فصلنامه بیماری های پستان ایران
سال پانزدهم شماره 4 (پیاپی 59، زمستان 1401)

Breast cancer, with an approximate prevalence of 25.1%, is the most common malignancy and the leading cause of cancer death in women. The presence of estrogen receptors (ER), progesterone receptors (PR), HER2, Ki67, and disease stage are the most important factors determining a patient’s treatment plan. The majority of treatment decisions are currently determined primarily based on the state of the primary tumor receptors and the patient’s functional status (according to Karnofsky Performance Status (KPS) criteria). However, changes in the status of hormone receptors at the site of metastasis have been observed with a high frequency in metastatic breast cancer; this study aimed to investigate the rate of receptor conversion and its impact on survival outcomes.

The records of patients diagnosed with metastatic breast cancer who had been treated between 2013 and 2018 at the Cancer Institute, Imam Khomeini Hospital, were retrieved. Demographic and clinical information of patients and the prevalence of receptors in primary and metastatic masses were collected and analyzed using appropriate statistical tests.

Of the 150 women with breast cancer, 31 (20.66%) had changes in ER, with 13 (41.93%) patients having a positive alteration and 18 (58.7%)having a negative change in metastatic compared with primary tumors. In 41 patients (27.33%)  PR conversion had occurred, with gain of expression in 19 patients (46.34%) and loss of expression in 22 patients (53.66%). Finally, discordance in HER2 expression was observed in 23 cases (15.33%), of whom 12 (52.17%) showed positive conversion, while 11 patients (47.83%) had a negative conversion. The conversion of hormone receptors was mostly negative, whereas the change in HER2 was mostly positive. Receptor discordance was significantly higher in patients who had lymphovascular invasion compared with those who did not have lymphovascular invasion (P = 0.023). No significant relationship was observed between receptor conversion and the stage of the disease or the age of the patients.

 To determine which patients would benefit most from a biopsy of the metastatic tumor, more studies on receptor discordance between primary and metastatic breast cancer, and predictive factors, particularly lymphovascular invasion, are required. It is suggested, up until further research, that patients with lymphovascular invasion are good candidates for re-evaluation of hormone receptor status in metastatic lesions.

Chemotherapy for the treatment of breast cancer has many side effects on the liver tissue. The aim of the present study was to investigate the effect of aerobic exercise and curcumin on oxidative stress indices in the liver of mice with cancer treated with doxorubicin.

The present study is basic and experimental. Thirty-six female BALB/c mice weighing 20 ± 2 g were randomly divided into 6 groups: healthy, patient, patient + treatment (doxorubicin), patient + treatment + training, patient + treatment + supplement, and patient + treatment + supplement + aerobic exercise. Cancer was induced by the injection of the 4T1 cell line. Doxorubicin was injected subcutaneously on days 1, 7, 14, 21, and 28, and curcumin was given orally. Aerobic exercise consisted of 30 minutes of running at an intensity of 40%-60% of the maximum speed, 5 days a week, for 6 weeks. The training started at 14 m/min in the first week and finally reached 18 m/min. Two-way analysis of variance was used to investigate the interactive effect of exercise and supplementation on the expression of target genes.

The interactive effect of curcumin and aerobic exercise on the expression of GSH (P = 0.054), SOD (P = 0.145), and CAT (P = 1.000) genes and concentration of MDA (P = 0.087) was not statistically significant.

It seems that aerobic exercise with curcumin may not have protective effects on the liver against oxidative stress caused by the drug; however, more studies are needed in this area.

Researchers have increasingly focused their concentration on the prognostic part played by inflammatory indices, such as the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR). In breast cancer, the therapeutic effect of neoadjuvant chemotherapy (differs in patients, and a higher response rate reflects a better outcome. Therefore, the purpose of this study was to assess the association of NLR and PLR with response to neoadjuvant chemotherapy in advanced nonmetastatic breast cancer

This cross-sectional study was performed on 120 patients with nonmetastatic advanced breast cancer who were candidates for neoadjuvant chemotherapy. Data were collected using a checklist and Peripheral blood samples were evaluated for the calculation of the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR). After completion of neoadjuvant chemotherapy and surgery, the response was evaluated based on the pathology report. chi-square test and logistic regression were also used for data analysis.

Patients with a PLR below 126.98 (n = 84) were categorized as having low PLR, and those with a PLR greater than 126.98 (n = 36) were categorized as having high PLR. The high-PLR group showed a significantly greater response to neoadjuvant chemotherapy than the low-PLR group (P = 0.01). NLR was not correlated to the response to neoadjuvant chemotherapy (P = 0.24). An inverse relationship was observed between PLR and tumor size after treatment (P = 0.01). No significant relationship was observed between PLR and age, node status, tumor grade, or Ki67 status. Multivariate analysis showed no significant relationship between ER, PR, or HER2 expression levels and NLR or PLR.

PLR is a good prognostic marker for breast cancer, and patients with a higher PLR respond better to neoadjuvant chemotherapy.

The worldwide incidence rate for cancer has been rising. However, the molecular mechanisms involved in tumor growth and metastasis are unclear. Autophagy is a cellular pathway that leads to cell death or survival depending on the specific condition of the tumor cells. The aim of this study was to evaluate the effects of activation or inhibition of the autophagy pathway using tunicamycin or N-acetylcysteine on cell viability in the MDA-MB-231 breast cancer cell line.

MDA-MB-231 cells were cultured in the presence of different doses of tunicamycin or N-acetylcysteine. Then, a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay was performed for the evaluation of tumor cell viability. Real-time PCR was carried out to evaluate the expression of the genes encoding for Becline-1 and the mammalian target of rapamycin (mTOR) (as autophagy markers) in the MDA-MB-231 cell line. The LC3-II to LC3-I ratio and p62 were measured with western blotting.

Tunicamycin significantly increased autophagy markers and inhibited cell viability in a time- and dose-dependent manner. A negative significant correlation was observed between the expression of autophagy markers and cell viability. However, N-acetylcysteine resulted in decreased autophagy and increased cell viability just at a concentration of 2mM.

Tunicamycin leads to activation of the autophagy pathway, resulting in a decrease in cell viability in breast cancer cells (MDA-MB-231); and N-acetylcysteine, at a low concentration, can inhibit autophagy and increase cell viability. Thus, the autophagy pathway can be considered a target in cancer treatment.

Biosurfactants are surface active molecules which consist mainly of two parts, hydrophobic and hydrophilic. According to their amphoteric property, and different characteristics of cancer and normal cell plasma membrane, they can exert specific anti-cancer effects. Hence,  these compounds are proposed to be widely applied in the treatment of diseases such as cancer.

Assessing the ability of  Bifidobacterium spp. For synthesis of  Biosurfactant and evaluate its cytotoxicity on WRL68 normal cell lines as well as MCF-7 cell lines.

Bifidobacterium spp. Were isolated from Breast human milk samples from healthy mothers and normal pregnancy conditions, and mothers with mastitis were excluded. The Biosurfactant was extracted and purified using the ion-exchange chromatography method. A total of 4 compounds was identified and the cytoxicity evaluated against the MCF-7 cancer cell line and WRL68 normal cell line by MTT.

four biosurfactant compounds were isolated via ion-exchange chromatography, the IC50 was measured for each compound, and each compound showed different cytotoxic activity toward MCF-7 and WRL68 normal cell line to each gel fraction. Compound No.4 was coined to be the best choice among the others, as it showed the most inhibitory effect on MCF-7 with the lowest effect on WRL68.

isolated  Bifidobacterium spp. Has ability to produce at least four new biosurfactant compounds varied in their activity and toxicity. One of these compounds exerts specific anti-tumor activity against MCF-7 breast cancer cells. Although complementary studies are needed, the isolated biosurfactant can be used in combination with current modalities to increase the efficacy of treatment in breast cancer.

Breast cancer is the most common cancer among Iranian women. Numerous studies have shown the positive effect of screening behaviors in reducing breast cancer mortality. The aim of this study was to determine the level of inequality in breast cancer screening tests uptake (breast self-exam (BSE), clinical breast exam (CBE), and mammography) in western Iran.

This cross-sectional study was performed among 907 women aged 30 and older in Kermanshah. Data were collected using a questionnaire through interviews. The concentration index and concentration curve were used to quantify and analyze inequality in breast cancer screening (SBE, CBE, and mammography). Crude and adjusted odds ratios were used to assess the relationship of each of the three screening behaviors with different subgroups.

The history of SBE, CBE, and mammography were 28.22%, 18.85%, and 17.75%, respectively. The concentration curve was calculated to be 0.268 (P < 0.001) for SBE, 0.126 (P < 0.001) for CBE, and 0.066 (P = 0.166) for mammography.

The focus of health promotion interventions should be on groups of low socioeconomic status. The development of public awareness-raising campaigns, especially for less educated women, can lead to favorable results in reducing inequality in breast cancer screening test uptake.

Diet is an important environmental risk factor for breast cancer. Grapes are one of the most abundant fruits in the world; they are a valuable source of active metabolic compounds that control the proliferation and growth of breast cancer cells.

The present narrative review is based on Persian and English papers published between 1996 and 2022. The papers were retrieved via an internet search on PubMed, Google Scholar, Science Direct, and Scopus databases using the keywords “cancer,” “breast,” “bioactive metabolites,” “Vitis vinifera,” and “grapes.”

The findings of the investigations showed that the bioactive compounds of grapes, including resveratrol, terpenoids, oleanolic acid, catechins, proanthocyanidins, anthocyanins, anthocyanidins, carotenoids, and flavonols, have the capacity to reduce oxidative stress, inhibit DNA synthesis, stop the cell division cycle, induce apoptosis of cancer cells, interact with multiple signaling pathways involved in the creation or destruction of tumors. Because of these functions, these compounds are of specific interest in the prevention and treatment of breast cancer.

Antitumor activities of natural compounds found in grapes indicate their possible role in the treatment of breast cancer.

COVID-19 has affected several aspects of healthcare systems worldwide. While our understanding of the impact of cancer and its treatment on COVID-19 mortality is improving, there is still little known regarding the possible mechanisms by which COVID-19 might interfere with cancer cells, especially breast cancer.  Several factors activated during COVID-19 have been implicated in tumorigenesis and the development of metastasis. Inflammation, hypoxia, reduced levels of angiotensin converting enzyme 2, elevated levels of Interleukin 6 and some other cytokines that are hallmarks of COVID-19 are capable of inducing tumor relapse and metastasis. Understanding the interaction between COVID-19 and breast cancer tumor cells is essential for evaluating the potential long-term risks of COVID-19 in the patients, and for scheduling necessary preventive, screening and therapeutic interventions.

Oncoplastic breast surgery was introduced over 25 years ago with the integration of plastic surgery and breast cancer surgery. It follows two goals: the first one is the improvement of disease outcomes and local control, and the second one is the improvement of the quality of life. In some situations, oncoplastic breast surgery faces challenges, such as large tumors, skin involvements, and certain tumor locations, like the inner or central parts.
In this paper, we aim to describe a technique that was an old-fashioned technique, firstly used for reduction mammoplasty, and how the surgeon can use it as a universal level two oncoplastic breast surgery in complex situations. Therefore, the authors would recommend it to be applied whenever the other classic OBS techniques are not feasible. This technique can be adopted and applied to remove the tumors located in any part of the breast but the central part.
The technique starts with a classic incision of reduction mammoplasty. The skin flaps are made liberally over the tumor and can be extended to most parts of the breast except for the central part. The thickness of the flap is considered identical to the mastectomy flap to have the safest oncologic operation. After the skin flap preparation over the tumor site and tumor resection with respect to the central posterior vessels to the nipple, rotational pedicles of breast tissue fill the tumor site, and the skin is closed in a routine form mammoplasty.
Although this technique can be used in most complex situations, the best indication is in patients whose breasts are significantly ptotic who desire to rectify it and make the contralateral breast symmetric. The importance of this technique would be clearer when routine mammoplasty techniques (superomedial and inferior) cannot be adopted because of insufficient tissue to fill up the resection cavity or the risk of compromise on the vascular pedicles.