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BACKGROUND: Despite its excellent screening effectiveness and sensitivity for breast cancer (BC), digital breast tomosynthesis (DBT) is controversial due to its high radiation exposure and long reading time. This study examines the diagnostic accuracy of DBT and digital mammography (DM) for BC screening and diagnosis in women with dense or non-dense breast tissue. MATERIAL AND METHODS: PRISMA-compliant searches were performed on Medline, Embase, PubMed, Web of Science, and the Cochrane databases for articles comparing DBT and DM for BC screening until March 2023. Meta-analysis was performed using RevMan sofware, and the Cochrane Risk of Bias Assessment Tool was employed to assess study quality. RESULTS: This meta-analysis included 11 trials with a total of 2,124,018 individuals. Screening with DBT resulted in a greater cancer detection rate, as demonstrated by a risk ratio (RR) of 1.27 (95% confidence interval (95% CI): 1.14-1.41). Digital breast tomosynthesis also had a reduced recall rate, with a RR of 0.88 (95% CI: 0.78-0.99), higher sensitivity and specificity values (pooled sensitivity of 0.91 (95% CI: 0.59-0.99)) and pooled specificity of 0.90 (95% CI: 0.42-1.0)) than DM (pooled sensitivity of 0.86 (95% CI: 0.52-1.0) and pooled specificity of 0.81 (95% CI: 0.12-1.0)). All acquired data exhibited reliability, lack of bias and statistical significance (p < 0.05). CONCLUSION: Digital breast tomosynthesis is a more effective screening and diagnostic assessment tool for women with dense or non-dense breasts than DM in terms of incremental cancer detection, sensitivity and recall rate.
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Background: Inflammation contributes to cancer pathobiology through different mechanisms. Higher levels of pro-inflammatory cytokines can lead to hyperinflammation and promote cancer development and metastasis. For cancer treatment, Doxorubicin (DOX) can be encapsulated into the poly-lactic-glycolic acid (PLGA) nanoparticles. This study aimed to investigate the impact of doxorubicin-loaded PLGA nanoparticles (DOX-PLGA NP) on the expression of pro-inflammatory genes TNF-α, IL-6, iNOS, and IL-1ß in the MCF-7 cells. Methods: The DOX-PLGA NP was prepared by loading doxorubicin into PLGA and characterized using dynamic light scattering (DLS) and atomic force microscopy (AFM). The cytotoxic effect of the nanoparticles was determined by the MTT assay, and their impacts on the expression of pro-inflammatory genes were assessed by qRT-PCR. Results: The encapsulation efficiency and loading capacity were 60±1.5 and 1.13±0.21 percent, respectively. The zeta potential and mean DOX-PLGA nanoparticle size were -18±0.550 mV and 172±55.6 nm, respectively. The 50% inhibitory concentration (IC50) of the DOX-PLGA NP on MCF-7 cell viability was 24.55 µg/mL after 72 hours of treatment. The qRT-PCR results revealed that the 20 µg/mL concentration of the DOX-PLGA NP significantly suppressed the expression of the pro-inflammatory genes TNF-α, IL-6, iNOS, and IL-1ß compared to DOX alone (20 µg/mL). Additionally, the suppression effect of DOX-PLGA NP on the expression of these pro-inflammatory genes was dose-dependent. Conclusions: These results show that DOX-PLGA NP efficiently suppressed the expression of pro-inflammatory genes. Furthermore, encapsulation of DOX into PLGA nanoparticles significantly improved the effectiveness of DOX in suppressing pro-inflammatory genes in MCF-7 breast cancer cells.
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Introduction: Conservative surgery is the gold standard for the treatment of single and small tumors and, combined with the concept of oncoplastic tumors, brings good aesthetic results while maintaining cancer safety. The objective was to comparatively analyze the degree of satisfaction of patients undergoing breast conserving surgery (BCS), with and without oncoplastic surgery (OPS) using level II OPS techniques. Methods: Review with a search in the databases MEDLINE (by PubMed), EMBASE, Clinical Trials, Scopus, Web of Science, BVS and Oppen gray. The meta-analysis of random effects was performed using the Der Simonian-Laird method considering the odds ratio (OR) with a 95% confidence interval (95% CI). Results: There was no statistically significant difference in the aesthetic outcome between women who underwent OPS and BCS (OR 0.90; 95% CI 0.62-1.30). The staging (OR 1.93; 95% CI 0.97-3.84; I 2 = 15.83%); tumor location [central (OR 1.28; 95% CI 0.06-27.49; I 2 = 17.63%); lower (OR 0.75; 95% CI 0.21-2.65; I 2 = 2.21%); superior (OR 0.67; 95% CI 0.26-1.74; I 2 = 0.00%] and tumor size (OR 8.73; 95% CI -11.82-29.28; I 2 = 93.18%) showed no association with the type of BCS performed, with or without OPS. The degree of satisfaction remains even in cases of extreme oncoplasty. Conclusion: The level of patient satisfaction in relation to BCS was similar to that of the group undergoing OPS, highlighting that OPS allows the patient's satisfaction rate to be maintained even in the case of large or multicentric tumors.
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Introduction: Screening and postoperative intervention of breast tumors are critical for the effective diagnosis and treatment of disease development, and reliable diagnostic/screening methods become a key link. Objective: Thromboelastogram (TEG), routine platelet (PLT) count, and the coagulation function indicators in patients with different breast diseases were determined and analyzed to explore their predictive value in secondary bleeding disorders. Methods: A total of 131 patients with breast diseases, admitted to Jiangsu University Affiliated Hospital from January 2019 to December 2022, were selected as the research subjects. The detection items were analyzed using the receiver operating curve (ROC) after grouping for secondary bleeding disorders of patients with breast cancer. Results: The reaction (R) and the coagulation (K) times were lower in the malignant breast disease group, while the coagulation angle (α), maximum amplitude (MA), coagulation index (CI), fibrinogen (FIB), and D-dimer (D-D) were higher than those in the benign breast disease group. The t-tests proved that the MA and FIB values were statistically significant (p < 0.05) in the benign and malignant breast disease groups. The R and K in patients with breast diseases were positively correlated with the activated partial thromboplastin time (aPTT) and D-D, but were negatively correlated with PLT. The α angle was negatively correlated with aPTT and D-D, but was positively correlated with PLT. The MA for PLT function was positively correlated with FIB and PLT. CI was negatively correlated with aPTT, thrombin time (TT), and D-D, but was positively correlated with PLT. ROC curve analysis showed that the CI and α angle had a significant predictive value, whereas the correlation of the other indicators was relatively low. Conclusion: Coagulation tests showed significant differences in patients with breast cancer, differing from those with benign breast diseases. TEG combined with conventional coagulation indicators is potentially valuable for the prediction of secondary bleeding disorders in patients with breast cancer.
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Breast cancer (BC) is one of the most common cancers with rare incidence of possible metastatic disease to the gastrointestinal (GI) tract. Early clinical suspicion is important for a timely referral to gastroenterology and for executing a treatment plan. It is difficult to distinguish primary gastric or colon cancer from metastatic disease, and the diagnosis of metastasis can only be established by pathological and immunohistochemistry analysis. We report an interesting case who had metastatic BC to cervical and axillary lymph nodes and was treated with radiation and endocrine therapy. She remained asymptomatic for years, then was found to have rising tumor markers on regular follow-up visits that led to an extensive workup that was negative for tumor recurrence. Five years after radiation therapy, she developed GI symptoms and was referred for esophagogastroduodenoscopy (EGD) and colonoscopy, revealing extensive GI metastatic disease involving the stomach to the rectum. For a patient with metastatic BC who presents with rising tumor markers or gastric symptoms, it is important to do diagnostic studies to rule out GI metastatic disease when no primary disease is identified in the workup.
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Background and aim Psychiatric pathology does not always start on its own but may be conditioned or triggered by a comorbidity with a high impact on the human psyche. When there are comorbidities, psychiatric pathology can occur due to the high diagnostic burden. Our study aims to find out if there is a correlation between the diagnosis of breast cancer and its severity, and psychiatric symptoms such as depressive mood, atypical anxiety, or even autolytic ideation that directly influence the quality of life of patients. Materials and methods The study is a prospective, cross-sectional, single-center study carried out between December 2023 and June 2024 at the MureÈ County Clinical Hospital in Romania. The sample population had to be at least 18 years old and had to be diagnosed with breast cancer recently. We applied two tests, WHODAS 2 (World Health Organization's Disability Assessment Schedule 2.0) and level 1 (level 1 of cross-sectional measurements of symptoms), to be able to measure and aid assessment of mental health domains that are important across psychiatric diagnoses and also the degree of disability triggered by breast cancer. The statistical analysis included descriptive statistics and interferential statistics. Statistical tests, such as Shapiro-Wilk, Kruskal-Wallis, and Mann-Whitney U tests with Bonferroni correction tests, were used. The p-value was set to 0.05 with a confidence interval (CI) of 95%. Results The study included 120 women diagnosed with breast cancer, with a mean age of 56.64 ± 9.46 years. Regarding the severity of the diagnosis, 44 women (36.66%) had non-invasive cancer, 58 (48.33%) had invasive cancer, and 18 (15%) had metastases. There was a statistically significant difference between three of the five selected level 1 domains across cancer types. The WHODAS 2.0 disability scores showed a significant difference between groups (p < 0.001). Subjects with non-invasive cancer had the lowest WHODAS 2.0 score, followed by the invasive group, while metastases had the highest score. Conclusions Following the application of the two tests, level 1 and WHODAS 2.0, to our group of subjects, statistically significant differences were observed between the three categories of subjects. The degree of disability and the occurrence of psychological symptoms differed according to the severity of breast cancer. Adapting to the status of an oncological patient entails multiple changes from a psycho-emotional, social, occupational, and professional point of view. Although the most recent medications prolong survival, a holistic approach that considers psychological aspects can improve patients' long-term results.
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Breast cancer remains the most common cancer in women worldwide. Among women with breast cancer, brain metastases are very prevalent among HER2-positive and affect those in the advanced stages of the disease. Various factors, including molecular subtypes, performance status, extracranial disease status, leptomeningeal metastasis, and the number of lesions, significantly influence the prognosis of patients with brain metastases from breast cancer (BCBrM). Understanding and addressing the specific risks associated with different breast cancer subtypes is crucial for developing tailored and effective medical treatments. This report presents a case of a breast cancer patient with recurrent disease and brain metastases who achieved long-term survival following a treatment regimen that included radiotherapy and a T-DM1 biosimilar.
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Aim Breast cancer is the most frequently diagnosed cancer and the primary cause of cancer-related mortality among women. Advances in medical science have led to chemotherapy drugs that significantly reduce cancer mortality and increase patient's life expectancy. However, the systemic nature of chemotherapy leads to a wide range of physical and psychosocial challenges. Chemotherapy is usually given on an outpatient basis and hence patients have to manage treatment-related symptoms at home. This study aimed to evaluate the efficacy of early health intervention programs, specifically health education and progressive muscle relaxation, in managing the adverse effects of chemotherapy among women with breast cancer. Methods A randomized controlled trial was carried out at the chemotherapy unit of a tertiary care hospital in Thiruvananthapuram, Kerala, India. The research involved 340 female breast cancer patients receiving their initial chemotherapy cycle, divided equally into an experimental group and a control group. Patients in the intervention group received an early health intervention program on the day of their first chemotherapy cycle. These interventions included a 40-minute session comprising health education to manage the adverse effects of chemotherapy at home and a demonstration of progressive muscle relaxation techniques, which must be practiced by the patients two times daily till the end of chemotherapy. Participants in the control group received routine care from the hospital. The primary outcome variable was the adverse effects of chemotherapy. Sociodemographic and clinical information were collected using a structured questionnaire. The severity of adverse effects was assessed using the Common Terminology Criteria for Adverse Events, version 3 (CTCAE v3). Result The average age of participants was 54.7 ± 9.7 years in the control group and 52.4 ± 9 years in the experimental group. The majority in both groups had invasive breast cancer, with 144 (84.7%) in the control group and 153 (90%) in the experimental group. In the post-test, most participants in the control group experienced severe fatigue (136, 80%), mucositis (82, 48.2%), nausea (83, 49.1%), and vomiting (81, 47.6%). Conversely, the majority in the experimental group reported mild mucositis (110, 64.7%), nausea (92, 54.1%), and vomiting (93, 54.7%), along with moderate fatigue (116, 68.2%). Hair loss was incomplete for all participants in the control group and 115 (97.6%) participants in the experimental group. There was a significant difference between the experimental and control groups regarding fatigue (p < 0.001), insomnia (p < 0.01), anorexia (p < 0.01), mucositis (p < 0.01), nausea (p < 0.01), vomiting (p < 0.01), leukopenia (p = 0.001), neutrophil count (p < 0.01), hair loss (p < 0.05), and taste alteration (p < 0.01) during the post-test. Conclusion The study demonstrated that early health interventions, such as health education and progressive muscle relaxation, significantly reduced the adverse effects experienced by breast cancer patients undergoing chemotherapy. This suggests that providing supportive education and exercise training to both patients and caregivers can be beneficial in managing these side effects.
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BACKGROUND: The quality of treatment plans for breast cancer can vary greatly. This variation could be reduced by using dose prediction to automate treatment planning. Our work investigates novel methods for training deep-learning models that are capable of producing high-quality dose predictions for breast cancer treatment planning. PURPOSE: The goal of this work was to compare the performance impact of two novel techniques for deep learning dose prediction models for tangent field treatments for breast cancer. The first technique, a "glowing" mask algorithm, encodes the distance from a contour into each voxel in a mask. The second, a gradient-weighted mean squared error (MSE) loss function, emphasizes the error in high-dose gradient regions in the predicted image. METHODS: Four 3D U-Net deep learning models were trained using the planning CT and contours of the heart, lung, and tumor bed as inputs. The dataset consisted of 305 treatment plans split into 213/46/46 training/validation/test sets using a 70/15/15% split. We compared the impact of novel "glowing" anatomical mask inputs and a novel gradient-weighted MSE loss function to their standard counterparts, binary anatomical masks, and MSE loss, using an ablation study methodology. To assess performance, we examined the mean error and mean absolute error (ME/MAE) in dose across all within-body voxels, the error in mean dose to heart, ipsilateral lung, and tumor bed, dice similarity coefficient (DSC) across isodose volumes defined by 0%-100% prescribed dose thresholds, and gamma analysis (3%/3 mm). RESULTS: The combination of novel glowing masks and gradient weighted loss function yielded the best-performing model in this study. This model resulted in a mean ME of 0.40%, MAE of 2.70%, an error in mean dose to heart and lung of -0.10 and 0.01 Gy, and an error in mean dose to the tumor bed of -0.01%. The median DSC at 50/95/100% isodose levels were 0.91/0.87/0.82. The mean 3D gamma pass rate (3%/3 mm) was 93%. CONCLUSIONS: This study found the combination of novel anatomical mask inputs and loss function for dose prediction resulted in superior performance to their standard counterparts. These results have important implications for the field of radiotherapy dose prediction, as the methods used here can be easily incorporated into many other dose prediction models for other treatment sites. Additionally, this dose prediction model for breast radiotherapy has sufficient performance to be used in an automated planning pipeline for tangent field radiotherapy and has the major benefit of not requiring a PTV for accurate dose prediction.
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Breast cancer related lymphedema (BCRL) affects many breast cancer survivors and drastically affects their quality of life. There are several surveillance methods for BCRL that are critical at early detection. Prevention of BCRL involves knowledge of alternatives to aggressive axillary surgery, avoidance of axillary surgery, and de-escalation of axillary surgery. There are also techniques to better delineate the anatomy in the axilla to avoid taking nodes that drain the upper extremity. A multidisciplinary approach with medical oncology and radiation oncology can also help avoid unnecessary surgery or radiation that can together strongly increase the risk of BCRL.
Subject(s)
Axilla , Breast Cancer Lymphedema , Breast Neoplasms , Lymph Node Excision , Humans , Female , Breast Cancer Lymphedema/prevention & control , Breast Cancer Lymphedema/etiology , Breast Cancer Lymphedema/therapy , Breast Neoplasms/surgery , Lymph Node Excision/adverse effects , Lymphedema/etiology , Lymphedema/prevention & control , Quality of Life , Mastectomy/adverse effectsABSTRACT
Surgery for the management metastatic breast cancer has traditionally been considered a palliative procedure. However, some retrospective publications indicated that there may be a survival benefit to surgery in the presence of metastatic disease. Recent randomized trials will be reviewed for both management of the intact primary tumor in de novo breast cancer and systemic secondary metastases.
Subject(s)
Breast Neoplasms , Neoplasm Staging , Humans , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Female , MastectomyABSTRACT
Papillary endothelial hyperplasia (PEH) or Masson's tumor is a rare benign vascular tumor that usually appears in the soft tissues of the head and neck, trunk and extremities, being extremely rare in the breast. Its diagnosis can be a challenge, especially in the follow-up of patients with previous disease of breast carcinoma. We present the case of a 65-year-old patient, with a history of bilateral breast cancer and reconstruction with implants, who presented a Masson's tumor during follow-up. An ultrasound scan was performed, showing a well-circumscribed mass in the left breast, located in the posterior contour of the implant. Subsequently, magnetic resonance imaging (MR) depicted an enhancing tumor, without infiltration of adjacent structures. Finally, the definitive anatomopathological diagnosis was obtained after surgical excision.
Subject(s)
Breast Diseases , Breast Neoplasms , Hyperplasia , Humans , Aged , Female , Hyperplasia/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Breast Diseases/diagnostic imaging , Breast Diseases/pathology , Magnetic Resonance ImagingABSTRACT
PURPOSE: Receptor and subtype discordance between primary breast tumours and metastases is a frequently reported phenomenon. The aim of this article is to review the current evidence on receptor discordance in metastatic breast cancer and to explore the benefit of performing a repeat biopsy in this context. METHODS: Searches were undertaken on PubMed and Clinicaltrials.gov for relevant publications and trials. CONCLUSION: The current guidelines recommend offering to perform a biopsy of a metastatic lesion to evaluate receptor status. The choice of systemic therapy in metastatic disease is often based on the receptor status of the primary lesion. As therapeutic decision making is guided by subtype, biopsy of the metastatic lesion to determine receptor status may alter treatment. This article discusses discordance rates, the mechanisms of receptor discordance, the effect of discordance on treatment and survival outcomes, as well as highlighting some ongoing clinical trials in patients with metastatic breast cancer.
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BACKGROUND: Conventional advice to reduce the risk of breast cancer-related lymphedema (BCLE) suggests avoidance of daily-living risks, and limited research has investigated these risks. OBJECTIVE: This study aimed to examine the occurrence, patterns, and effects of daily-living risks on BCLE. METHODS: A cross-sectional design was used to collect data from 567 patients at a metropolitan cancer center in the United States. The Lymphedema Risk-Reduction Behavior Checklist was used to assess the occurrence of 11 daily-living risks. Descriptive, regression, and factor analyses were performed. RESULTS: Significant odds of BCLE were associated with infection (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.95-3.42), cuts/scratches (OR 2.65, 95% CI 1.97-3.56), sunburn (OR 1.89, 95% CI 1.39-3.56), oil splash or steam burns (OR 2.08, 95% CI 1.53-3.83), and insect bites (OR 1.59, 95% CI 1.18-2.13). The daily-living risks were clustered into factors related to skin trauma and carrying objects. Skin trauma risk was significantly associated with BCLE (B = 0.539, z = 3.926, OR 1.714, 95% CI 1.312-2.250; p < 0.001). Having three, four, or five skin trauma risks significantly increased the odds of BCLE to 4.31, 5.14, and 6.94 times, respectively. The risk of carrying objects had no significant or incremental effects on BCLE. CONCLUSION: Complete avoidance of daily-living risks is challenging given 52.73% of patients incurred more than five daily-living risks. Our study findings underscore the importance of 'what to do' strategies to minimize infection and skin trauma.
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BACKGROUND: Oncology databases that integrate genomic and clinical data have become valuable resources for precision medicine. However, the generalizability of these databases has not been comprehensively assessed. OBJECTIVES: To describe the demographics, clinical characteristics, treatments, and overall survival of breast cancer cohorts in GENIE-BPC and three other databases. METHODS: This study utilized GENIE-BPC, SEER, SEER-Medicare, and Merative MarketScan Research Databases. Women with invasive breast cancer were identified through EHR, cancer registries or ICD-9/10-CM codes. The ages were 18+ years or per database requirement. Treatments were based on EHR or HCPCS/NDC codes in claims. Overall survival was estimated as time from diagnosis to death. RESULTS: Of female breast cancer patients in GENIE-BPC (n = 775), SEER (n = 548 336), SEER-Medicare (n = 68 914), and Marketscan (n = 109 499) databases, the median ages at initial diagnosis were 44, 62, 74, and 57 years, respectively. A greater proportion of patients in GENIE-BPC, compared to SEER/SEER-Medicare, had higher nuclear grades (%III-%IV: 57% vs. 26%/24%), advanced disease stage (%IV: 25.3% vs. 5%/3.6%), percent of triple negative breast cancer (19.7% vs. 10.2%/8.5%), and receipt of chemotherapy (85.0% vs. NA/22.3%). The 1-, 3-, and 5-year overall survival rates were lower in GENIE-BPC (78.5%, 60.5%, 55.5%) than in SEER (95.8%, 89.5%, 85.5%) and SEER-Medicare (91.6%, 81.4%, 75.0%). CONCLUSION: Breast cancer patients in GENIE-BPC were younger, had more advanced disease, had a higher proportion of triple negative breast cancer and recipients of chemotherapy, and had poorer overall survival. Researchers must use statistical adjustment when extrapolating results (e.g., biomarker prevalence) from GENIE-BPC to the larger breast cancer population.
Subject(s)
Breast Neoplasms , Databases, Factual , Genomics , SEER Program , Humans , Female , Breast Neoplasms/therapy , Breast Neoplasms/genetics , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Middle Aged , Aged , Adult , United States/epidemiology , Cohort Studies , Precision Medicine/methods , Aged, 80 and over , Young AdultABSTRACT
The truancy of representation of the estrogen, progesterone, and human epidermal growth factor receptors occurs during TNBC. TNBC is recognized for the upper reappearance and has a poorer diagnosis compared with rest breast cancer (BC) types. Presently, as such, no targeted therapy is approved for TNBC and treatment options are subjected to chemotherapy and surgery, which have high mortality rates. Hence, the current article focuses on the scenario of TNBC vital pathways and discusses the latest advances in TNBC treatment, including immune checkpoint inhibitors (ICIs), PARP suppressors, and cancer vaccines. Immunotherapy and ICIs, like PD 1 and PD L1 suppressors, displayed potential in clinical trials (CTs). These suppressors obstruct the mechanisms which allow tumor cells to evade the system thereby boosting the body's defense against TNBC. Immunotherapy, either alone or combined with chemotherapy has demonstrated patient outcomes such as increased survival rates and reduced treatment-related side effects. Additionally, targeted therapy approaches include BRCA/2 mutation poly ribose polymerase inhibitors, Vascular Endothelial Growth Factor Receptor (VEGFR) inhibitors, Epidermal growth factor receptor inhibitors, Fibroblast growth factor inhibitors, Androgen Receptor inhibitors, PIK3/AKT/mTOR pathway inhibitors, Cyclin-dependent kinase (CDK) inhibitors, Notch signaling pathway inhibitors, Signal transducer and activator of transcription 3 (STAT3) signaling pathway inhibitors, Chimeric antigen receptor T (CAR-T) cell therapy, Transforming growth factor (TGF) -ß inhibitors, Epigenetic modifications (EPM), Aurora Kinase inhibitors and antibody-drug conjugates. We also highlight ongoing clinical trials and potential future directions for TNBC therapy. Despite the challenges in treating TNBC, recent developments in understanding the molecular and immune characteristics of TNBC have opened up new opportunities for targeted therapies, which hold promise for improving outcomes in this aggressive disease.
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Background: Multiple primary malignant tumors (MPMTs) pose a significant clinical challenge, denoting the occurrence of two or more distinct malignant tumors with differing histological characteristics, all diagnosed within a 6-month timeframe. MPMT is a rare condition and due to the unique treatment requirements for each specific cancer type, it is crucial for healthcare professionals to accurately differentiate between metastatic growth and distinct primary tumors. Case Description: In this case report, we present a 41-year-old female patient who received diagnoses of three separate synchronous primary tumors. The patient presented for evaluation of a right breast mass that had been present for 1 year. Initial diagnostic tests, including mammography and ultrasound, did not provide any conclusive results. Subsequent magnetic resonance imaging (MRI) of the breast prompted an ultrasound-guided biopsy which confirmed moderately differentiated invasive ductal carcinoma (IDC). During pre-surgical testing, a suspicious opacity was detected on a chest X-ray, prompting further investigation with a computed tomography (CT) scan of the chest to distinguish between metastatic disease and a potential new primary tumor. Clinical and pathological examinations revealed the presence of bilateral masses originating from two different origins: invasive mucinous pulmonary adenocarcinoma in the left lower lobe and a neuroendocrine carcinoma in the right middle lobe of the lung. Conclusions: Cases of this nature present a complex challenge to physicians and underscore the critical importance of maintaining a high level of clinical suspicion to ensure the delivery of high-quality care. Effective management of such patients requires a multidisciplinary collaboration among breast surgeons, thoracic surgeons, and medical and radiation oncologists.
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Contrast-enhanced breast magnetic resonance imaging (MRI) is currently recommended as a screening tool for high-risk women and has been advocated for women with radiologically dense breast tissue. While breast MRI is acknowledged for its high sensitivity (with an exception for lower-grade ductal carcinoma in situ (DCIS) where emerging techniques like diffusion-weighted imaging offer improvement), its limitations include sensitivity to hormonal changes and a relatively high false-positive rate, potentially leading to overdiagnosis, increased imaging uncertainty, and unnecessary biopsies. These factors can exacerbate patient anxiety and impose additional costs. Molecular imaging with breast-targeted Positron Emission Tomography (PET) has shown the capability to detect malignancy independent of breast density and hormonal changes. Furthermore, breast-targeted PET has shown higher specificity when compared with MRI. However, traditional PET technology is associated with high radiation dose, which can limit its widespread use particularly in repeated studies or for undiagnosed patients. In this case report, we present a clinical application of low-dose breast imaging utilizing a breast-targeted PET camera (Radialis PET imager, Radialis Inc). The case involves a 33-year-old female patient who had multiple enhanced lesions detected on breast MRI after surgical removal of a malignant phyllodes tumor from the right breast. A benign core biopsy was obtained from the largest lesion seen in the left breast. One month after the MRI, 18F-fluorodeoxyglucose (18F-FDG) PET imaging session was performed using the Radialis PET Imager. Although the Radialis PET Imager has proven high count sensitivity and the capability to detect breast lesions with low metabolic activity (at a dose similar to mammography), no areas of increased 18F-FDG uptake were visualized in this particular case. The patient underwent a right-sided nipple-sparing mastectomy and left-sided lumpectomy, with bilateral reconstruction. The excised left breast tissue was completely benign, as suggested by both core biopsy and the PET results. The case presented highlights a promising clinical application of low-dose breast-targeted PET imaging to mitigate the uncertainty associated with MRI while keeping radiation doses within the safe range typically used in X-ray mammography.
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Globally, breast cancer is a primary contributor to cancer-related fatalities and illnesses among women. Consequently, there is a pressing need for safe and effective treatments for breast cancer. Bioactive compounds from endophytic fungi that live in symbiosis with medicinal plants have garnered significant interest in pharmaceutical research due to their extensive chemical composition and prospective medicinal attributes. This review underscores the potentiality of fungal endophytes as a promising resource for the development of innovative anticancer agents specifically tailored for breast cancer therapy. The diversity of endophytic fungi residing in medicinal plants, success stories of key endophytic bioactive metabolites tested against breast cancer and the current progress with regards to in vivo studies and clinical trials on endophytic fungal metabolites in breast cancer research forms the underlying theme of this article. A thorough compilation of putative anticancer compounds sourced from endophytic fungi that have demonstrated therapeutic potential against breast cancer, spanning the period from 1990 to 2022, has been presented. This review article also outlines the latest trends in endophyte-based drug discovery, including the use of artificial intelligence, machine learning, multi-omics approaches, and high-throughput strategies. The challenges and future prospects associated with fungal endophytes as substitutive sources for developing anticancer drugs targeting breast cancer are also being highlighted.
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Introduction: breast cancer is the most commonly diagnosed malignancy and an important cause of cancer death among females worldwide. The disease accounted for 25% (1.67 million) of new cancer cases and the fifth cause of cancer deaths. Incidence of all types of cancers is approximately 25% in Sierra Leone. However, there was no documented evidence on risk factors for breast cancer among women in the country. The main aim of this study was to assess risk factors associated with breast cancer among women screened for breast cancer in Freetown Sierra Leone. Methods: we conducted a case-control study on breast cancer involving 116 confirmed breast cancer cases and 116 controls. Questionnaire was designed to collect data on socio-demographic, reproductive and behavioral risk factors. Analysis was carried using logistic regression to assess the associations between breast cancer and the risk factors. Results: in the final multiple logistic regression, had formal educational level, (aOR 0.1, 0.03-0.26, p= 0.001) physical activity for more than 30 minutes per week (aOR 0.5 (0.9- 0.7, p=0.001). Cigarette smoking (aOR 4.8, 1.2-18.5, p=0.023) and family history of breast cancer (aOR 9.9 cigarette smoking (OR 4.4, 1.2-18.5, p=0.023) and family history of breast cancer (OR 9.9, 2.7-36.45, p=0.040) were identified as the main risk factors for breast cancer. This study did not find any statistically significant associations between reproductive risk factors and breast cancer. Conclusion: risk factors for breast cancer among women in Sierra Leone include educational level, physical activity, cigarette smoking and family history of breast cancer. We recommended screening program for women above 40 years and had history of breast cancer. Also, to establish breast cancer registry.