Archives of Breast Cancer
Volume:8 Issue: 4, Nov 2021

Breast cancer is the most common and life-threatening cancer in females characterized by the abnormal proliferation of tumor cells in lobules and ducts. For years, many anti-breast cancer drugs have been tested with some of them showing severe health problems and drug resistance. Recently, different biological and pharmacological actions of bee venom have been indicated to play antibacterial, anti-viral and anti-inflammatory role against different cancers especially breast cancer.

This review study is based on PubMed, Google Scholar and PubMed search. Search terms used were Melittin, Breast cancer and Honey Bee Venom.

Many studies have shown that a positively charged C-terminal sequence of mellitin facilitates plasma membrane contact and antitumor action. Precise targeting and selective activity of melittin has been found in recent studies as it suppresses the activation of growth factor receptors in HER2-enriched and triplenegative breast cancer that are generally difficult to treat. Significantly, it leaves healthy cells intact. The most striking feature of melittin is the pore formation property. Monomers of melittin bind to the plasma membrane of cancer cells in a collective manner and start forming pores, ultimately bringing cell lysis.

Since melittin has a very selective action against the HER-2 related tumors, a combinational therapy of melittin and HER-2 targeted agents could be a very potent strategy in breast cancer. This review reflects the importance of honey bee venom and melittin as a potential therapy for aggressive breast cancer.

Breast cancer-related lymphedema (BCRL) is a devastating potential complication of axillary lymphadenectomy and radiotherapy. Several effective surgical treatment measures now exist, including lymphaticovenicular anastomosis (LVA), vascularized lymph node transplant (VLNT), and vascularized lymph vessel transplant (VLVT) for fluid-predominant disease, and liposuction and radical excision for solid-predominant disease. Super-microsurgical LVA is of particular interest, owing to its minimally invasive nature and highly favorable outcomes in the hands of experienced supermicrosurgeons. As LVA techniques are refined and improved, interest is rising in utilizing it to prevent the manifestation of disease in the first place. Lymphatic microsurgical preventive healing approach (LYMPHA), also known as immediate lymphatic reconstruction (ILR), is the most widely used approach. It involves performing axillary LVA immediately following axillary lymphadenectomy. While preliminary results are favorable, the high-pressure proximal axillary venous branches used in ILR and the site’s vulnerability to damage from radiotherapy endanger the long-term patency of these anastomoses. Moreover, a theoretical oncologic concern exists regarding creating a direct conduit for the remaining malignant cells in the axilla into the circulation. Finally, coordinating ILR with axillary lymphadenectomy creates significant logistical challenges. Delayed, distally-based LVA (DD-LVA) has emerged as an alternative method that avoids these issues. This article presents an overview of the development of preemptive lymphatic reconstruction, and the senior author’s approach to the novel technique of DD-LVA.

Nowadays breast cancer (BC) is the most common cancer in women. More than 1.5 million cases are detected yearly. Survival of patients is dependent on several factors. Metastasis and cancer recurrence of different types and in different locations have various outcome.

This is a retrospective cohort study to describe survival of patients after diagnosis of breast cancer based on receptor subtypes and sites of metastasis among Iranian population. A total number of 2051 females with breast cancer were evaluated and among these, 138 patients with recurrent BC were investigated.

The 1-year survival of local, bone, visceral and brain metastasis were 64.99%, 63%, 32.83%, and 21.57%, respectively. Based on sites of metastasis, bone and local metastasis showed the best survival while brain and visceral metastasis had the worst survival and prognosis.

Our study showed that Her2 enriched positive BCs had the worst survival, this may be due to Trastuzumab uncovered insurance till 10 years ago in our country. Also, drugs related to luminal A and B which are used to improve their survival and hormonal therapy could be associated with their better prognosis in comparison to triple negative receptor subtype. But this study showed that triple negative BC had better survival.

There is no data on the outcome of COVID-19 infection in patients with breast cancer from India. This study was done to assess the outcome of patients with breast cancer who had COVID-19 infection.

We analyzed patients with breast cancer who were diagnosed with COVID-19 infection from May to September 2020 in the medical oncology department of a tertiary cancer center in India. Symptomatic patients (fever and influenza-like illness symptoms) or asymptomatic patients planned for systemic therapy were tested for COVID-19 by RT-PCR.

A total of 441 breast cancer patients received 1174 systemic therapies from May to September 2020. Among them, 36 patients who had COVID-19 infection were analyzed in detail. The majority (86%) were asymptomatic at presentation. The most common symptoms were fever followed by cough. Patients were either admitted to the hospital (53%) or kept in home quarantine (47%). Patients who received oxygen, non-invasive assisted ventilation (NIV), and mechanical ventilation (MV) were 8%, 3%, and 3% respectively. The median duration of hospitalization and home quarantine was 11 days and 19 days respectively. The recovery of patients with COVID-19 infection was 94%. The median duration to clearing SARS-COV-2 by RT-PCR was 19 days. The total/all-cause mortality was 6% (n=2). The mortality due to COVID-19 infection was 3% (n=1). Subsequently, 89% were restarted on systemic therapy. The median delay in restarting systemic therapy was 23 days.

Systemic therapy can be safely administered during the ongoing COVID19 pandemic. Further, follow-up of patients is warranted to assess the long-term impact of COVID-19 infection.

Triple-negative breast cancer (TNBC) is defined as tumors without estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. This cancer is associated with higher rates of recurrence risk when compared to other subtypes of breast cancers. In this study, we aimed to explore the basic clinicopathological characteristics, prognosis, and recurrence patterns of TNBC patients.

In the current study, forty-five TNBC female patients operated on for breast cancer in the General Surgery Clinic of Kayseri City Training and Research Hospital between 2016 and 2021 were included and retrospectively evaluated.

The percentage of TNBC was 12% of the 502 breast cancer patients who could access all three pieces of receptor information. The mean age of the patients was 58.9±15.2 years (27-90), and the mean BMI was 30.4±5.17 (21.5-40.6). It was observed that the most common histological subtype was invasive ductal carcinoma, and at the time of diagnosis, 11 patients were stage 1 (24.4%), 31 patients were stage 2 (68.8%), 2 patients were stage 3 (4.4%), and 1 patient was stage 4 (2.2%). During the follow-up period, 11 patients (24,4%) developed metastasis and the most common sites were the brain and bones. The mean time from diagnosis to metastasis was 20.7±5.75 (12-29) months. The 3-year disease-free survival was 62%, and the 3-year overall survival (OS) was 70%.

TNBCs are cancers with varying prevalence, poor prognosis, and limited treatment alternatives. The prevalence of TNBC in our center was found to be lower than the literature rates and consistent with the literature, the lymph node stage was related to poor OS and disease free survival (DFS).

Axillary lymph node metastasis (ALNM) is one of the important prognostic factors of breast cancer. The objective of this study was to assess the risk of ALNM in different molecular subtypes determined by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (her2neu) of breast cancer.

This retrospective study was conducted on patients who had undergone upfront breast conserving surgery (BCS) or modified radical mastectomy (MRM). Patients were classified as HR (hormone receptor) +/ her2neu- (ER or PR positive and her2neu negative), HR+/her2neu+ (ER or PR positive and her2neu positive), HR-/her2neu- (ER, PR and her2neu negative or triple negative or basal type), and HR-/her2neu+ (ER or PR negative and her2neu positive). The association between clinicopathological variables and ALNM was evaluated in logistic regression analyses.

In this study, 476 patients met the inclusion criteria, and had 67.2% ALNM at diagnosis. ALNM was statistically significantly correlated with age ≤ 40 years (p=0.026), tumor grade (p=0.007), pathological tumor size (P<0.001), estrogen receptor (P=0.045), molecular subtypes (P=0.021), LVI (P<0.001), and PNI (P<0.001). Post Hoc test revealed that HR-/her2neu+ subtypes of breast cancer had the highest and HR+/her2neu- had the lowest risk of ALNM.

ALNM may be predicted by molecular subtypes of breast cancer. The risk of ALNM is less in TNBC although it is clinically more aggressive. These findings may play an important role in gauging the individualized axillary management in breast cancer.

The serotonin, copper, and ceruloplasmin markers are altered in various cancers, including breast cancer. It has been reported that these markers have the potential to be used in the study of cancer recurrence. The purpose of this study was to compare the levels of serotonin, copper and ceruloplasmin besides the routine breast cancer markers such as CEA and CA15-3 in the blood sample of patients with invasive ductal breast cancer, before and after chemotherapy.

This study was performed on 30 patients with breast cancer. Blood samples were taken from the patients before and after chemotherapy. Necessary data including age, tumor grade and status of Her-2, ER, PR receptors were obtained from patient records. Serotonin, CEA and CA15-3 levels were measured by ELISA method. Ceruloplasmin and copper were measured by nephelometry and colorimetric methods, respectively.

Results showed a decrease in serotonin, ceruloplasmin, copper, CEA and CA15-3 after treatment but only the levels of serotonin and ceruloplasmin showed a steady decrease. No significant relationship was observed between tumor grade and ER-PR, Her-2 receptors.

This study showed that chemotherapy resulted in steady decline in serotonin and ceruloplasmin levels but this decrease was not steady in levels of CA15-3 and CEA. Therefore, if our results are confirmed by further research, they can be considered as a viable alternative to routine markers in cancer recurrence after chemotherapy.

This study aimed to prospectively record changes to treatment for early breast cancer patients during the first wave of the COVID-19 pandemic in Australia. The purpose was to assess the impact on breast cancer outcomes and to determine the need for any mitigative actions.

The study was conducted in the breast cancer unit of a tertiary referral hospital. Patients with early (non-metastatic) breast malignancy discussed in multidisciplinary team meetings between March and June 2020 were included. Patients were newly diagnosed, post-operative or post-neoadjuvant chemotherapy. Standard treatment was defined by Westmead Breast Cancer Institute protocols and any variations related to the pandemic were recorded.

In the study, 145 patients were included (median age 59 years). Pandemic-related changes to management were noted in 13 of 145 (9.0%) patients. Four patients experienced a delay to cancer treatments, four were not offered reconstructive/ symmetrisation surgical procedures, three had altered radiotherapy protocols and two patients were not offered enrolment to a clinical trial. These impacts affected the groups presenting with new cancers (n=7/86, 8.1%), postoperative cases (n=4/25, 16.0%) and post-neoadjuvant chemotherapy cases presenting for surgical planning (n=2/34, 5.9%).

Most patients (91.0%) received standard treatment during the first wave of the pandemic. The minor variations from institutional protocols observed in this study are unlikely to affect local control or survival in this patient cohort, but close follow-up is required. Quality of life may have been affected for four patients who had downgraded or delayed reconstructive procedures.

The importance and relevance of serum inflammation biomarkers and DNA methylation-dependent micronutrients in breast tumorigenesis is gaining wider acceptance. However, the association of serum inflammation biomarkers and micronutrient status with expression of estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor-2 (HER-2) by the tumor has not been investigated in Nigerian breast cancer patients. The objective of this study was to determine the levels of serum biomarkers of inflammation (Homocysteine, Nitric Oxide (NO), Hydrogen peroxide (H2O2), Myeloperoxidase (MPO), Tumor necrosis factor alpha (TNF-α), Interleukins 6 and 8 (IL-6 and IL-8) and DNA methylation-dependent micronutrients [Zinc (Zn), Folic acid, Vitamin B6 and B12] in breast cancer patients with different hormone receptor levels (ER, PR and HER-2).

One hundred and fifteen women (80 with breast cancer and 35 controls) were randomly recruited for this study. Serum levels of homocysteine, folic acid, vitamins B6, vitamin B12, TNF-α, IL-6 and IL-8) were analyzed using ELISA. The levels of NO, MPO, H2O2 and Zn were analyzed using spectrophotometer. The levels of serum inflammation biomarkers and DNA methylation-dependent micronutrients in patients with breast cancer and control subjects without breast cancer as well as breast cancer patients with ER, PR and HER-2 expression were determined.

The results showed that mean serum levels of IL-6 (p=0.002), IL-8 (p=0.018) and H2O2 (p=0.000) were significantly increased while TNF-α (p=0.014) and NO levels (p=0.044) were significantly decreased in breast cancer compared to healthy controls (p<0.05). However, there were no statistically significant differences in the levels of Zn, homocysteine, Vitamin B6, Vitamin B12 and MPO in breast cancer patients and controls (p>0.05). Furthermore, the levels of serum inflammatory biomarkers and methylation-dependent micronutrients were similar in HER-2, ER and PR breast cancer hormone subtypes.

Systemic inflammation exists in breast cancer patients but the inflammation biomarkers and methylation-dependent micronutrients did not differ among patients with PR, ER and HER-2 antigen expression.

Mucinous carcinoma (MC) is a rare breast malignancy with a large extracellular mucin secretion. It has a good prognosis in comparison to other breast malignancies.

We report a 32 years old female with multiple hard palpable masses in the left breast with rapid growth in 6 months. She was mentally retarded with lower limb varicose veins associated with mucocutaneous lesions on the face. She underwent ultrasound examination of the breast, thyroid and lower extremity veins. Core needle biopsy and fine needle aspiration from left breast lesions and right thyroid nodules showed MC and follicular lesion with hurtle cell change, respectively. Suspected metastasis in the left rib and calvarium in the subsequent bone scan survey and brain magnetic resonance imaging was reported. She underwent radical mastectomy and right hemi-thyroidectomy.

Pure mucinous carcinoma with micropapillary pattern (MUMPC) is a new histology variant of Pure Mucinous Carcinoma (PMC) that shows favorable prognosis with less aggression and occurs in older patients. However, PMC in our patient occurred at a young age with greater aggression.

Dermatofibrosarcoma Protuberans (DFSP) is a rare, locally aggressive superficial soft tissue tumor that can occur in many parts of the body. Surgical resection with a wide margin of safety is the main treatment modality of this rare tumor of the breast. According to the postoperative pathology report, the patient can be followed up or adjuvant radiotherapy (RT) can be added.

A 22-year-old woman presented with a mass filling the lower inner quadrant of her right breast. Tru-cut biopsy revealed a mesenchymal tumor, but excision was recommended for definitive diagnosis. A right breast quadrantectomy was performed. The result came as DFSP. Tumor diameter was 10x9x6.5 cm and the tumor was positive in most of the surgical margins. The patient underwent re-resection and a residual tumor with a diameter of 0.2 cm was detected at a distance of 3.3 cm from the surgical margin. Although the surgical margins were negative, the distance of the posterior surgical margin, in particular, could not be assured. Because of the uncertainty of surgical margins, 60 Gy RT was planned.

The localization of DFSP in the breast is extremely rare and surgery is the primary treatment. RT should be added as an adjuvant when safe surgical margins cannot be obtained.

Spindle cell carcinoma (SpCC) is an unusual form of squamous cell carcinoma (SCC) and can sometimes present in the breast. Owing to the rarity of breast SpCC, few case studies are available nowadays and proper evidence is scarce.

We herein report a 60-year-old female patient, who was referred to the surgery services after presenting with a right breast ulcerated mass. On physical examination, a 7x7 cm mass was found along with a 3 cm ulcer on the top of it. Both mammography and ultrasound showed a dense mass, and tru-cut and skin punch biopsies confirmed neoplastic spindle cells within the lesion. The patient underwent a right total mastectomy with sentinel lymph node biopsies with no further chemotherapy or radiotherapy.

Owing to the heterogeneity of SpCC, there is no exact treatment protocol for this type of cancer, and mastectomy or conservative surgery can be performed in certain groups of patients depending on tumor size, stage, and lymph node involvement. Fortunately, promising medical and biological therapies might be of use in the near future.