Archives of Breast Cancer
Volume:7 Issue: 1, Feb 2020

This study is the last part of a quadruple series investigating the relationship between breast disorders and the consumption of exogenous sex hormones. Due to the structural similarity of phytoestrogens to estrogen and the confusion associated with their possible estrogenic activity in the breast, this part aims at reviewing of the literature on the relationship between phytoestrogens and breast disorders.

We carried out a thorough search of the existing literature using appropriate keywords with the aim of finding systematic reviews, reviews, cohort studies and clinical trials regarding the effects of phytoestrogens on the breast in the general population, breast cancer survivors, women at high risk of breast cancer and those with benign breast diseases.

Many studies have approached the relationship between phytoestrogens and the risk of breast cancer or recurrence of the disease. Also, a few studies have considered the effects of phytoestrogens on benign breast disorders, BRCA genes, and the risk of breast cancer in high risk women. However, the variety of studies and the retrospective nature of many of them make it impossible to draw definite conclusions.

Existing data generally supports the safety of phytoestrogen consumption regarding the risk of breast cancer in the general population, in women with benign breast disorders, in those at risk of breast cancer, and even in survivors of the cancer. However, due to insufficient evidence, prescription of high doses of phytoestrogens is still not recommended.

Triple-negative subtype does not have any of the receptors that are commonly found in breast cancer. Patients suffering from Triple-negative breast cancer are at risk of early metastasis and BRCA mutation. The conversion of the receptors during the metastatic progression or local recurrence of breast cancer is a well-known topic that affects the therapeutic measures and outcome. Confirmation of immunohistochemistry is essential in these conditions, but genetic evaluation is controversial.

A woman suffering from primary luminal breast cancer presented with femoral bone metastasis in the follow-up after two years. Bone metastasis was compatible with the triple-negative subtype. This case was discussed at the weekly breast multidisciplinary team session of the Department of Breast Surgery, Tehran University of Medical Sciences. Question: Does the patient need genetics counseling in a conversion setting? And does the new specimen need CISH/FISH techniques to confirm TNBC tumors?

There are no strong guidelines to recommend genetic counseling and BRCA testing for patients with breast cancer biomarkers conversion. Re-assessing the specimen for ER, PR, and HER-2 is necessary for this setting.

In March 2020, the World Health Organization declared the novel COVID-19 infection a pandemic. Among high-risk patients infected by the virus, breast cancer patients are vulnerable to present more severe infections. Iran is among the countries with a high incidence of COVID-19 , and most of the routine activities of medical centers are affected by the epidemic disease. Thus, there is a need to make some modifications to international protocols for dealing with breast cancer in the affected countries.

The headings of breast cancer management protocols have been discussed among the university-affiliated professors in different disciplines involved in breast cancer management. The discussions were done through a “WhatsApp” group considering the tiles and the latest news about COVID-19. Under each title, we provide the consensus of all members in the related disciplines. Recommendations and

In each specialty, all members agreed to choose minimal intervention. The modifications aim to reduce the workload of the medical centers as well as to provide the least interface of the patients with the medical centers. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in epidemic COVID-19 situation in the country.

Breast cancer (BC) is a prevalent disease and a major cause of mortality among women worldwide. A substantial number of BC patients experience metastasis which in turn leads to treatment failure and death. The survival rate has been significantly increased due to more rapid detection and substantial improvements in adjuvant therapies including newer chemotherapeutic and targeted agents, and better radiotherapy techniques.

In this study, we cross-compared the application of advanced artificial intelligence algorithms such as Logistic Regression, K-Nearest Neighbors, Discrete Cosine Transform, Random Forest Classifier, Support Vector Machines, Multilayer Perceptron, and Ensemble to diagnose BC metastasis. We further combined MLP with genetic algorithm (GA) as a hybrid method of intelligent analysis. The core data we used for comparison belonged to the images of both benign and malignant tumors collected from Wisconsin Breast Cancer dataset from the UCI repository.

The application of several different algorithms to the collection of BC data indicated that these algorithms have comparable accuracy rate in detecting and predicting cancer. However, our hybrid algorithm showed superior accuracy, sensitivity and specificity compared to the individual algorithms. Two methods of comparison (Cross-Validation and Holdout) were applied to this study which produced consistent results.

Our findings indicate that our MLP-GA hybrid algorithm can speed up diagnosis with higher accuracy rate than the individual patterns of algorithm.

The incidence of breast cancer is rising rapidly worldwide. Midwives have an important role in early detection of the disease by providing the patients with awareness and an accurate Clinical Breast Examination (CBE) of the patients that are effective in early detections. This study investigated the knowledge, attitudes and practices of midwives toward breast cancer.

The study was conducted on 210 of midwives aged 20-62 who participated in a seminar for clarifying the role of knowledge, attitudes and practices in breast cancer early detection and prevention. The data were collected using a standard questionnaire which has 4 sections with 55 items including age, educational level, number of family members, marital status, family history of breast cancer and their knowledge, attitude and practices about breast cancer screening. Data were analyzed using SPSS version 13.0.

About two-third of the participants (65.9%) had excellent knowledge about the signs and symptoms of breast cancer. The results revealed that 30.8% of respondents performed self-examination once a month. There was a significant correlation between the knowledge of breast cancer and adopting preventive practices (P = 0.02). The level of their attitude was significantly associated with a positive family history of breast cancer (P= 0.03). There was no significant relationship between marital status or family history of breast cancer with CBE.

An appropriate level of knowledge and practice of breast cancer screening was observed to help prevention among midwives. The findings can have remarkable practical implications as midwives can play an important role to broaden the breast-cancer-related knowledge of women.

Considering the remarkable role of students in society and the relatively high prevalence of breast cancer in women, this study aimed to determine the factors related to adopting preventive behaviors for breast cancer in students.

This was a descriptive cross-sectional study. The study population consisted of 375 female students of Qazvin city, who were selected by stratified random sampling during the year 2019. Data collection tools included a demographic and contextual questionnaire and a valid and reliable questionnaire for measuring breast cancer preventive behaviors. Data were analyzed using SPSS 23 software program, descriptive statistics and logistic regression.

Using there was a statistically significant relationship between adopting preventive behaviors against breast cancer and physical activity (P <0.001), so that the chances of adopting good preventive behaviors in students with "occasionally", "rarely" and "never" physical activity were respectively 0.410, 0.113, and 0.098 times chance for the students with daily physical activity. There was a significant relationship between breast cancer prevention and academic years (p= 0.027), so that the chances of adopting good-level preventive behaviors in the senior students was 1.498 times higher than the first year students. There was also a significant relationship between adopting preventive behaviors and employment (P = 0.017), so that the chances of adopting good-level preventive behaviors in unemployed students was 1.725 times higher than that of the employed students.

Students with lower education and less physical activity and the employed individuals less commonly adopted preventive behaviors. Therefore, it is necessary to pay more attention to these students in designing educational programs.

Breast fibroepithelial lesions encompass a wide variety of tumors from benign fibroadenomas to malignant phyllodes tumors (PTs). Local recurrence was reported in 20% of all subgroups and 20-25% risk of distant metastasis though superaggressive tumors are rare. Two young patients with nonresponsive, frequent recurrences of phyllodes tumors turned into the aggressive metastatic sarcoma are presented.

Case 1: A 34-year-old married woman referred with the chief complaint of a mass and pain in her right breast. There was a 3cm well defined mass in right breast. An intermediate grade benign phyllodes tumor was confirmed in biopsy. Patient underwent surgical wide excision, radiotherapy. Three weeks later the mass recurred in her right breast with severe pain and nonproductive cough without hemoptysis. A single lung metastasis is conformed in the CT scan. Total mastectomy and thoracoscopic metastasectomy was performed and spindle cell sarcomas in both specimens is confirmed. Chemotherapy was done. Two weeks after chemotherapy she presented with multiple bilateral lung metastasises and thoracic wall involvement. No regression in metastasis was seen receiving the second line chemotherapeutic agents. Case 2: A 17-year-old young girl was referred to the breast clinic with a 2 cm firm mobile mass in left breast. The histopathology of the mass was benign phyllodes tumor. (1.5 cm margins) The tumor recurred 3 months later treated. During radiotherapy, the patient referred to the emergency department with the complaint of dyspnea and sever pleural effusion. The cytology reported malignant cells. CT-guided biopsy showed a high grade sarcoma. During chemotherapy, large ulcer in the site of the breast was appeared and mastectomy with Latissmus dorsi flap was performed and angiosarcoma was confirmed. Despite the second and third line chemotherapy the disease was progressed and multiple lung metastasis were confirmed in chest CT scan.

It seems that some subtypes of breast sarcomas could have an extremely an aggressive behavior which threatens the life of the patients in a short period of time. Further studies is suggested to discriminate the aggressive subtypes at the first step.