The Correlation of Social Support and Fear of Breast Cancer among Women in Northeast of Iran: A Cross-Sectional Study

Background

Breast cancer (BC) is the most commonly diagnosed cancer worldwide. Screening programs are the most common prevention methods. Perceived social support and fear are two important factors affecting women's participation in breast cancer screening. This study aimed to determine the relationship between fear of BC and perceived social support among women in Torbat Heydarieh, northeast of Iran.

Methods

This study is an online cross-sectional survey that was conducted on 352 women in Torbat Heydarieh city of Northeast Iran, from October 26th, 2021 to December 26th, 2022. Along with collecting sociodemographic characteristics, the Breast Cancer Fear Scale (BCFS), and the Multidimensional Scale of Perceived Social Support were electronically administered to participants. Data were analyzed through SPSS software version 25, using independent samples t-tests, one-way analysis, Pearson's correlation coefficient, and multiple linear regression models. The statistical significance level was set at P<0.05.

Results

The mean score for the BCFS was 20.67±1.03 which was in the moderate range for the total score of 40. Assessment of perceived social support indicated a moderate level of perceived support for all dimensions. Also, a significant correlation was found between the women's BCFS scores and perceived social support (r=-0.29, P<0.001).

Conclusion

We found that there was a negative statistically significant correlation between the BCF and social support. Therefore, this study suggests that healthcare providers pay attention to these factors. Moreover, further research is needed to explore the long-term effects of BCF due to low social support.

Comparative Evaluation of Biosimilar Trastuzumab with Reference Trastuzumab Activity in HER2-Positive Breast Cancer Patients

One of the breast cancer subtypes, epidermal growth factor receptor 2 (HER2), accounts for 15% of all breast cancers and is characterized by aggressive behavior and a poor prognosis. For patients with HER2-positive breast cancer, trastuzumab, a monoclonal antibody that targets HER2 receptors, is prescribed in addition to chemotherapy to increase their chances of survival. However, the high expense of this treatment makes it impossible for patients in developing nations to easily afford it and undergo this biological therapy. Consequently, trastuzumab biosimilars have been launched as a substitute that offers comparable effectiveness at a reduced price. This study aimed to compare the biological activity and cardiac safety of reference trastuzumab with biosimilar trastuzumab by monitoring serum levels of the tumor biomarker CA15-3 and evaluating N-terminal pro-B-type natriuretic peptide (NT-proBNP) for the adverse cardiac effects of both treatments on HER2-positive breast cancer patients before and after six cycles of biological therapy. This prospective research was performed on 36 females with metastatic and early-stage HER2-positive breast cancer who visited the Oncology Department at Rizgary Hospital, Erbil, Iraq. The patients were within the age range of 30-80 years old. Eighteen individuals received reference trastuzumab, while the remaining 18 received both chemotherapy and biosimilar trastuzumab. Each patient had a data sheet that contained details from hospital-reserved files. In the Herceptin group, there was an insignificant difference in the median of CA15-3, while no significant difference was detected between the means of NT-proBNP before and after treatment. In the biosimilar group, there was a significant reduction in the median CA15-3 as well as a significant increase in the level of NT-proBNP before and after the treatment. Evaluation of the association of trastuzumab-induced cardiotoxicity during breast cancer treatment with different factors indicated that there might be an increased risk of cardiotoxicity after trastuzumab treatment.

The Impact of Human Mammary Tumor Virus (HMTV) on the Expression of Epidermal Growth Factor Receptor (EGFR) and Death-Domain Associated Protein (DAXX) in Breast Carcinoma Tissues

The presence and characteristics of HMTV in Iraqi breast cancer women are still unknown. Furthermore, the identification of HMTV in human breast carcinoma tissue of patients differs by country, and the factors that influence it are still unknown. In many epithelial tumor types, the EGFR and its signaling pathways outcomes are necessary for the behavior of cells and regulating their proliferation, and it has been discovered that DAXX has strong carcinogenic characteristics and could be a new treatment target. This case-control retrospective study investigated the presence of HMTV in paraffin-embedded blocks (FFPT) of tumor samples from 60 Iraqi women patients diagnosed with primary breast cancer and 20 cases of benign tumors as a control group. HMTV env sequences were identified by Real-time PCR. EGFR and DAXX expression were immun0-detected by the immuno-histochemistry technique. HMTV sequences were detected in 15 (25%) samples of malignant breast tumors and 8 (40%) samples of benign breast tumors. There was no statistically significant association between the detection of env sequences of HMTV and age, grade, hormone receptors, EGFR, or DAXX expression compared to clinicopathological characteristics. However, statistically, the data showed a highly significant difference in the Expression of EGFR between study groups, age, and histological types (P=0.0001), and a significant negative association was observed between EGFR and both Her2 and TNBC. There was a statistically significant difference between DAXX (+) and DAXX (-) in study groups (P=0.002), and it was significantly associated with age and histological types of breast cancer (P=0.031 and 0.007, respectively). No significant association was found between DAXX and EGFR, grade, Her2. TNBC of breast cancer. The current study found HMTV env sequences in breast tumors of Iraqi women, suggesting that a larger sample size is needed to illustrate the potential causative role of HMTV in the development of human breast malignancy. Moreover, a negative association was found between HMTV and DAXX and EGFR Expression.

Osteoprotegerin, Parathyroid Hormone and Vitamin D as Effective Factors on Serum-Urine Calcium Levels in Breast Cancer Patients

Breast cancer represents one of the most popular kinds of cancer worldwide. During the early stages of the disease, the level of Osteoprotegerin remained within normal limits, showing that the bone was not being damaged to get calcium due to an increase in parathyroid hormone. The current study aimed to assess a number of biochemical variables in a group of women with malignant breast cancer who had reached menopause (less than 45 years old). One hundred thirty women were randomly divided into three groups as follows. The first group (G1) is made up of women who have never had breast cancer or any other disease, and their number (40) corresponds to the same age range (below menopause) as the control group. The second group (G2) comprises women diagnosed with breast cancer at an early stage whose numbers were relatively low (45). The third group (G3) included women of the same age who received one or two doses of chemotherapy and whose total number was (45) over the same period. The variables studied include Vitamin D, Parathyroid Hormone, Osteoprotegerin, blood calcium, and urine calcium, all of that are thought to play a role in the progress of the disease. Vitamin D levels were extremely low in the second group (G2), while they were slightly higher in the third group (G3) but remained extremely low. The first group (G1) maintained parameters within acceptable limits. There was a significant difference between the two breast cancer groups (9.38 1.43) and (4.98 1.67) when compared to the control group (20.04 2.80). (G1). The two breast cancer groups (G2) and (G3) had higher parathyroid hormone levels than the control group (G1), and there was a significant difference between the two breast cancer groups (136.52 58.56) (G3) and (G2) (167.79 35.21) compared to the control group (68.52 20.44) (G1). There was no significant difference in Osteoprotegerin levels between the two breast cancer groups (313.38 109.02) (G3) and (315.0 123.98) (G2) compared to the control group (G1) (324.11 104.73). The three groups' blood calcium levels were all within normal ranges, and there was no statistically significant difference between them (9.21 0.45), (9.23 0.38), and (9.23 0.38) (G3) (9.28 0.43). (G1), but urine-calcium levels were lower in both groups of breast cancer patients compared to the control group, and there was a significant difference between the two breast cancer groups (63.96 15.66) (G3) and (68.42 14.05) (G2) compared to the control group (213.77 63.94) (G1). In breast cancer patients, vitamin D deficiency and high parathyroid hormone levels were discovered, suggesting that vitamin D may play a role in cancer prevention. Osteoprotegerin levels were within normal ranges early in the illness, although this may alter as the patient matures and the disease advances.

An insight into the invasion of breast ductal carcinoma in situ based on clinical, pathological and hematological data

Background

Ductal carcinoma in situ (DCIS) has become a non-negligible part of breast cancers owing to the greatly increased incidence. While its natural history was not fully elucidated, which is the reason for current controversies in clinical treatment. Exploration of this issue from a clinical perspective is meaningful.

Methods

Medical records of 389 patients diagnosed with DCIS or DCIS with invasive ductal carcinoma (IDC) were reviewed. All of them received appropriate medical care in our center. All 324 patients in training cohort were divided into invasion and non-invasion groups based on pathology. Differences in DCIS immunohistochemical markers and hematological indicators between them were analyzed. In the invasion group, differences between DCIS and matched IDC were compared to explore changes in the tumor heterogeneity during invasion. Conclusions are validated in the validation cohort of 65 patients.

Results

Patients in invasion and non-invasion groups were balanced in baseline characteristics and no statistically significant differences were noticed for DCIS immunohistochemical markers. For hematological indicators, high expression of platelet >291.50) (odds ratio, 2.46; CI [1.35-4.46]; p = 0.003) and SII (>347.20) (odds ratio, 2.54; CI [1.56-4.12]; p < 0.001) were established as independent predictors for invasion by logistic analysis and were validated in the validation cohort. Ki-67 of IDC was significantly higher than that of matched DCIS (p < 0.001). HER2 expression and histological grade of DCIS were separately linearly related to those of IDC.

Conclusion

The change in hematological indicators is an independent predictor for invasion and can be incorporated into the treatment decision-making process for DCIS. Invasion tumor cells exhibit a stronger proliferative capacity compared with the in-situ ones. There are linear relationships in HER2 expression and histological grades between DCIS and matched IDC. DCIS subclones with different histological grades will develop into invasive carcinomas separately.

Significance of the Estrogen Hormone and Single Nucleotide Polymorphisms in the Progression of Breast Cancer among Female

Breast cancer is one of the most frequent types of malignancies among women and is internationally recognized as the main reason for cancer-caused mortality. Most breast tumors are heterogeneous and genetically complicated due to the involvement of several genes. Therefore, it is clinically important to study genetic variants that increase the risk of breast cancer. It is identified that the presence of polymorphisms in genes encoding regulatory hormones is linked to a higher risk of breast cancer. Additionally, circulating estrogen levels are connected to aromatase (CYP19A1) genes, which is a recognized risk factor for breast cancer progression. In this paper, the authors present a review study on the effect of estrogen and its Single Nucleotide Polymorphisms (SNPs) in the occurrence of breast cancer. This review mainly aimed to find out the connection between CYP19A1 gene variations and the risk of breast cancer, as well as its clinical characteristics and prognosis. Due to the highly special activity of the CYP19A1 enzyme in steroid production, suppression of the targeted CYP19A1 is a focused medication for breast cancer patients, which has only minor adverse effects. Numerous clinical trials over the last decade have shown that Aromatase inhibitors (AIs) not only outperform tamoxifen in terms of effectiveness but also have a lower adverse effect profile.  The AI is now widely accepted as a routine therapy option for postmenopausal females with Estrogen receptor-positive (ER+) breast cancer. Furthermore, not only dysregulation of gene expression in different genes related to distinguished pathways, such as estrogen metabolism, is essential in the progression of breast cancer but also particular SNPs can play an essential role in particular genes, such as CYP19A1. Different studies have demonstrated that these SNPs can be located in different sites of these genes, which are collected in this review. In a nutshell, more specific clinical trials are required to demonstrate the precise meditative role of anti-estrogen drugs in the treatment of ER+ breast cancer patients. Furthermore, more genotype analyses are needed to confirm the role of SNPs in the progression of breast cancer.

Conditional Human BRD4 Knock-In Transgenic Mouse Genotyping and Protein Isoform Detection

Bromodomain-containing protein 4 (BRD4) is an acetyl-lysine reader protein and transcriptional regulator implicated in chromatin dynamics and cancer development. Several BRD4 isoforms have been detected in humans with the long isoform (BRD4-L, aa 1-1,362) playing a tumor-suppressive role and a major short isoform (BRD4-S, aa 1-722) having oncogenic activity in breast cancer development. In vivo demonstration of the opposing functions of BRD4 protein isoforms requires development of mouse models, particularly transgenic mice conditionally expressing human BRD4-L or BRD4-S, which can be selectively induced in different mouse tissues in a spatiotemporal-specific manner. Here, we detail the procedures used to genotype transgenic mouse strains developed to define the effects of conditional human BRD4 isoform expression on polyomavirus middle T antigen (PyMT)-induced mouse mammary tumor growth, and the key steps for Western blot detection of BRD4 protein isoforms in those tumors and in cultured cells. With this protocol as a guide, interpretation of BRD4 isoform functions becomes more feasible and expandable to various biological settings. Adequate tracking of BRD4 isoform distributions in vivo and in vitro is key to understanding their biological roles, as well as avoiding misinterpretation of their functions due to improper use of experimental procedures that fail to detect their spatial and temporal distributions. Graphic abstract.

Evaluation of Bax and BCL 2 Genes Polymorphisms in Iraqi Women with Breast Cancer

The present study aimed to examine the polymorphism -938C > A of BCL-2 gene and promoter -248G>A in the Bax gene, as well as their relationship with specific clinical-pathological characteristics, in patients with breast cancer. Blood samples were obtained from 70 patients who had been diagnosed with breast cancer and 34 healthy women as the control group. Polymorphic analysis was performed using the polymerase chain reaction-restriction fragment length polymorphism assay. Anthropometric data were assessed. Estrogen receptor (ER), human epidermal growth factor receptor 2 (Her-2),  and progesterone receptor (PR) were measured by immunohistochemistry. The data of age and body mass index (BMI) demonstrated no significant variations between the two groups (P>0.05). The results of HER-2 revealed that 42.86% of breast cancer patients reflected positively for Her-2/neu expression, while 24.29% reflected negative results of Her-2/neu. Moreover, the results of ER revealed that 42.86% and 28.57% of subjects were positive and negative ER, respectively; moreover, the missing data was 28.57%. In addition, the results of PR indicated that 35.71% of patients (25/70) were positive for PR, while 28.57% reflected negative results, and the missing results were 35.71%. The genotype and allele frequencies of BCL-2(-938C>A) were not statistically significant in women with breast cancer and the control group (P=0.574, P=0.533) for heterozygous and recessive models, respectively. The genotype of BCL-2(-938C>A) in control and patients in codominant, dominant, recessive, and additive models demonstrated no significant variations of all genotypes in all groups. Genotypes and allele frequencies for Bax (-248G>A) in patients with breast cancer and control indicated that the frequencies of GG, AG, and AA genotypes in cases were 16.67%, 3.33%, and 80 %, while in controls, these values were 3.23 %, 58.06 %, and 3.23 %, respectively. The heterozygous genotype (AG) in the codominant model was OR=36.00 (95% CI 4.5608 - 284.1608; P=0.0007). In comparison with the wild type (GG), there was a 36-fold increase in the risk of breast cancer. Furthermore, the findings of this study revealed a significant correlation between Bax (-248G>A) polymorphism and breast cancer risk under the dominant and overdominant (OR=6.33; 95% CI 2.2604 -17.7452; P=0.0004, and OR=40.154; 95% CI 5.1365 - 313.8949; P=0.0004, respectively. The recessive model revealed that there was a decreased risk of breast cancer (OR= 0.167; 95% CI 0.0303 to 0.9168; P=0.039). Based on the results, it can be concluded that there were no significant variations in BCL-2 (-938C>A) polymorphism of all genotypes models when breast cancer women are compared with healthy ones. In a similar vein, there was no significant association between the BCL-2 (-938C>A) polymorphism and breast cancer risk under dominant, codominant, or recessive models.

Circular RNA circPRMT5 is upregulated in breast cancer and is required for cell proliferation and migration

BACKGROUND

To evaluate the role of cyclic protein arginine methyltransferase 5 (circPRMT5) in the occurrence and development of breast cancer (BC).

METHODS

A total of 90 BC patients who underwent radical mastectomy and 40 age-matched healthy female controls were recruited in the Second People's Hospital of China Three Gorges University, Yichang Second People's Hospital from 2017 to 2020. Quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to detect the expression levels of circPRMT5 in BC tissues, serum, normal breast cell line (MCF-10A), and BC cell line (T47D, MCF-7, BT549, Hs-578T, and MDA-MB-231, MDAMB-468). The associations between circPRMT5 expression level and age, tumor size, degree of differentiation, TNM stage, distant metastasis, estrogen receptor (ER) or progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status were analyzed. BC cell lines with circPRMT5 knockdown or overexpression were subject to CCK-8 cell proliferation assay, and transwell cell invasion/migration assay.

RESULTS

CircPRMT5 expression in BC tissue was higher than that in adjacent normal breast tissue. Consistently, the expression level of circPRMT5 was also elevated in serum samples collected from BC patients when compared with healthy controls. And in multiple breast cancer cell lines, circPRMT5 was upregulated as compared to normal breast epithelial MCF-10A cells. CircPRMT5 expression level was correlated with tumor size, TNM stage, lymph node metastasis distant metastasis, but no correlation was observed with ER, PR, HER2 status. Overexpression of circPRMT5 promoted the proliferation, invasion, and migration of MCF7 cells; while the knockdown of circPRMT5 inhibited cell proliferation, invasion, and migration.

DISCUSSION

CircPRMT5 seems to act as an oncogene in the progression of BC. Our data suggest that CircPRMT5 may be used as a biomarker for the diagnosis, prognosis evaluation, and targeted therapy of breast cancer.

Assessment of the Cytotoxic Activity of Alcoholic Extract of Eucalyptus camaldulensis on Breast Cancer Cell Line

The spread of different types of cancer has been on a rise in the recent century. The use of chemical medications develops drug resistance and causes serious side effects. Eucalyptus camaldulensis (E. camaldulensis) is one of the most famous herbal remedies considered owing to its anti-inflammatory effect and boosting the intimate immune system; moreover, it has demonstrated some anti-proliferative effects on cancerous cell lines. The current study assessed the cytotoxic activity of alcoholic extract of Eucalyptus camaldulensis (E. camaldulensis) at different concentrations of 6.125, 12.5, 25, 50, and 100 µg/mL on breast cancer cell line MCF-7. The 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) and 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid (ABTS)) analyses were employed to study the antioxidant efficiency of ethanolic extract of Eucalyptus camaldulensis. The results of Fourier transmission infra-red analysis and Phytochemical screening pointed to the presence of many active compounds in this extract, such as Tannins, Saponins, Phenolic compounds, Reducing sugar, Terpenoids, Steroids, Glucosides, Alkaloids, and Flavonoids. Furthermore, the results demonstrated that this extract significantly inhibited the growth of the MCF-7 cell line in a concentration-dependent manner, as compared to the control, and the cytotoxic activity of this extract elevated with an increase in the concentration. The results pointed out that E. camaldulensis can be considered a particularly valuable source of effective anti-proliferative and cytotoxic agents. The experimental findings demonstrated that E. camaldulensis extract possessed significant antioxidant efficiency and anti-proliferative effects on cancerous cell lines.

Downregulation of Stemness Genes and Induction of Necrosis in Rat LA7 Cancer Stem Cells Induced Tumors Treated with Starved Fibroblasts Culture Supernatant

BACKGROUND

Stem cell differentiation therapy is a promising strategy in cancer treatment. we show that protein cocktail prepared from serum starved fibroblasts has therapeutic potential based on this strategy.

METHODS

The condition medium was prepared from foreskin isolated fibroblasts and analyzed by Liquid chromatography electrospray ionization mass spectrometry-mass spectrometry (LC-ESI-MS/MS). LA7 mammary gland cancer stem cells originated tumors were induced in Sprague Dawley rats. The rats treated subcutaneously with DMEM (group A), condition medium (group B), or normal saline (group C) once daily for 7 days. Then the tumors were removed and divided into the two parts, one part was used to quantify gene expression by stem-loop RT-qPCR assay and the other part was used for Hematoxylin & Eosin (H & E), Giemsa, and immunohistochemistry (IHC) staining.

RESULTS

All induced tumors appeared as sarcomatoid carcinoma (SC). Immunohistochemistry staining confirmed this conclusion by recognizing the tumor as Ki67+, cytokeratin+, vimentine+, and estrogen receptor negative SC. RT-qPCR analysis revealed that Oct4-, Sox-2, Nanog- gene expression was much reduced in the condition medium treated tumors versus proper controls (p< 0.05). Tissue necrosis was more prevalent in this group while tumors volume was diminished almost by 40%. The LC-ESI-MS/MS analysis unrevealed the stemness reducing and the cell death inducing proteins such as, pigment epithelium-derived factor (PEDF), insulin like growth factor binding protein-5 (IGFBP-5) and -7 (IGFBP-7) in the condition medium.

CONCLUSION

This study showed that the substances released from starved human fibroblasts were able to down-regulate the stemness-related genes and induce necrosis in LA7 derived tumors.

Avoidant Insecure Attachment as a Predictive Factor for Psychological Distress in Patients with Early Breast Cancer: A Preliminary 1-Year Follow-Up Study

OBJECTIVE

To identify attachment insecurity as an associative factor with unresolved psychological distress 1 year after surgery in the early breast cancer (BC) population.

METHODS

One-hundred fourteen participants completed the Hospital Anxiety and Depression Scale (HADS) and the Experiences in Close Relationship (ECR-M36) questionnaire within 1 week (baseline) and at 1-year post-surgery (follow-up). Participants were categorized into the distress and the non-distress groups based on a HADS-total score cut-off of 15. Logistic regression analysis revealed predictive factors of distress at follow-up.

RESULTS

At baseline, 53 (46.5%) participants were found to be in the distress group. The degree of distress decreased over 1 year (p= 0.003); however, 43 (37.7%) showed significant remaining distress at follow-up. Baseline scores of the ECR-M36 avoidance [odds ratio (OR)=1.045, 95% confidence interval (CI)=1.002-1.090] and HADS-total (OR=1.138, 95% CI=1.043-1.241) were predictors of distress at follow-up.

CONCLUSION

A substantial proportion of early BC patients suffer distress even one-year after surgery. Avoidant attachment appeared to be an influential factor on distress in early BC patients. Moreover, the finding that initial distress level could predict one at 1-year postoperation warrant a screening and management of distress along with BC treatment.

The Comparison of Two Types of Relaxation Techniques on Postoperative State Anxiety in Candidates for The Mastectomy Surgery: A Randomized Controlled Clinical Trial

BACKGROUND

Anxiety among patients after surgery can affect their physiological and psychological well-being. The aim of this study was to investigate and compare the effects of Benson's relaxation and rhythmic breathing techniques on postoperative anxiety in candidates for the mastectomy surgery.

METHODS

This randomized controlled clinical trial study was conducted with ninety patients in 2013. The patients were hospitalized for the mastectomy surgery in three surgical wards in a teaching hospital, Tehran, Iran. They were randomly assigned into three groups: Benson's relaxation including the cognitive relaxation technique type, rhythmic breathing including the somatic relaxation technique type and control groups. According to the Davidson and Schwartz multi-process theory, the Benson's relaxation and the rhythmic breathing techniques have cognitive and somatic effects, respectively. One day before the surgery, the patients in the intervention groups were trained regarding relaxation and breathing techniques and were asked to perform the techniques under the supervision of the researcher in the night before the surgery. The cognitive somatic anxiety questionnaire was used to measure anxiety before the intervention and half an hour after recovery of consciousness after the surgery. Descriptive and inferential statistics were used for data analysis via the SPSS v.21 software.

RESULTS

There were no statistically significant differences between the groups in terms of demographic characteristics. The application of both techniques reduced the level of patients' anxiety after the surgery. The patients in the Benson's relaxation technique group reported only the relief of somatic anxiety. However, the breathing technique patients reported a reduction in both cognitive and somatic anxiety.

CONCLUSION

The Benson's relaxation and rhythmic breathing techniques can reduce postoperative anxiety in patients after the mastectomy surgery. Trial Registration Number: IRCT2014042017350N1.

[Malignant phyllodes tumour : a case report]

A 28 year old woman has suffered over the previous month from a post-traumatic swelling sensation of the left breast. Ultrasonography demonstrates a 9 cm, sharply-cut, rounded, hypo-echogenic lesion. Surgery is performed, with the hypothesis of an haematoma. The pathological analysis of the lesion shows a malignant phyllodes tumour with heterologous rhabdomyosarcomatous features. No metastasis is found. A radical mastectomy is performed and the patient benefits from an adjuvant radio-chemotherapy. Phyllodes tumours represent up to 1 % of all mammary cancers, with 10-20 % of malignant lesions. These tumours behave differently from usual breast cancers. This atypical case, arising in a traumatic context, provides the opportunity to discuss the treatment and classification of phyllodes tumours of the breast.