Archives of Breast Cancer
Volume:7 Issue: 2, May 2020

The application of FDG PET/CT scan for assessment of patients with breast cancer is increasing. The cost effectiveness of the application could be different in a developing country with limited PET scanners and treatment priorities

Open discussions of the PET reviewers from 2 out of 4 PET centers of Tehran, the capital city of Iran, were organized to provide insight into their opinions on the indications of FDG PET in breast cancer patients.

The sensitivity of FDG PET scan is high for detection of distant metastases; however, assessment of lymph node pathology and the local extension of the breast cancer are questionable. Considering the cost of the procedure itself and the downstream diagnostic procedures, its application and diagnostic accuracy are hindered for breast cancer screening, staging, and assessment of response to treatment and prognosis. The advantages and disadvantages of FDG PET CT and dedicated breast FDG PET scan have been briefed in different clinical scenarios with a focus on limitations faced by a developing country.

We suggest reserving the use of FDG PET for selected cases of suspected but not proven recurrent disease and in patients with high risk of metastasis before high risk surgery.

Inflammatory breast cancer is a very aggressive type of breast cancer which invades skin lymphatics. The standard treatment includes neoadjuvant chemotherapy followed by modified radical mastectomy and postsurgical radiation. Preserving the skin or nipple are not considered reasonable due to the involvement of the dermal lymphatics and therefore skin sparing or nipplesparing mastectomy are not usually carried out for this type of breast cancer.

In this article, we present a case of inflammatory breast cancer in a very young woman who was positive for BRCA2 genes.

The possibility to perform nipple sparing or skin sparing mastectomy and immediate breast reconstruction, and the indication for prophylactic contralateral mastectomy as discussed in the tumor board are presented in this article.

Neither of the more conservative techniques of mastectomy was appropriate for this case. Also, the prognosis of the patient mostly depends on the course of the ipsilateral tumor and prophylactic mastectomy would be wise only if the subsequent course of the disease is favourable.

While there is much information available about breast cancer in Australia overall, less is known about breast cancer in immigrant women and specifically Iranian-born women. Understanding this group is important to provide appropriate screening, treatment and support interventions. The aim of this study was to describe breast cancer presentation, tumour and treatment characteristics in Iranian-born women in Australia.

Women were eligible for this retrospective audit if treated for breast malignancy with country of birth recorded. Demographic, tumour and surgical data were extracted and analysed. Data for Iranian-born women were compared to data for Australian-born (comparison group 1) and women born in countries other than Australia or Iran (comparison group 2, referred to as ‘other’).

2086 women were eligible: Iranian-born n=27, Australian-born n=894 and Other n=1165. Iranian-born women were younger, mean age of 53.9 (five years younger in overall mean, SD 11.98, F=3.171, p=0.042). Iranian-born women were significantly less likely to present with a screen-detected cancer (X2= 11.481, p=0.003) and more likely to have a high-grade cancer (X2=14.383, p=0.006). There was no difference in mastectomy rate (X2=1.698, p=0.428).

Iranian-born women treated for breast cancer in Australia were younger, had higher-grade tumours and were less likely to have a screen-detected cancer than Australian-born women or women born in other countries. Strategies to encourage screening participation in Iranian-born women are required. Support for these women is required as they are more likely to receive toxic treatments (chemotherapy and extended adjuvant endocrine therapy) due to younger age and higher grade tumours.

We investigated molecular mechanisms behind astaxanthinmediated induction of apoptosis in breast cancer cell lines toward combination therapy against cancer drug resistance.

Breast cancer cell lines were treated with serial concentrations of astaxanthin to determine its IC50. We used drug-design software to predict interactions between astaxanthin and receptor tyrosine kinases or other key gene products involved in intracellular signaling pathways. Changes in gene expression were examined using RT-PCR. The effect of astaxanthin-nanocarbons combinations on cancer cells was also evaluated.

Astaxanthin induced cell death in all three breast cancer cell lines was examined so that its IC50 in two HER2-amplifying lines SKBR3 and BT-474 stood, respectively, at 36 and 37 ?M; however, this figure for MCF-7 was significantly lowered to 23 ?M (P<0.05). Astaxanthin-treated SKBR3 cells showed apoptotic death upon co-staining. Our in silico examinations showed that some growth-promoting molecules are strongly bound by astaxanthin via their specific amino acid residues with their binding energy standing below -6 KCa/Mol. Next, astaxanthin was combined with either graphene oxide or carboxylated multi-walled carbon nanotube, with the latter affecting SKBR cell survival more extensively than the former (P<0.05). Finally, astaxanthin coinduced tumor suppressors p53 and PTEN but downregulated the expression of growth-inducing genes in treated cells.

These findings indicate astaxanthin carries' multitarget antitumorigenic capacities and introduce the compound as a suitable candidate for combination therapy regimens against cancer growth and drug resistance. Development of animal models to elucidate interactions between the compound and tumor microenvironment could be a major step forward towards the inclusion of astaxanthin in cancer therapy trials.

Specialists, researchers, patients, and even their families use metaphors to describe diseases. Metaphors are known to be central tools in both communication and thinking. Crucially, even though many metaphors become conventionalized, metaphor choices are seldom neutral.

This study investigated metaphors associated with breast cancer using data from SID, magiran, and noormags databases.

The results showed that a number of medical concepts of cancer are expressed using conceptual metaphors, and that Persian speakers use different metaphors to express medical concepts related to breast cancer, such as "breast cancer is bad", "breast cancer results in an inactive life", and so on. These metaphors can have both positive and negative effects on common perceptions of breast cancer. The use of metaphors to address diseases, especially breast cancer, can cause feelings of fear and phobia among patients directly or indirectly, leading to a lack of timely referral for early treatment, fear of stigma or loneliness and death.

The findings of this research can inform experts, researchers and doctors that the use of words can be both curative and destructive. Thus, they should consider this issue in their careers and statements.

Metastases to breast and axilla from extramammary sites are uncommon and have been reported in only 2% of breast malignancies. Ovarian cancer metastatic to breast and axillary lymph nodes is extremely rare and only accounts for 0.03%-0.6% of all breast neoplasms. The most common histologic feature of ovarian cancer metastatic to breast is papillary serous adenocarcinoma. Differentiating the secondary breast malignancies from primary ones is crucial as the treatment and prognosis are different, which could avoid many unnecessary procedures. Prognosis is generally poor because most patients have simultaneous spread of the disease.

A 67-year-old woman with a history of ovarian cancer, undergoing chemotherapy presented with redness and swelling in her left breast and pathologic axillary lymph nodes. Work ups revealed ovarian cancer metastases to breast and axillary lymph nodes. She underwent chemotherapy with second line chemotherapeutics. The results were satisfying and the patient is well.

The history of cancer in patients with a breast mass, even if clinically benign, may give rise to potential metastases. Screening with physical examination and serial mammography for patients with ovarian cancer could be beneficial. Early and accurate diagnosis of breast metastatic tumors is critical for proper management and preventing unnecessary and possibly harmful procedures.

Phyllodes tumours are rare fibroepithelial neoplasm of connective tissue of the breast accounting for 0.3-1% of all breast tumours with 10% of them being malignant. They resemble fibroadenomas clinically and can be mistakenly ignored.

A 38-year-old unmarried Philipino lady presented to the primary health center with a mass in the right breast for the past year. Over the preceding 6 months, it had progressively increased in size and pain. On examination, a 5 x 3 cm firm and lobulated mass was palpated in the right upper outer quadrant. Ultrasound scan showed a solid 4.25 x 3.3 x 2.4 cm mass with heterogeneous mixed echopattern. She was referred to Surgery department where an ultrasound-guided core biopsy showed a lesion suspicious for benign phyllodes tumor. An excision biopsy revealed three foci of malignant Phyllodes on the background of fibroadenoma. A staging CT was performed which showed no evidence of lymph node involvement or distant metastasis. A simple mastectomy was performed and histopathology confirmed the diagnosis of malignant phyllodes tumor. Postoperatively, the patient is on regular follow up in the breast clinic and physiotherapy department.

Phyllodes tumor bears specific clinical characteristics and should be considered as a differential diagnosis in any mass lesion of the breast.. Diagnosis and management are crucial in phyllodes tumor because of their malignant potential recurrence. Clinicians should be competent in distinguishing between fibroadenoma and a phyllodes tumor. Lastly, given the rarity of phyllodes tumors, there is a need to establish guidelines to incorporate regular follow up for early detection of distant metastasis.