeneity by histology persisted after restricting to Luminal A subtype, suggesting both tumor histology and intrinsic subtype play integral parts in breast cancer risk.
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Affiliation(s)
- Lindsay A Williams
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Katherine A Hoadley
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Chiu Kit Tse
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Joseph Geradts
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, 02115, USA
| | - Mary Elizabeth Bell
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Charles M Perou
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Michael I Love
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Melissa A Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Lynge E, Bak M, von Euler-Chelpin M, Kroman N, Lernevall A, Mogensen NB, Schwartz W, Wronecki AJ, Vejborg I. Outcome of breast cancer screening in Denmark. BMC Cancer 2017; 17:897. [PMID: 29282034 PMCID: PMC5745763 DOI: 10.1186/s12885-017-3929-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Denmark, national roll-out of a population-based, screening mammography program took place in 2007-2010. We report on outcome of the first four biennial invitation rounds. METHODS Data on screening outcome were retrieved from the 2015 and 2016 national screening quality reports. We calculated coverage by examination; participation after invitation; detection-, interval cancer- and false-positive rates; cancer characteristics; sensitivity and specificity, for Denmark and for the five regions. RESULTS At the national level coverage by examination remained at 75-77%; lower in the Capital Region than in the rest of Denmrk. Detection rate was slightly below 1% at first screen, 0.6% at subsequent screens, and one region had some fluctuation over time. Ductal carcinoma in situ (DCIS) constituted 13-14% of screen-detected cancers. In subsequent rounds, 80% of screen-detected invasive cancers were node negative and 40% ≤10 mm. False-positive rate was around 2%; higher for North Denmark Region than for the rest of Denmark. Three out of 10 breast cancers in screened women were diagnosed as interval cancers. CONCLUSIONS High coverage by examination and low interval cancer rate are required for screening to decrease breast cancer mortality. Two pioneer local screening programs starting in the 1990s were followed by a decrease in breast cancer mortality of 22-25%. Coverage by examination and interval cancer rate of the national program were on the favorable side of values from the pioneer programs. It appears that the implementation of a national screening program in Denmark has been successful, though regional variations need further evaluation to assure optimization of the program.
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MESH Headings
- Aged
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/mortality
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Denmark/epidemiology
- Early Detection of Cancer/mortality
- Female
- Follow-Up Studies
- Humans
- Mammography/mortality
- Middle Aged
- Outcome Assessment, Health Care
- Prognosis
- Survival Rate
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Affiliation(s)
- Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Martin Bak
- Department of Pathology, Odense University Hospital, J. B. Winsløws Vej 15, 5000 Odense, Denmark
| | - My von Euler-Chelpin
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anders Lernevall
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NØ, Denmark
| | | | - Walter Schwartz
- Mammography Centre, Odense University Hospital, J. B. Winsløws Vej 15, 5000 Odense, Denmark
| | - Adam Jan Wronecki
- Radiology Department, Aalborg Univeristy Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Ilse Vejborg
- Radiology Department, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2200 Copenhagen, Denmark
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He D, Fang Y, Gunter MJ, Xu D, Zhao Y, Zhou J, Fang H, Xu WH. Incidence of breast cancer in Chinese women exposed to the 1959-1961 great Chinese famine. BMC Cancer 2017; 17:824. [PMID: 29207944 PMCID: PMC5718143 DOI: 10.1186/s12885-017-3794-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The association of malnutrition in early life with breast cancer risk has been studied in Europe by investigating survivors of the Dutch Hunger Winter Famine, but not in China. We evaluated the effect of exposure to the 1959-1961 Great Leap Forward famine on subsequent breast cancer risk in Chinese women. METHODS A total of 59,060 women born in 1955~1966 were recruited from Minhang district, Shanghai, China, during the period 2008 to 2012. A baseline survey was conducted to collect demographic characteristics and known risk factors for breast cancer. Incident breast cancers were identified by conducting record linkage with the Shanghai Cancer Registry up to June 30, 2015, and confirmed through medical records. Cumulative probabilities of cancer incidence were evaluated after adjusting for age, educational level and other confounders. Cox regression models were applied to estimate the hazard ratios (HR) and 95% confidence intervals (CI) of breast cancer. RESULTS The overall crude incidence of in situ and invasive breast cancer were 19.2 and 115.0 per 100,000, respectively, in women conceived or born during the famine (1959-1962), slightly higher than those in women born before (1955-1958) (13.2 and 109.8/100,000) and after (1963-1966) (10.4 and 101.5/100,000). Particularly, at age group of 50-52 years when all participants contributed person-year of observations, the age-specific incidence of invasive breast cancer was higher in pre-natal exposed women (123.7/100,000, 95%CI: 94.5-161.9/100,000) than in post-natal exposed (109.6/100,000, 95%CI: 69.1-174.0/100,000) and unexposed women (82.7/100,000, 95%CI: 46.9-145.7/100,000). However, the incidence of cancer in situ was slightly lower in pre-natal exposed women at the age group. Adjusted cumulative probabilities of breast cancer incidence, both in-situ and invasive, were also observed to be higher in women exposed to the famine, however, the difference was not statistically significant. CONCLUSION Our results suggest a possible adverse, but limited, impact of exposure to the Great famine on the risk of breast cancer in Chinese women.
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Affiliation(s)
- Dandan He
- Center for Disease Control and Prevention of Minhang District, 965 Zhong Yi Road, Shanghai, 201101 China
| | - Yuan Fang
- Department of Epidemiology, School of Public Health, Fudan University; Key Laboratory of Public Health Safety, Ministry of Education (Fudan University), 138 Yi Xue Yuan Road, Shanghai, 200032 China
| | - Marc J. Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008 Lyon, France
| | - Dongli Xu
- Center for Disease Control and Prevention of Minhang District, 965 Zhong Yi Road, Shanghai, 201101 China
| | - Yanping Zhao
- Center for Disease Control and Prevention of Minhang District, 965 Zhong Yi Road, Shanghai, 201101 China
| | - Jie Zhou
- Center for Disease Control and Prevention of Minhang District, 965 Zhong Yi Road, Shanghai, 201101 China
| | - Hong Fang
- Center for Disease Control and Prevention of Minhang District, 965 Zhong Yi Road, Shanghai, 201101 China
| | - Wang Hong Xu
- Department of Epidemiology, School of Public Health, Fudan University; Key Laboratory of Public Health Safety, Ministry of Education (Fudan University), 138 Yi Xue Yuan Road, Shanghai, 200032 China
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Beinse G, Berger F, Cottu P, Dujaric ME, Kriegel I, Guilhaume MN, Diéras V, Cabel L, Pierga JY, Bidard FC. Circulating tumor cell count and thrombosis in metastatic breast cancer. J Thromb Haemost 2017; 15:1981-1988. [PMID: 28779538 DOI: 10.1111/jth.13792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Indexed: 11/28/2022]
Abstract
Essentials Tumor cells circulating in blood (CTC) may favor thrombotic events in cancer patients. We assessed the impact of CTC on the risk of thrombosis in metastatic breast cancer. Baseline CTC detection was the only independent factor associated with the risk of thrombosis. CTC detection under therapy may be the hidden link between tumor progression & thrombosis. SUMMARY Background Circulating tumor cell (CTC) count is a major prognostic factor in metastatic breast cancer (MBC) and has been reported to be associated with thrombosis in short-term studies on MBC patients. Objective To assess whether CTC detection (CellSearch® ) before first-line chemotherapy impacts the risk of thrombosis throughout the course of MBC. Patients/Methods Among patients included before first-line chemotherapy for MBC in the prospective IC2006-04 CTC detection study (NCT00898014), the electronic medical files of those patients treated at Institut Curie (Paris, France) were searched in silico and manually checked for incident venous or arterial thrombotic events (TE) in the course of MBC. Univariate and multivariate analyses were performed using Cox and Fine-Gray models, adjusted for age and Khorana score. Results/Conclusions With a median follow-up of 64 months (25-81 months), among the 142 patients included, 34 (24%) experienced a TE (incidence rate, 8 TE/100 patient-years). The TE incidence rate was 13 TE/100 patient-years for the 80 patients with ≥ 1 CTC/7.5 mL of blood before initiating first-line chemotherapy, vs. only 4 TE/100 patient-years for the 62 CTC-negative patients. Fine-Gray multivariate analysis (with death as competing event) included age, Khorana score and baseline lactate dehydrogenase and CTC levels: detectable CTC was the only factor significantly associated with an increased risk of TE (sub-distribution hazard ratio [SHR] for patients with [1-4] CTC = 3.1, 95% CI [1.1; 8.6], SHR for patients with ≥ 5 CTC = 1.4, 95% CI [0.5; 4.6]). This study shows that CTC detection before starting first-line chemotherapy is an independent risk factor for TE in MBC patients.
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Affiliation(s)
- G Beinse
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris, France
| | - F Berger
- Institut Curie, Unit of Biometry, PSL Research University, INSERM U900, Paris, France
| | - P Cottu
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris, France
| | - M-E Dujaric
- Institut Curie, Unit of Biometry, PSL Research University, INSERM U900, Paris, France
| | - I Kriegel
- Department of Anesthesiology, Institut Curie, PSL Research University, Paris, France
| | - M-N Guilhaume
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris, France
| | - V Diéras
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris, France
| | - L Cabel
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris, France
| | - J-Y Pierga
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris, France
- Université Paris Descartes, Paris, France
| | - F-C Bidard
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris, France
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Cui X, Wei S. Carcinoma In Situ Involving Sclerosing Adenosis: Seeking the Salient Histological Characteristics to Prevent Overdiagnosis. Ann Clin Lab Sci 2017; 47:529-534. [PMID: 29066477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ductal or lobular carcinoma in situ (DCIS/LCIS) can rarely arise from sclerosing adenosis (SA). The combination of cytologically malignant cells and the infiltrative growth pattern may make it challenging to distinguish it from an invasive carcinoma. The authors reviewed 50 consecutive cases of CIS involving SA to seek the salient histologic characteristics in order to prevent overdiagnosis. The features commonly seen with CIS were the lobular configuration at low magnification (94%), uninvolved SA in neighboring tissue (84%), at least focally identifiable myoepithelial cells on H&E-stained sections (76%), separate foci of unequivocal CIS (58%), associated microcalcifications (54%), and hyaline basement membrane surrounding tumor cell nests (48%). The group of DCIS with high nuclear grade showed a tendency to occupy the entire lobule of SA, whereas those with non-high grade were more often partially involving the affected lobule. The presence of adjacent separate foci of CIS was more closely related to the DCIS lesions when compared to those of LCIS. The finding of an SA lobule entirely involved by CIS was signifi-cantly correlated with the presence of an invasive carcinoma; this should thus strongly prompt the pathologist to search for other evidence of invasion. Awareness of these features is an additional, useful tool for reaching a proper diagnosis.
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MESH Headings
- Alabama/epidemiology
- Basement Membrane/pathology
- Breast/pathology
- Breast/surgery
- Breast Carcinoma In Situ/diagnosis
- Breast Carcinoma In Situ/epidemiology
- Breast Carcinoma In Situ/pathology
- Breast Carcinoma In Situ/surgery
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Calcinosis/diagnosis
- Calcinosis/epidemiology
- Calcinosis/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Cohort Studies
- Diagnostic Errors/prevention & control
- Female
- Hospitals, University
- Humans
- Myoepithelioma/diagnosis
- Myoepithelioma/epidemiology
- Myoepithelioma/pathology
- Neoplasm Grading
- Neoplasm Invasiveness/pathology
- Neoplasms, Complex and Mixed/diagnosis
- Neoplasms, Complex and Mixed/epidemiology
- Neoplasms, Complex and Mixed/pathology
- Prevalence
- Sclerosis
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Affiliation(s)
- Xiaoyan Cui
- Department of Pathology, the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shi Wei
- Department of Pathology, the University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abstract
IMPORTANCE Many established breast cancer risk factors are used in clinical risk prediction models, although the proportion of breast cancers explained by these factors is unknown. OBJECTIVE To determine the population-attributable risk proportion (PARP) for breast cancer associated with clinical breast cancer risk factors among premenopausal and postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS Case-control study with 1:10 matching on age, year of risk factor assessment, and Breast Cancer Surveillance Consortium (BCSC) registry. Risk factor data were collected prospectively from January 1, 1996, through October 31, 2012, from BCSC community-based breast imaging facilities. A total of 18 437 women with invasive breast cancer or ductal carcinoma in situ were enrolled as cases and matched to 184 309 women without breast cancer, with a total of 58 146 premenopausal and 144 600 postmenopausal women enrolled in the study. EXPOSURES Breast Imaging Reporting and Data System (BI-RADS) breast density (heterogeneously or extremely dense vs scattered fibroglandular densities), first-degree family history of breast cancer, body mass index (>25 vs 18.5-25), history of benign breast biopsy, and nulliparity or age at first birth (≥30 years vs <30 years). MAIN OUTCOMES AND MEASURES Population-attributable risk proportion of breast cancer. RESULTS Of the 18 437 women with breast cancer, the mean (SD) age was 46.3 (3.7) years among premenopausal women and 61.7 (7.2) years among the postmenopausal women. Overall, 4747 (89.8%) premenopausal and 12 502 (95.1%) postmenopausal women with breast cancer had at least 1 breast cancer risk factor. The combined PARP of all risk factors was 52.7% (95% CI, 49.1%-56.3%) among premenopausal women and 54.7% (95% CI, 46.5%-54.7%) among postmenopausal women. Breast density was the most prevalent risk factor for both premenopausal and postmenopausal women and had the largest effect on the PARP; 39.3% (95% CI, 36.6%-42.0%) of premenopausal and 26.2% (95% CI, 24.4%-28.0%) of postmenopausal breast cancers could potentially be averted if all women with heterogeneously or extremely dense breasts shifted to scattered fibroglandular breast density. Among postmenopausal women, 22.8% (95% CI, 18.3%-27.3%) of breast cancers could potentially be averted if all overweight and obese women attained a body mass index of less than 25. CONCLUSIONS AND RELEVANCE Most women with breast cancer have at least 1 breast cancer risk factor routinely documented at the time of mammography, and more than half of premenopausal and postmenopausal breast cancers are explained by these factors. These easily assessed risk factors should be incorporated into risk prediction models to stratify breast cancer risk and promote risk-based screening and targeted prevention efforts.
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Affiliation(s)
- Natalie J Engmann
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Brian L Sprague
- Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington
| | - Karla Kerlikowske
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Medicine, University of California, San Francisco
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38
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Chen Z, Yang J, Li S, Lv M, Shen Y, Wang B, Li P, Yi M, Zhao X, Zhang L, Wang L, Yang J. Invasive lobular carcinoma of the breast: A special histological type compared with invasive ductal carcinoma. PLoS One 2017; 12:e0182397. [PMID: 28863134 PMCID: PMC5580913 DOI: 10.1371/journal.pone.0182397] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/17/2017] [Indexed: 12/13/2022] Open
Abstract
The clinical outcomes and therapeutic strategies for infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC) are not uniform. The primary objectives of this study were to identify the differences in the clinical characteristics and prognoses between ILC and IDC, and identify the high-risk population based on the hormone receptor status and metastasis sites. The Surveillance, Epidemiology, and End Results Program database was searched and patients diagnosed with ILC or IDC from 1990 to 2013 were identified. In total,796,335 patients were analyzed, including 85,048 withILC (10.7%) and 711,287 withIDC (89.3%). The ILC group was correlatedwith older age, larger tumor size, later stage, lower grade, metastasis disease(M1) disease, and greater counts ofpositive lymph nodesandestrogen-receptor-positive (ER)/progesterone receptor-positive (PR) positive nodes. The overall survival showed an early advantage for ILC but a worse outcome after 5 years. Regarding the disease-specific survival, the IDC cohort had advantages over the ILC group, both during the early years and long-term. In hormone status and metastasis site subgroup analyses, the ER+/PR+ subgroup had the best survival, while the ER+/PR- subgroup had the worst outcome, especially the ILC cohort. ILC and IDC had different metastasis patterns. The proportion of bone metastasis was higher in the ILC group (91.52%) than that in the IDC (76.04%), and the ILC group was more likely to have multiple metastasis sites. Survival analyses showed patients with ILC had a higher risk of liver metastasis (disease-specific survival[DSS]; P = 0.046), but had a better overall survival than the bone metastasis group (P<0.0001). We concluded that the long-term prognosis for ILC was poorer than that for IDC, and the ER+/PR- subgroup had the worst outcome. Therefore, the metastasis pattern and prognosis must be seriously evaluated, and a combination of endocrine therapy and chemotherapy should be considered.
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Affiliation(s)
- Zheling Chen
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jiao Yang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Shuting Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Meng Lv
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yanwei Shen
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Biyuan Wang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Pan Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Min Yi
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Xiao’ai Zhao
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Lingxiao Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Le Wang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jin Yang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Obeidat F, Ahram M, Al Khader A, Battah K, Alchalabi M, Melhem JM, Suleiman A. Clinical and histopathological features of breast cancer in Jordan: Experience from a tertiary care hospital. J PAK MED ASSOC 2017; 67:1206-1212. [PMID: 28839305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To analyse breast cancer cases with respect to age, menopausal status, hormone receptors and human epidermal growth factor receptor 2 expression, in addition to nodal and distant metastases. METHODS This retrospective study was conducted at Jordan University Hospital, Amman, Jordan, and comprised cases of breast carcinoma among females between 2006 and 2015. Clinicopathological data was collected from patient files and laboratory reports. Data was analysed using SPSS v 17. RESULTS Of the 752 cases, 559(74.3%) were invasive ductal carcinomas of non-specific type, followed by 36(4.8%) cases of invasive lobular carcinoma. Upon investigating the clinicopathological data on the breast cancer cases, 466(61.97%) cases had sufficient information for further analysis. Of them, 414(61.97%) patients were aged above 40 years and 190(40.77%) were post-menopausal. Moreover, 221(47.42%) cases showed lymph node metastases, but only 32(6.87%) had distant metastases. The expression of oestrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was found to be positive in 343(73.6%), 299(66.7%) and 97 (24.6%) cases, respectively. Besides, 42(9.01%) cases were triple negative, which were diagnosed only in females below 40 years age. CONCLUSIONS These results were in concordance with international reports, except for the association of triple negative breast cancer with age where it was mainly diagnosed among females younger than 40 years age.
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MESH Headings
- Adult
- Age Distribution
- Age Factors
- Breast Neoplasms/epidemiology
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Female
- Humans
- Jordan/epidemiology
- Lymph Nodes/pathology
- Middle Aged
- Neoplasm Grading
- Neoplasm Metastasis
- Postmenopause
- Premenopause
- Prevalence
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Tertiary Care Centers
- Triple Negative Breast Neoplasms
- Tumor Burden
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40
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Yadav S, Yadav D, Zakalik D. Squamous cell carcinoma of the breast in the United States: incidence, demographics, tumor characteristics, and survival. Breast Cancer Res Treat 2017; 164:201-208. [PMID: 28432512 DOI: 10.1007/s10549-017-4251-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 04/17/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Squamous cell carcinoma of breast accounts for less than 0.1% of all breast cancers. The purpose of this study is to describe the epidemiology and survival of this rare malignancy. METHODS Data were extracted from the National Cancer Institute's Surveillance, Epidemiology and End Results Registry to identify women diagnosed with squamous cell carcinoma of breast between 1998 and 2013. SEER*Stat 8.3.1 was used to calculate age-adjusted incidence, age-wise distribution, and annual percentage change in incidence. Kaplan-Meier curves were plotted for survival analysis. Univariate and multivariate Cox proportional hazard regression model was used to determine predictors of survival. RESULTS A total of 445 cases of squamous cell carcinoma of breast were diagnosed during the study period. The median age of diagnosis was 67 years. The overall age-adjusted incidence between 1998 and 2013 was 0.62 per 1,000,000 per year, and the incidence has been on a decline. Approximately half of the tumors were poorly differentiated. Stage II was the most common stage at presentation. Majority of the cases were negative for expression of estrogen and progesterone receptor. One-third of the cases underwent breast conservation surgery while more than half of the cases underwent mastectomy (unilateral or bilateral). Approximately one-third of cases received radiation treatment. The 1-year and 5-year cause-specific survival was 81.6 and 63.5%, respectively. Excluding patient with metastasis or unknown stage at presentation, in multivariate Cox proportional hazard model, older age at diagnosis and higher tumor stage (T3 or T4) or nodal stage at presentation were significant predictors of poor survival. CONCLUSIONS Our study describes the unique characteristics of squamous cell carcinoma of breast and demonstrates that it is an aggressive tumor with a poor survival. Older age and higher tumor or nodal stages at presentation were independent predictors of poor survival for loco-regional stages.
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MESH Headings
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Estrogen Receptor alpha/genetics
- Female
- Gene Expression Regulation, Neoplastic/genetics
- Humans
- Mastectomy
- Middle Aged
- Neoplasm Staging
- Receptors, Progesterone/genetics
- SEER Program
- Survival Analysis
- United States/epidemiology
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Affiliation(s)
- Siddhartha Yadav
- Department of Internal Medicine, Beaumont Health, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA.
- Nancy and James Grosfeld Cancer Genetics Center, Beaumont Cancer Institute, Beaumont Health, Royal Oak, MI, 48073, USA.
| | - Dhiraj Yadav
- Department of Internal Medicine, Siedman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Dana Zakalik
- Nancy and James Grosfeld Cancer Genetics Center, Beaumont Cancer Institute, Beaumont Health, Royal Oak, MI, 48073, USA
- Oakland University William Beaumont School of Medicine, 2200 N Squirrel Rd, Rochester, MI, 48309, USA
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Usmani A, Shoro AA, Shirazi B, Memon Z, Hussain M. MiR-16: A novel hereditary marker in breast cancer and their offspring. J PAK MED ASSOC 2017; 67:446-450. [PMID: 28303998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To analyse micro ribonucleic acid-16 in sera of invasive intraductal breast carcinoma in stage III and compare its expression in their daughters and healthy women. METHODS The study took place from January 2013 till December 2015. This case-control study was conducted at the Ziauddin Cancer Hospital, Karachi, and comprised breast cancer patients and healthy individuals. Stage III invasive intraductal breast cancer patients (cases), their age-matched healthy individuals (control group A) and patients' daughters (control group B) were included. Subjects with stage I cancer and their daughters and subjects with stage IV and their daughters were also included. Serum tests were run on real-time quantitative reverse transcription polymerase chain reaction. Threshold cycle was determined and fold change was calculated. Fold change was applied between the groups. SPSS 20 was used for data analysis. RESULTS Of the 194 participants, there were 50(25.8%) cases, 50(25.8%) group A controls, 35(18%) group B controls, 20(10.3%) stage I patients, 11(5.7%) daughters of stage 1 patients, 20(10.3%) patients of stage IV and 8(4.1%) daughters of stage IV patients. Micro ribonucleic acid-16 was higher in cases than controls (p=0.001). Group B showed significant gene expression than group A (p=0.001). Stage IV patients and daughters showed expression of micro ribonucleic acid-16 (p=0.001). Triple negative receptor cases showed a greater expression of gene (p=0.001). CONCLUSIONS Micro ribonucleic acid-16 can be used as a prognostic, diagnostic as well as a predictive marker in breast cancer patients and their offspring.
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MESH Headings
- Adolescent
- Adult
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Breast Neoplasms/blood
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/genetics
- Carcinoma, Ductal, Breast/blood
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/genetics
- Case-Control Studies
- Female
- Humans
- MicroRNAs/blood
- Middle Aged
- Young Adult
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Darouich S, El Amine El Hadj O, Betaieb I, Goucha A, Dhiab T, Rahal K, Gamoudi A, El May A. Triple negative breast cancer: A clinico-epidemiological and histopronostic study of 90 cases. Tunis Med 2017; 95:37-44. [PMID: 29327767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The aim of this study was to describe the clinico-epidemiological and histopronostic characteristics of triple negative breast cancer (TNBC) and to evaluate the therapeutic results in tunisian women. METHODS We reported the results of a retrospective study including 90 patients treated for TNBC between Junuary 2008 and December 2009 in the Salah Azaiz Institute of Tunis. RESULTS TNBCoccured in 14% of diagnosed breast cancers. The mean age at diagnosis was 53.67 years. Family history of breast cancer was reported in 10% of cases.The majority of tumors were classified as T2 (41%) and associated with invasive ductal carcinoma histological type (99%) and SBR grade-II (54%). Tumor lymph node metastases were detected in 44% of patients.Among operated patients, 46% of patients underwent conservative surgery and 54% radical surgery. Chemotherapy and postoperative radiotherapy were given in97% and 80%of patients, respectively. After a median follow-up of 33.51 months, 61% of patients remained free of disease, 12% hadloco-regional recurrence, 9% had disease progression during chemotherapy and 21% developed systemic disease. CONCLUSION TNBC diagnosis is often made in the advanced stage and has a tendency to recur after treatment. The variable responseto chemotherapy is due to the molecular tumor heterogeneity. The development of targeted therapies is necessary to improve outcome of chemoresistant TNBC.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Female
- Humans
- Incidence
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Prognosis
- Retrospective Studies
- Risk Factors
- Triple Negative Breast Neoplasms/diagnosis
- Triple Negative Breast Neoplasms/epidemiology
- Triple Negative Breast Neoplasms/pathology
- Triple Negative Breast Neoplasms/therapy
- Tunisia/epidemiology
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Khalil AI, Bendahhou K, Mestaghanmi H, Saile R, Benider A. [Synchronous bilateral breast cancer: experiences in the Mohammed VI Cancer Treatment Center, CHU Ibn Rochd, Casablanca]. Pan Afr Med J 2016; 25:121. [PMID: 28292084 PMCID: PMC5325485 DOI: 10.11604/pamj.2016.25.121.9967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022] Open
Abstract
Synchronous bilateral breast cancers (SBBC) are characterized by extensive clinical and morphological heterogeneity, with an frequency between 1.5 and 3.2%. Women treated for unilateral breast cancer are at higher risk of developing contralateral breast cancer. Screening and advances in breast imaging have improved detection rates of SBBC. Our study aims to analyze the epidemiological, clinical, histological and therapeutic features of bilateral breast cancer. We conducted a cross-sectional study of patients with breast cancer treated at the Mohammed VI Center over a two year period. Statistical analysis of the results was performed using R. software. 31 patients had SBBC, representing 2.4% of breast cancer cases in our Center. The average age was 47.8 ± 8.4 years, 22.6% of patients used oral contraceptives. A family history of breast cancer was observed in 22.6% of cases. The most common histological type was invasive ductal carcinoma (58.1%), SBR grade II and III were common (38.7%). Hormone receptors were positive for progesterone (38.7%) and for estrogen (41.9%). HER2 was overexpressed in 20.0% of cases. 29.0% of patients received hormonal therapy and 3.2% targeted therapies. Our study showed that bilateral breast cancer represents a small percentage of all breast cancers but have specific clinical features that help to differentiate it from unilateral breast cancer.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Contraceptives, Oral/administration & dosage
- Cross-Sectional Studies
- Female
- Humans
- Middle Aged
- Morocco
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
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Affiliation(s)
- Ahmadaye Ibrahim Khalil
- Laboratoire de Physiopathologie et Génétique Moléculaire, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | | | - Houriya Mestaghanmi
- Laboratoire de Physiopathologie et Génétique Moléculaire, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | - Rachid Saile
- Laboratoire de Biologie et Santé, Unité de Recherche Associée au CNRST-URAC 34, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | - Abdellatif Benider
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd Casablanca, Maroc
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Madubata CC, Liu Y, Goodman MS, Yun S, Yu J, Lian M, Colditz GA. Comparing treatment and outcomes of ductal carcinoma in situ among women in Missouri by race. Breast Cancer Res Treat 2016; 160:563-572. [PMID: 27771840 DOI: 10.1007/s10549-016-4030-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether treatment (surgery, radiation therapy, and endocrine therapy) contributes to racial disparities in outcomes of ductal carcinoma in situ (DCIS). PATIENTS AND METHODS The analysis included 8184 non-Hispanic White and 954 non-Hispanic Black women diagnosed with DCIS between 1996 and 2011 and identified in the Missouri Cancer Registry. Logistic regression models were used to estimate odds ratios (ORs) of treatment for race. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of ipsilateral breast tumor (IBT) and contralateral breast tumor (CBT) for race. RESULTS There was no significant difference between Black and White women in utilization of mastectomy (OR 1.16; 95 % CI 0.99-1.35) or endocrine therapy (OR 1.19; 95 % CI 0.94-1.51). Despite no significant difference in underutilization of radiation therapy (OR 1.14; 95 % CI 0.92-1.42), Black women had higher odds of radiation delay, defined as at least 8 weeks between surgery and radiation (OR 1.92; 95 % CI 1.55-2.37). Among 9138 patients, 184 had IBTs and 326 had CBTs. Black women had a higher risk of IBTs (HR 1.69; 95 % CI 1.15-2.50) and a comparable risk of CBTs (HR 1.19; 95 % CI 0.84-1.68), which were independent of pathological features and treatment. CONCLUSION Racial differences in DCIS treatment and outcomes exist in Missouri. This study could not completely explain the higher risk of IBTs in Black women. Future studies should identify differences in timely initiation and completion of treatment, which may contribute to the racial difference in IBTs after DCIS.
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MESH Headings
- Adenocarcinoma in Situ/diagnosis
- Adenocarcinoma in Situ/epidemiology
- Adenocarcinoma in Situ/mortality
- Adenocarcinoma in Situ/therapy
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/mortality
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/therapy
- Combined Modality Therapy
- Ethnicity
- Female
- Follow-Up Studies
- Healthcare Disparities
- Humans
- Middle Aged
- Missouri/epidemiology
- Missouri/ethnology
- Neoplasm Grading
- Neoplasm Staging
- Proportional Hazards Models
- Registries
- SEER Program
- Treatment Outcome
- Tumor Burden
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Affiliation(s)
- Chinwe C Madubata
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA.
| | - Melody S Goodman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Shumei Yun
- Missouri Department of Health and Senior Services, Jefferson City, MO, USA
| | - Jennifer Yu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Min Lian
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
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Fu J, Wu L, Jiang M, Li D, Jiang T, Hong Z, Wang F, Li S. Clinical Nomogram for Predicting Survival Outcomes in Early Mucinous Breast Cancer. PLoS One 2016; 11:e0164921. [PMID: 27760180 PMCID: PMC5070827 DOI: 10.1371/journal.pone.0164921] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/03/2016] [Indexed: 01/08/2023] Open
Abstract
Background The features related to the prognosis of patients with mucinous breast cancer (MBC) remain controversial. We aimed to explore the prognostic factors of MBC and develop a nomogram for predicting survival outcomes. Methods The Surveillance, Epidemiology, and End Results (SEER) database was searched to identify 139611 women with resectable breast cancer from 1990 to 2007. Survival curves were generated using Kaplan-Meier methods. The 5-year and 10-year cancer-specific survival (CSS) rates were calculated using the Life-Table method. Based on Cox models, a nomogram was constructed to predict the probabilities of CSS for an individual patient. The competing risk regression model was used to analyse the specific survival of patients with MBC. Results There were 136569 (97.82%) infiltrative ductal cancer (IDC) patients and 3042 (2.18%) MBC patients. Patients with MBC had less lymph node involvement, a higher frequency of well-differentiated lesions, and more estrogen receptor (ER)-positive tumors. Patients with MBC had significantly higher 5 and10-year CSS rates (98.23 and 96.03%, respectively) than patients with IDC (91.44 and 85.48%, respectively). Univariate and multivariate analyses showed that MBC was an independent factor for better prognosis. As for patients with MBC, the event of death caused by another disease exceeded the event of death caused by breast cancer. A competing risk regression model further showed that lymph node involvement, poorly differentiated grade and advanced T-classification were independent factors of poor prognosis in patients with MBC. The Nomogram can accurately predict CSS with a high C-index (0.816). Risk scores developed from the nomogram can more accurately predict the prognosis of patients with MBC (C-index = 0.789) than the traditional TNM system (C-index = 0.704, P< 0.001). Conclusions Patients with MBC have a better prognosis than patients with IDC. Nomograms could help clinicians make more informed decisions in clinical practice. The competing risk regression model, as a more rational model, is recommended for use in the survival analysis of patients with MBC in the future.
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MESH Headings
- Adenocarcinoma, Mucinous/epidemiology
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/mortality
- Aged
- Analysis of Variance
- Breast Neoplasms/epidemiology
- Breast Neoplasms/metabolism
- Breast Neoplasms/mortality
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/mortality
- Female
- Humans
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Grading
- Prognosis
- Receptors, Estrogen/metabolism
- Risk Factors
- SEER Program
- Survival Analysis
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Affiliation(s)
- Jianfei Fu
- Department of Oncology, Zhejiang University Jinhua hospital, Jinhua, Zhejiang Province, China
- * E-mail: ,
| | - Lunpo Wu
- Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mengjie Jiang
- Department of Radiation Oncology, The First Affiliated Hospital of ZheJiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang Province, China
| | - Dan Li
- Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ting Jiang
- Department of Nuclear Medicine, Zhejiang University Jinhua hospital, Jinhua, Zhejiang Province, China
| | - Zhongwu Hong
- Department of Oncology, Zhejiang University Jinhua hospital, Jinhua, Zhejiang Province, China
| | - Fan Wang
- Department of Oncology, Zhejiang University Jinhua hospital, Jinhua, Zhejiang Province, China
| | - Shuguang Li
- Department of Oncology, Zhejiang University Jinhua hospital, Jinhua, Zhejiang Province, China
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Moschetta M, Telegrafo M, Introna T, Coi L, Rella L, Ranieri V, Cirili A, Stabile Ianora AA, Angelelli G. Role of specimen US for predicting resection margin status in breast conserving therapy. G Chir 2016; 36:201-4. [PMID: 26712255 DOI: 10.11138/gchir/2015.36.5.201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard. PATIENTS AND METHODS A total of 132 consecutive patients (age range, 34-87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard. RESULTS The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US. CONCLUSIONS Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnostic imaging
- Adenocarcinoma, Mucinous/epidemiology
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/surgery
- Female
- Humans
- Italy/epidemiology
- Mastectomy, Segmental/methods
- Middle Aged
- Predictive Value of Tests
- Sensitivity and Specificity
- Treatment Outcome
- Ultrasonography
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Adachi Y, Ishiguro J, Kotani H, Hisada T, Ichikawa M, Gondo N, Yoshimura A, Kondo N, Hattori M, Sawaki M, Fujita T, Kikumori T, Yatabe Y, Kodera Y, Iwata H. Comparison of clinical outcomes between luminal invasive ductal carcinoma and luminal invasive lobular carcinoma. BMC Cancer 2016; 16:248. [PMID: 27015895 PMCID: PMC4807554 DOI: 10.1186/s12885-016-2275-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 03/13/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The pathological and clinical features of invasive lobular carcinoma (ILC) differ from those of invasive ductal carcinoma (IDC). Several studies have indicated that patients with ILC have a better prognosis than those with ductal carcinoma. However, no previous study has considered the molecular subtypes and histological subtypes of ILC. We compared prognosis between IDC and classical, luminal type ILC and developed prognostic factors for early breast cancer patients with classical luminal ILC. METHODS Four thousand one hundred ten breast cancer patients were treated at the Aichi Cancer Center Hospital from 2003 to 2012. We identified 1,661 cases with luminal IDC and 105 cases with luminal classical ILC. We examined baseline characteristics, clinical outcomes, and prognostic factors of luminal ILC. RESULTS The prognosis of luminal ILC was significantly worse than that of luminal IDC. The rates of 5-year disease free survival (DFS) were 91.9% and 88.4% for patients with luminal IDC and luminal ILC, respectively (P = 0.008). The rates of 5-year overall survival (OS) were 97.6% and 93.1% for patients with luminal IDC and luminal ILC respectively (P = 0.030). Although we analyzed prognosis according to stratification by tumor size, luminal ILC tended to have worse DFS than luminal IDC in the large tumor group. In addition, although our analysis was performed according to matching lymph node status, luminal ILC had a significantly worse DFS and OS than luminal IDC in node-positive patients. Survival curves showed that the prognosis for ILC became worse than IDC over time. Multivariate analysis showed that ILC was an important factor related to higher risk of recurrence of luminal type breast cancer, even when tumor size, lymph node status and histological grade were considered. CONCLUSIONS Luminal ILC had worse outcomes than luminal IDC. Consequently, different treatment approaches should be used for luminal ILC than for luminal IDC.
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MESH Headings
- Aged
- Breast Neoplasms/classification
- Breast Neoplasms/drug therapy
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/classification
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/classification
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/pathology
- Disease-Free Survival
- Female
- Humans
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Recurrence, Local/classification
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Prognosis
- Treatment Outcome
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Affiliation(s)
- Yayoi Adachi
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showaku, Nagoya, 466-8560 Japan
| | - Junko Ishiguro
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Haruru Kotani
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Tomoka Hisada
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Mari Ichikawa
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Naomi Gondo
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Akiyo Yoshimura
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Naoto Kondo
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Takashi Fujita
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Toyone Kikumori
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showaku, Nagoya, 466-8560 Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showaku, Nagoya, Aichi 466-8560 Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusaku, Nagoya, 464-8681 Japan
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Affiliation(s)
- Yiwey Shieh
- Division of General Internal Medicine University of California, San Francisco, CA, USA
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura Esserman
- Departments of Surgery and Radiology, University of California, San Francisco, 1600 Divisadero Street, Box 1710, San Francisco, CA 94115, USA
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Duffy SW, Dibden A, Michalopoulos D, Offman J, Parmar D, Jenkins J, Collins B, Robson T, Scorfield S, Green K, Hall C, Liao XH, Ryan M, Johnson F, Stevens G, Kearins O, Sellars S, Patnick J. Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study. Lancet Oncol 2016; 17:109-14. [PMID: 26655422 PMCID: PMC4691349 DOI: 10.1016/s1470-2045(15)00446-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/29/2015] [Accepted: 10/19/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The value of screen detection and treatment of ductal carcinoma in situ (DCIS) is a matter of controversy. At present, the extent to which the diagnosis and treatment of DCIS could prevent the occurrence of invasive breast cancer in the future is not clear. We sought to estimate the association between detection of DCIS at screening and invasive interval cancers subsequent to the relevant screen. METHODS We obtained aggregate data for screen-detected cancers from 84 local screening units within 11 regional Quality Assurance Reference Centres in England, Wales, and Northern Ireland from the National Health Service Breast Screening Programme. Data for DCIS diagnoses were obtained for women aged 50-64 years who were invited to and attended mammographic breast screening from April 1, 2003, to March 31, 2007 (4 screening years). Patient-level data for interval cancer arising in the 36 months after each of these were analysed by Poisson regression with invasive interval cancer screen detection rate as the outcome variable; DCIS detection frequencies were fitted first as a continuous and then as a categorical variable. We repeated this analysis after adjustment with both small size and high-grade invasive screen-detected cancers. FINDINGS We analysed data for 5,243,658 women and on interval cancers occurring in the 36 months after the relevant screen. The average frequency of DCIS detected at screening was 1·60 per 1000 women screened (median 1·50 [unit range 0·54-3·56] [corrected to] per 1000 women). There was a significant negative association of screen-detected DCIS cases with the rate of invasive interval cancers (Poisson regression coefficient -0·084 [95% CI -0·13 to -0·03]; p=0·002). 90% of units had a DCIS detection frequency within the range of 1·00 to 2·22 per 1000 women; in these units, for every three screen-detected cases of DCIS, there was one fewer invasive interval cancer in the next 3 years. This association remained after adjustment for numbers of small screen-detected invasive cancers and for numbers of grade 3 invasive screen-detected cancers. INTERPRETATION The association between screen-detected DCIS and subsequent invasive interval cancers suggests that detection and treatment of DCIS is worthwhile in prevention of future invasive disease. FUNDING UK Department of Health Policy Research Programme and NHS Cancer Screening Programmes.
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MESH Headings
- Aged
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Early Detection of Cancer
- Female
- Humans
- Incidence
- Mammography
- Middle Aged
- Retrospective Studies
- Time Factors
- United Kingdom/epidemiology
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Affiliation(s)
- Stephen W Duffy
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK.
| | - Amanda Dibden
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
| | - Dimitrios Michalopoulos
- Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
| | - Judith Offman
- Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
| | - Dharmishta Parmar
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
| | - Jacquie Jenkins
- East Midlands QARC, Nottingham University Hospital City Campus, Nottingham, UK
| | | | | | | | | | | | | | | | | | | | - Olive Kearins
- West Midlands QARC, Public Health Building, University of Birmingham, Birmingham, UK
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