Archives of Breast Cancer
Volume:6 Issue: 3, Aug 2019

Accelerated partial breast irradiation (APBI) is defined as applying high doses of radiation with a shorter interval to the lumpectomy cavity in the setting of breast-conserving therapy for early-stage breast cancer. This treatment strategy is attractive to patients, and its utilization has increased during recent years because of the shorter treatment schedule, better cosmetic outcomes, and acceptable local control rates in selected patients undergoing breast-conserving therapy. Here we provide an overview of various APBI techniques in terms of clinical and cosmetic outcomes, quality of life, and cost of treatment. We also review the current guidelines for selecting suitable breast cancer patients for APBI strategy.

A comprehensive literature search of PubMed between 1996 -2019 that was made was made for case series and randomized studies with at least 2 years of follow-up in term of clinical and cosmetic outcomes, quality of life, and treatment costs.

Technological advances have made various APBI modalities, including intracavitary and interstitial brachytherapy, intraoperative radiation therapy, and external-beam radiation therapy, more accessible in the community. Mature data from several randomized and prospective nonrandomized trials have contributed to the development of consensus guidelines for selecting the most appropriate candidates ABPI.

APBI represent an attractive treatment option for appropriately selected patients with early breast cancer. Irrespective to various techniques used for APBI it is very important to select the most appropriate patient population according to reliable guidelines for this treatment strategy that could be non-inferiority to whole breast irradiation especially in high-volume radiation centers with long waiting lists and for patients who live far away from the radiotherapy centers.

The carcinogenic effect of exogenous steroid hormones on the breasts is a matter of debate, causing confusion for physicians at the time of making prescriptions. This article, as part of a quadruple series about exogenous sex hormones and breast disorders, reviews the association of breast cancer and hormone replacement therapy (HRT) in the general population, women with benign breast disorders, women with personal or family history of breast cancer, and BRCA carriers.

We accomplished an extensive search of the literature by using relevant keywords to identify pertinent cohort studies, clinical trials, and reviews. Then, we extracted all points regarding the question.

An extensive literature exists on the risk of breast cancer following HRT in the general population, and HRT has been mentioned as a risk factor for breast cancer, especially in recent, long-term users of combined formulations. However, there is still no consensus about it. Conversely, few studies have considered challenging issues like the use of HRT in breast cancer survivors and high-risk women.

HRT up to 5 years can safely be used for management of menopausal symptoms in healthy women, and those with low-risk benign breast disorders. On the contrary, its use in high-risk women should be limited to refractory menopausal symptoms after describing potential harms to the patient.

Locoregional recurrence of breast cancer has significantly decreased over the last decades, particularly due to effective systemic therapy. While there is little controversy regarding local management of locoregional recurrences, in light of previous systemic treatment, additional chemotherapy regimens and their benefit to the patient are still subject to debate in tumors boards.

A 45-year-old woman was referred to our tertiary care center with a local recurrence of breast cancer 9 years after modified radical mastectomy for a ypT2N2a invasive ductal carcinoma. She received neoadjuvant treatment consisting of FEC-D (5-FU-epirubicin-cyclophosphamide, followed by docetaxel) for hormone receptor positive, HER-2-neu negative cancer in 2009, as well as adjuvant radiotherapy and tamoxifen for 9 years. After R0 resection of the hormone receptor positive, HER-2-neu negative recurrence in 2019, adjuvant therapy with ovarian suppression and an aromatase inhibitor was undertaken. A multigene assay identified a recurrence score at 37 and benefit from chemotherapy > 15%.
Question: What would the ideal chemotherapy regimen consist of for this patient with an R0 resection of late recurrence of breast cancer?

After reviewing history, imaging and pathology, members of the multidisciplinary team recommended treatment with Taxotere and cyclophosphamide (TC) x 4 for our patient.

Telling bad news to the patients after a diagnosis of breast cancer is one of the most important duties of a physician. The aim of this study was to explore breast cancer patient's preferences regarding how to receive bad news.

A group of 15 women with breast cancer were purposively recruited to this qualitative study. Semi-structured in-depth interviews were conducted to identify the patients' preferences through content analysis.

The age of participants ranged between 28 and 58 years. Nine patients had undergone mastectomy and the remaining 6 had received conservative surgery. The minimum time between the diagnosis and receiving the news of cancer was 1 month, the maximum 15. Altogether, 250 codes were extracted after content analysis and categorized into 7 categories and 43 subcategories. The main categories were the method of disclosure of bad news, medical information, communication skills, emotional support, family involvement, the setting, psycho-spiritual care, and the word “cancer.”

Knowing about patients' preferences regarding the methods of breast cancer diagnosis disclosure can help physicians to effectively deliver bad news. Therefore, it is necessary that the clinicians be informed about the themes that the patients consider important while delivering bad news to patients.

Cancer of unknown primary involving axillary lymph nodes (CUPAx) is a very rare type of cancer. There are still many challenges about the management and outcome of the disease. This retrospective study is an attempt to assess the overall survival and the outcome of CUPAx in Iranian women.

Based on inclusion and exclusion criteria, 20 patients primarily diagnosed with CUPAx referred to our breast multidisciplinary team (MDT) sessions between July 2010 and December 2016 were evaluated. The patients were categorized into three groups based on the types of treatment: mastectomy and radiation therapy, radiation therapy, and observation group.

The mean age of the subjects was 52 ± 7.91 years (range: 42-74). The results manifested significant differences between the outcomes of three types of treatments. The patients who received both mastectomy and radiotherapy had a higher survival rate and no sign of the disease compared with other groups (P= 0.03). The median survival time in the mastectomy group was 78 months and 23 months for the group with no mastectomy (95% CI: 7.64-38.36) (P <0.001).

The result suggested that mastectomy was effective in lowering the risk of disease progression in Iranian women diagnosed with CUPAx and highly suspicious breast origin. More studies on larger sample groups are needed.

Although various Oncoplastic Breast Surgery (OBS) techniques have been introduced for varied sizes of the breast and locations of tumors , surgeons are still faced with serious challenges for tumors which have developed in special anatomic part of the breast. A good instance of these challenges is the tumors located far from Nipple Areola Complex (NAC) especially in the upper inner quadrant. We aimed to assess the application of newly introduced OBS technique (Cross Technique) in these situations.

The data of 95 patients who suffered from breast cancer and operated with Cross method were assessed in this prospective survey. Data was gathered regarding demographic variables, the size, location, and pathologic characteristics of tumors, patients' BMI and breast circumference and cup size. The patients were recruited to the study according to inclusion and exclusion criteria and the study protocol which was approved by the research deputy of department of surgery, Tehran University of Medical Sciences. Data was presented in a descriptive method.

Nighty-five patients underwent oncoplastic breast surgery using the Cross method from November 2015 to May 2018. Patients had a mean age of 48.2 ranging from 25 to 70 years. The patients had a wide range of breast circumference and cup size (70 to 95 for the breast circumference and A to E for the cup size).
Clear surgical margin was obtained in 93 cases according to the permanent pathology reports. The complications were seen in 5 patients all managed conservatively (2 slight hematoma and three ischemic skin flaps). The most common histologic type was insitu and invasive ductal carcinoma (DCIS-IDC). Mean tumor size was 22.7 mm with standard deviation of 9.2mm, most of which were positive for estrogen receptor (ER)/progesterone receptor (PR). As the surgery of axilla, six lymph nodes were excised on average and 22 patients had axillary lymph node involvement.

The Cross method is not only a reliable choice for tumors located in the UIQ, but it can also be applied safely for tumors in UOQ and upper central part of the breast, although the best application for the technique is the tumors located far from nipple areola complex.

Breast involvement during malignant lymphomas is a rare condition, whether in primary or secondary cases, whereas according to the literature, primary breast lymphomas represents merely less than 0.5% of the breast malignancies.

The case was a 48 years-old patient referred to the clinic with contralateral breast diffuse large B cell malignant lymphoma. She had an operation for right breast mucosa-associated lymphoma tissue (MALT) lymphoma two-years earlier. The participant experienced surgical excision of the right breast mass and radiotherapy subsequently. Surprisingly, after two years she developed a mass on the left breast, for which we were not able to establish an evident relationship between the earlier MALT lymphoma and the second diffused B cell lymphoma.

Although, our report emphasizes on the undeniable role of the breast examination in prevention of catastrophic events, we are far from providing diagnostic approaches on breast MALT lymphoma, due to minimal case sizes and lack of adequate information and evidences.