Need assessment for the content of educational programs about breast cancer from the viewpoint of unaffected women.

BACKGROUND: Breast cancer is the most common cancer among females, and early diagnosis is possible in case the patients seek medical attention on time. For this to come true, they must know about the existence and risks of the disease and be aware of the appropriate attitude and actions toward prevention or early diagnosis. However, we see that women have unanswered questions about these issues. In this study, we sought to investigate healthy women's information needs about breast cancer from their own perspective. METHODS: This prospective study was carried out by using the maximum variation sampling, and theoretical saturation to reach sample saturation. Women who came to different clinics of Arash Women's Hospital (except the Breast Clinic) during two months were entered in the study. Participants were asked to write down all the questions and subjects they would like to be explained in a breast cancer educational program. The questions were reviewed and categorized after every fifteen consecutive forms were filled until there was not even one new question. Afterwards, all the questions were reviewed and matched based on their similarity and repeated items were eliminated. Finally, questions were organized according to their common topics and the range of details they comprised. RESULTS: Sixty patients were included in the study, and 194 questions were gathered and categorized according to common scientific terms, resulting in 63 questions in 5 categories. CONCLUSIONS: Many studies have been conducted on breast cancer education, but none have addressed healthy women's personal queries. This study outlines the questions of unaffected women about breast cancer that need to be addressed in educational programs. The results can be used for development of educational material at community level. TRIAL REGISTRATION: This study was conducted as the preliminary phase of a study approved in Tehran University of Medical Sciences (Approval Code 99-1-101-46,455) and by the Ethics Committee of the University (Ethical Code IR.TUMS.MEDICINE.REC.1399.105).

COVID-19 Outbreak and Consequent Delays in Schedules of the Breast Clinic: Effects on Patients' Breast and Emotional Symptoms.

OBJECTIVE: The pandemic of COVID-19 has affected many aspects of life, and emotional symptoms have been reported to worsen during this time. Also, elective visits in the Breast Clinic have been cancelled or postponed based on the priorities defined in local and international guidelines. Our aim was to investigate the effect of these delays on the breast symptoms and emotional status of our patients. MATERIALS AND METHODS: We called patients whose appointments should have taken place between March and May 2020. After asking for their consent to participate in the study, we asked questions about their breast and emotional symptoms and any worsening of these due to cancellation of their schedules because of the COVID-19 outbreak. We also inquired the relation of breast symptoms with news and thoughts about COVID-19, and if the patients or their close relatives or friends had been affected by COVID-19. We compared the worsening of breast symptoms in patients with and without a positive self- or family history of COVID-19. RESULTS: None of the breast or emotional symptoms had significantly got worse in the patients. Also, there was no significant difference between the two groups regarding the changes in their breast symptoms or emotional health. CONCLUSION: We believe that these results might be evidence in favor of the Breast Clinic triage system, which conforms to most international and specifically to our local recommended strategies.

Aspects of Anesthesia for Breast Surgery during Pregnancy.

Non-obstetric surgery is needed in 0.75-2% of pregnant women, and safety of anesthesia for mother and child are key points at this time. Some breast diseases need to be approached in a short time interval, and surgery must be performed during pregnancy . In these cases, the technique of anesthesia regarding local, regional or general anesthesia and type of anesthetic medicine are selected based on the extent of the procedure, gestational age, and condition of the mother and child. The ideal timing for any surgery during pregnancy is in the second trimester because the risk of fetal adverse effects as well as preterm labor are lower. However, surgery of breast cancer during pregnancy is performed in any trimester as guided by treatment guidelines and is not deferred based on anesthesia preferences. Various types of anesthesia for breast surgery during pregnancy , preoperative and postoperative considerations are discussed in this chapter.

Phyllodes Tumor of the Breast in Pregnancy and Lactation.

Phyllodes tumor constitutes around 1% of all and 2.5% of fibroepithelial breast lumps. Three types including benign, borderline, and malignant tumors have been described. The benign variant is the most common, is close to fibroadenoma, but is usually larger and recurs more frequently. The rare malignant type is aggressive. Standard treatment consists of lumpectomy with appropriate margins for benign phyllodes tumor, while the borderline and malignant variants must be treated by wide resection or mastectomy. Phyllodes tumor is a rare tumor in pregnancy and lactation, and the effect of gestational alterations in hormone levels on this tumor have not been discussed in the literature, except for several case reports. In summary and alluding to our recent literature review, large size, fast growth, bilaterality, and probably malignancy are more commonly expected in gestational phyllodes tumors.

Phyllodes Tumor of the Breast during Pregnancy and Lactation; A Systematic Review.

BACKGROUND: Phyllodes tumor (PT) is a rare tumor of the breast, which may occur during pregnancy or lactation. Several studies have reviewed and discussed PT occurring in pregnancy, gathering up to 14 patients. We performed a thorough systematic review of the literature in an attempt to find all reported cases, and identify their common characteristics. METHODS: We searched Google scholar, PubMed, Ovid Medline, Scopus and ClinicalTrials.gov with several relevant combinations of keywords, looking for texts or abstracts without any date or language limitations, but using only English keywords. The existing literature only consisted of case reports and series; therefore any paper including one or several cases of PT presenting during pregnancy or breastfeeding was recognized as eligible. Articles with vague description of the tumor which made the diagnosis uncertain, and those lacking data about the tumor and management data were excluded. We contacted authors for more details in cases with incomplete information. RESULTS: After excluding those with very deficient data, we included 37 studies, counting 43 cases. The mean age of the patients was 31 years (21-43 years). Some features were different from usual PT: bilaterality (16.2%), large size (14.2 ± 8.6 cm), rapid enlargement (79.5%), and rate of malignancy (60.5%). CONCLUSION: Our findings show high rates of bilaterality, large size, rapid growth, and malignant pathology in the reported gestational PTs.

Systematic review of effects of pregnancy on breast and abdominal contour after TRAM/DIEP breast reconstruction in breast cancer survivors.

Transverse rectus abdominis myocutaneous (TRAM) and its derivatives are the most commonly performed autologous breast reconstruction procedures. These procedures were not recommended in the past for those who planned for subsequent childbearing because of the transposition of portions of the abdominal wall during the procedure into the anatomic position of the breast, implying possible adverse effects over the contour of these manipulated areas during pregnancy and delivery. We conducted a systematic review to assess the literature on esthetic or functional consequences of childbearing over the breast and abdomen after these procedures in patients that were affected by breast cancer. A comprehensive literature search in databases and citation indexes was conducted from February 2014 to April 2015. Any paper on pregnancy after breast reconstruction by TRAM or its derivatives and modifications, written in English or French, were included. The search results underwent a first screening to exclude duplicate and irrelevant papers. Full texts were then reviewed as to the criteria for inclusion, and data were extracted into data extraction forms from eligible papers. The initial search yielded 5132 articles. After screening and review, overall 17 papers met all criteria for inclusion in this review. Our work revealed that uneventful pregnancy and delivery can be anticipated in breast cancer survivors who had undergone breast reconstruction via TRAM or its derivatives with minor negative effects on either the breast or the abdomen.

Benefits and harms of phytoestrogen consumption in breast cancer survivors.

Worldwide, breast cancer is the most common malignant neoplasm and the second most common cause of cancer death in women. This malignancy is recognized to be estrogen-dependent and due to this feature, hormone replacement therapy is regarded as potentially dangerous in breast cancer survivors who seek relief of their menopausal symptoms. Whereas hot flashes are detected in nearly half of postmenopausal women with a relatively high frequency and severity, botanic sources of estrogens have been proposed as an alternative treatment. Nevertheless, estrogenic properties of these compounds suggest possibility of stimulating cancer recurrence or worsening prognosis in survivors. As well, effects in improving vasomotor climacteric changes is controversial. Many studies have considered the subject, some focusing on efficacy of phytoestrogens for control of menopausal symptoms, and others discussing effects of these compounds on breast cancer outcome in terms of survival or recurrence. The present article is a concise review of the effects of consumption of phytoestrogens on menopausal symptoms, namely hot flashes, and breast cancer recurrence and mortality in survivors of the disease. Overall, the major part of the current existing literature is in favor of positive effects of phytoestrogens on breast cancer prognosis, but the efficacy on menopausal symptoms is probably minimal at the best.