[Other approaches in breast cancer screening]. / Autres approches en dépistage du cancer du sein.

French breast cancer screening is based on organized screening with a mammography every two years for women between 50 and 74, and individualized screening for women at high or very high risk of breast cancer (personal history of breast cancer or atypical breast lesion or thoracic radiotherapy before the age of 25, high family risk without genetic mutation, genetic mutation). A novel approach of risk-based breast cancer screening is currently under evaluation in many countries, including France. This personalized screening, based on individual risk of having breast cancer in the next years, uses algorithms which combine clinical parameters, mammographic density, familial history and genomic (using polygenic risk score), to estimate breast cancer risk and adapt screening's frequency.

Effects of local laser treatment on vulvovaginal atrophy among women with breast cancer: a prospective study with long-term follow-up.

PURPOSE: Women with breast cancer (BC) often suffer from severe vulvovaginal atrophy (VVA) which ultimately leads to poor sexual and urinary quality of life. We conducted a prospective study among women with BC and VVA, in order to evaluate the long-term effect of laser therapy on VVA. METHODS: Women with BC and VVA were proposed to have fractional microablative CO2 laser therapy (MonaLisaTouch®, DEKA) once per month for 3 months. Efficacy of laser therapy was assessed at baseline, 6 months and 18 months after treatment, using Female Sexual Function Index (FSFI) score, Ditrovie score and vaginal pH. A pap smear was also performed and the epithelial maturation pattern was noted. Paired statistical tests were used to compare results between baseline, 6 months and 18 months. RESULTS: 46 women with BC (median age [interquartile range] 56.5 years [47.0 - 59.4]) were included between May and October 2018. PH level slightly decreased over time (mean Δ at 18 months -0.3, SD = 0.7, p = 0.02) whereas maturation pattern on pap smear did not change. Sexual quality of life was significantly improved at 6 months and 18 months (mean Δ at 6 months 8.3, SD = 6.2 (p < 0.0001) and mean Δ at 18 months 4.3, SD = 8.4 (p = 0.01)). Ditrovie total score improved at 6 months (mean Δ -1.2, SD = 2.7, p = 0.01) but returned to baseline afterwards. Side effects were very mild. Three women developed low (2)- and high (1)-grade HPV-linked cervical lesions during follow-up. CONCLUSION: Among women with BC, fractional microablative CO2 laser is effective on the long term on VVA symptoms and gynaecological quality of life. TRIAL REGISTRATION NUMBER: ID-RCB 2018-A01500-55.

Breast tissue density change after oophorectomy in BRCA mutation carrier patients using visual and volumetric analysis.

OBJECTIVE: BRCA1/2 mutations account for 30-50% of hereditary breast cancers and bilateral oophorectomy is associated with a reduced risk of breast cancer in these patients. Breast density is a well-established breast cancer risk factor and is also associated with increased risk in BRCA carriers. The aim of the study was to evaluate the impact of oophorectomy on mammographic breast density and to assess which method of breast density assessment is more sensitive to change over time. METHODS: Retrospective study of 50 BRCA1/2 patients who underwent bilateral oophorectomy and had at least a baseline and post-surgery mammogram. Mammographic breast density was determined by Volpara and consensus visual assessment by two radiologists. The primary endpoint was change in density between baseline and the first mammogram post-surgery. RESULTS: At baseline, there was a non-significant trend for decreased density with increasing age. Volumetric breast density (VBD) significantly decreased after oophorectomy from a median VBD of 12.5% at baseline to 10.2% post-surgery which was driven by a reduction in fibroglandular volume. There was a higher absolute decrease in VBD in patients aged between 40-50 (p < 0.01). Using Volpara Density Grades (analogous to BI-RADS 4th edition density categories), 84% of females displayed a decrease in density category over the study period compared to only 76% using the radiologists' visual classification (p < 0.001) Conclusion: Oophorectomy is associated with a decrease in breast density and younger patients exhibit a larger absolute decrease. Volpara is more sensitive to identify change over time compared to visual assessment. Advances in knowledge: Oophorectomy is associated with a significant decrease in VBD in patients with BRCA mutations and Volpara Density Grades were more sensitive to identify decreases in density compared to visually assessed BI-RADS categories. Decreases in breast density following oophorectomy surgery in BRCA patients may be one of the mechanisms contributing to the observed decreased breast cancer risk after surgery. However, further studies are needed to investigate the relationship between breast density, oophorectomy and breast cancer risk in BRCA patients.

Breast intracystic papillary carcinoma: an update.

Intracystic papillary carcinoma (IPC), a breast tumor mainly occuring in the elderly, has long been considered as a variant of ductal carcinoma in situ (DCIS). This is now debated since metastatic cases have been reported. In this study, surgical pieces of 20 IPCs were reassessed, and markers of myopepithelial layer (p63, CD10 and Smooth Muscle Actin) as well as estrogen receptors (ER) and progesterone receptors (PgR) and C-erb-B2 oncoprotein expression were systematically performed and quantified. In 10 cases, an associated unequivocal invasive component was found. In all 20 cases, no myoepithelial layer was found. Eighteen tumors were ER positive, 14 were PgR positive. Moreover, none of the tumors over-expressed C-erb-B2 oncoprotein. Therefore this study showed that in all cases of IPC there were microscopic features of invasive carcinoma despite good clinical prognostic indicators, and that precise characterization of tumors requires extensive paraffin embedding of surgical pieces.