Archives of Breast Cancer
Volume:9 Issue: 1, Feb 2022

In December 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), also named “COVID-19”, has produced a global pandemic and has seriously affected many health systems around the world. Since the World Health Organization (WHO) declared the novel COVID-19 outbreak as a global pandemic, many international societies and groups of experts have published clinical guidelines and recommendations for surgical management of breast cancer patients in this time of crisis and issued COVID guidelines to prioritize surgery where time is critical and it cannot be deferred.

In this study, we review current recommendations for breast cancer surgery during the COVID-19 pandemic and propose a plan for future waves of the current pandemic while minimizing the risk of the contagious disease and oversaturating the health systems regarding the burden of accumulating untreated disease.

We create a critical and constructive vision from learnt lessons for similar future situations and propose a moving forward plan during and after the COVID- 19 pandemic.

Although in many parts of world, it would appear that now we are past the peak of the COVID-19 pandemic, we still face as uncertainty as to the future course of the pandemic and the challenges of the second wave. It is important to reappraise continuously the guidance and to emphasize the need for new protocols under new norms to continue to deliver breast cancer surgery safely.

Recurrence of breast cancer remains a critical problem. Therefore, it is imperative to identify biomarkers that accurately reflect disease state and develop novel drug therapies that are effective even after recurrence. MicroRNAs (miRNAs) are involved in the malignant transformation of various tumors. Circulating miRNAs are promising biomarkers for the diagnosis and treatment of cancers. Additionally, miRNAs are regarded as next-generation drug targets. Currently, various clinical trials are being conducted for anti-cancer drugs using miRNAs. In this review, we summarized recent studies on miRNA functions and circulating miRNAs in breast cancer, and discussed the status of miRNAs as drug discovery candidates. We also discussed the role of extracellular vesicles (EVs) in the clinical application of miRNAs.

Relevant articles published from 2002 to 2021 were acquired from PubMed database using the following key words: “miRNA” and “breast neoplasia”. Clinical trial data were retrieved from the database, ClinicalTrials.gov.

Regulating these miRNAs may provide a new therapeutic strategy. Furthermore, miRNAs may be useful diagnostic and prognostic biomarkers for breast cancer. In addition, miRNAs have potential as anti-cancer agents, and may also be used in combination with other therapies to enhance the efficacies of other drugs.

In summary, miRNAs have shown promise as biomarkers and therapeutic targets. In addition, EVs will be the key to expanding the applications of miRNAs.

Breast core needle biopsies are not perfect and could miss cancer. The need for a repeat breast core biopsy is not uncommon and can occur for a multitude of reasons. Radiologists should carefully correlate the pathology results with imaging features after each breast biopsy and must recognize why certain core biopsies must be repeated to avoid missed or delayed cancer diagnosis. In this review, we discuss the main reasons for repeat core biopsies via case presentation with radiological images and pathological correlation. This review will help multidisciplinary breast care team recognize when to repeat a biopsy to reduce false negatives and will also familiarize radiologists with techniques for improving initial biopsy success.

We performed literature and chart reviews of cases at our institution between January 2015 and December 2019.

While some repeat biopsies are inevitable, most can be avoided with careful pre-biopsy planning, adequate sampling techniques, and proper radiological- pathological correlation.

Repeat breast core needle biopsies occur due to multiple avoidable and unavoidable radiological or pathological issues. It is imperative for both multidisciplinary breast care team and radiologists to recognize when to repeat a biopsy to reduce false negative or delayed cancer diagnosis via careful reviews before and after the procedure and adequate radiological and pathological correlation.

Young breast cancer survivors (YBCS) face greater needs than their older counterparts. These needs require characterization for success of breast cancer assistance programs because needs vary by survivor race and where they are in their survivorship journey. This study evaluated quality of life (QOL) for YBCS in three states with poorer survivorship outcomes and identified differences in QOL for white and African American (AA) YBCS.

A survey identifying QOL needs was sent to YBCS in Louisiana, Mississippi, and Alabama. It assessed domains including relationships, women’s health, employment, fertility, and menopause. The survey was resent to participants after one-year completion of the first survey to identify QOL changes.

Overall, 371 baseline surveys and 127 follow-up surveys were collected. At baseline, AA YBCS faced more problems in five QOL domains and were less likely to have spoken with healthcare providers about genetic testing for breast cancer than white YBCS. After one year, all YBCS showed improvement in five different QOL domains, but indicated an increase in memory problems.

Survey results reflect existing literature that AA YBCS face greater QOL issues as well as disparities in the provision of genetic counseling. Additionally, all YBCS require more counseling from providers related to various physical and psychological symptoms. This survey identified QOL deficiencies faced by YBCS and differences based on survivor race. Defining and understanding these features allows for the development of culturally appropriate programming for survivors, while adapting to YBCS’ QOL changes as they move further from treatment.

2-thio-6-azauridine (TAU) is a nucleoside analog and potential antiviral drug. The antiproliferative activity of TAU has been evaluated in limited cancer cell lines. The present study is aimed to evaluate the effect of TAU on drug sensitization mechanism in paclitaxel (PTX) resistant triple-negative breast cancer (TNBC) cells.

The cell death mechanism was determined using MTT, BrdU incorporation, apoptosis, and DNA damage Western blot and RT-PCR assays. A specific ELISA method was used to determine the caspase-3 activity and expression levels of MRP1, MDR1, BCRP, and MRP8. Western blot analysis was used to assess the expression of CD151, MRP1, MDR1, and BCRP in CD151 overexpressing PTX-resistant TNBC cells.

The combination of TAU and PTX (10:20nM) synergistically inhibited the 50% viability of 12-fold PTX-resistant TNBC cells. Mechanistically, the combination inhibited the proliferation by arresting the cell cycle at the G2M phase and induced apoptosis by altering cell integrity and nuclear morphology as well as damaging DNA. The combination sensitized the PTX-resistant TNBC cells by increasing BAX and decreasing Bcl-2 expression, activating caspase-3, and reducing the expression of ABC transporters MRP1 and MDR1. The combination reduced the expression of MRP1 and MDR1 in CD151 overexpressing PTX-resistant TNBC cells, indicating the role of CD151in TAU mediated sensitization of PTX-resistant TNBC cells. The combination also reduced the mammosphere formation efficiency of PTX-resistant TNBC cells.

Overall, the present study illustrated the promising ability of TAU in sensitizing drug-resistant TNBC cells to PTX

Triple negative breast cancer (TNBC) lacks expressions of estrogen receptor-α (ER-α), progesterone receptor (PR) and amplified human epidermal growth factor receptor-2 ( HER2). Current treatment for TNBC includes anthracyclin, taxol and cisplatin-based conventional chemotherapy and survival pathway PARP, PI3K, AKT and mTOR selective targeted therapy. These treatments exhibit dose-limiting systemic toxicity and presence of drug resistant cancer stem cells, which highlight the need for identification of efficacious testable alternatives that are not toxic to non-tumorigenic cells. Dipsacus asperoides (DA) is a Chinese nutritional herb and its root represents a common ingredient in Chinese herbal formulations used in women for estrogen related health issues, osteoporosis and breast diseases. This study aims to investigate the growth inhibitory effects of DA, and to detect mechanisms for its efficacy.

Human mammary carcinoma derived triple negative MDA-MB-231 cell line represented the TNBC model. Non-fractionated aqueous extract from DA represented the test agent. Anchorage dependent growth, anchorage independent (AI) colony formation and cell cycle progression quantified growth inhibition. Western blot-based analysis for inhibition of RAS, PI3K and AKT and RB signaling identified mechanistic leads.

Treatment with DA induced a dose dependent cytostatic growth arrest (IC50 : 15μg/ml; IC90: 30μg/ml), reduced AI growth and inhibited cell cycle progression via G2/M arrest. DA affected the RAS, PI3K, AKT and RB signaling pathways, and functioned as a natural inhibitor of cyclin dependent kinase 4/6. Cellular apoptosis paralleled increase in pro-apoptotic Caspase 3/7 activity.

These results demonstrate that DA inhibited growth, affected cell cycle progression, induced apoptosis and inhibited cancer cell survival pathways. This study validates a mechanism-based approach to identifying testable substitutes for secondary prevention/therapy of TNBC.

Adenoid cystic carcinoma of the breast (ACCB) is a rare breast malignancy. Despite often being a triple negative tumor, it has a favorable prognosis, with low rates of recurrence and progression. The ideal treatment of ACCB is debatable; thus, the aim of this study was to characterize a population diagnosed with ACCB and to evaluate the treatment outcomes.

We performed a single-center retrospective analysis of patients with a histological diagnosis of ACCB treated at our dedicated Oncological Center between 1987 and 2020. The patients were identified in collaboration with the Anatomical Pathology Department, which also reviewed the surgical pathology reports.

Thirteen women with a median age of 68 years old were diagnosed with ACCB. The most frequent clinical diagnosis was a breast nodule (n=5); the preoperative image was suggestive of malignancy in nine patients, with seven being diagnosed with a ACCB in the preoperative biopsy. Regarding treatment, nine patients underwent conservative surgery, but three required re-excision. Sentinel lymph node biopsy (SLNB) was performed in seven patients, none revealing metastases; one patient had stage III ACCB and was initially treated with a modified radical mastectomy (MRM); the remaining were stage I (n=7) and II (n=5). Adjuvant radiotherapy was performed in eight patients, and two were initially proposed for chemotherapy but were considered unfit. With a median follow-up of 123 months (16-407), one case of local recurrence and two cases of distant metastasis were identified, one of whom died of disease.

ACCB is a rare tumor with a good prognosis; however, as demonstrated, it can present an aggressive behavior. Conservative surgery and adjuvant radiotherapy are the indicated treatment and SLNB may be omitted in grade 1 tumors.

The study aimed to assess the effect of anti-tumor and anti- proliferative properties of Sambucus nigra (SNA) on MCF-7 and MDA-MB-231 breast tumor cell lines.

The cytotoxicity of SNA was assessed based on dose/time by the MTT assay. Also, the influence of SNA on apoptotic pathways, cellular and metabolic resistance in these cell lines was examined by real-time PCR, lipid peroxidase was measured by malondialdehyde (MDA) and the effect of apoptosis and necrosis was determined by flow cytometry.

Our data showed that DOX, SNA, and DOX + SNA treatment induced the expression of p53, Bax, Bcl-2, Caspase-3, and 8 levels involved in the apoptotic pathways. ATP binding cassette subfamily B member 4 (ABCB4) gene expression was decreased in MDA‑MB-231 breast cancer cells compared to MCF-7. Also, we observed that DOX, SNA, and DOX + SNA treatment induced expression of Monocarboxylate transporters (MCTs) metabolic pathways such as MCT1 and MCT4.

Overall, the outcomes of this investigation show that the combination of SNA-Doxorubicin (DOX) in different groups of these cancer cells, especially in the MDA‑MB-231 cell lines synergistically intensified the induction of apoptosis in them. SNA enhances the anti-cancer effects of DOX to induce cellular apoptosis, alter metabolic pathways, and reduce cellular resistance. The research highlights the promising use of SNA as a chemosensitizer in the chemotherapy.

Cancer has experienced an alarming growth in the last two decades and is considered a pressing health problem of modern life. This study investigated the validity of Snyder's Adult Hope Scale (AHS) in Iranian women with breast cancer.

177 Iranian women with breast cancer were randomly selected for the present descriptive cross-sectional study. Participants completed a demographic questionnaire and the Persian version of Snyder's Adult Hope Scale (AHS), the DASS-21. The psychometric properties of the AHS were examined using confirmatory factor analysis (CFA) and discriminant validity using analysis of the DASS-21.

The results of CFA showed that the two-factor provided an excellent fit to the data. All items of the loadings delivered a significant factor. These results are acceptable because the factor loadings of all items were significant, and the factor load of all items other than item 1 is higher than 0.5, indicating the model's optimal fit. There was a significant negative relationship between AHS and DASS-21 scores for anxiety (r=-0.49), depression (r=-0.51), and stress (r=-0.47), indicating acceptable divergent validity.

Snyder's Adult Hope Scale (AHS) can be used as a valid and appropriate tool in clinical and educational settings to assess the hope of women with breast cancer and prepare treatment and prevention programs

Breast cancer is the commonest malignancy in women of Myanmar. Mastectomy is one of the main surgical treatments of breast cancer. Postoperative seroma is a common complication after mastectomy, which increases chances of infection, delays wound healing, causes flap necrosis, persistent pain, and dehiscence of the wound and thus increases the convalescence period. This study aimed to compare the seroma formation between single drainage and double drainage after total mastectomy and axillary dissection for breast cancer patients.

One-year hospital based comparative study was conducted at general surgical wards of Yangon General Hospital where 150 patients were included. Patients were randomized into two groups: 75 patients were with single drain into axilla and another 75 patients were with double drains (one into axilla and one into mastectomy bed). Drainage volume was recorded daily and summed up into total amount. The drain was removed when output was <30ml in 24 hours for two consecutive days. Follow-up visits were made at second, third and fourth weeks to check for seroma.

Mean age was 48.66 years in the single drain group and 51.22 years in the double drain group. Mean Body Mass Index (BMI) were 28.20kg/m2 in the first group and 28.79kg/m2 in the second. Statistically significant differences were not seen between the groups regarding total drain amount (315.13ml and 325.47ml, P=0.38). Duration of drains in the single group remained significantly shorter than in the double group (5.78 days and 6.38 days, P=0.002). Seroma during immediate postoperative period was seen in 29.3% and 36%, respectively (P=0.38). For one month follow-up, seroma was developed in 3 patients (4%) from each group. Statistically significant differences were not observed regarding the number of aspiration and the amount of aspiration between the two groups (P>0.05).

Both single and double drain methods had almost similar rates of seroma formation after total mastectomy and axillary dissection. But single drain is recommended to reduce patients’ discomfort with less morbidity and cost.

In 2006, the Institute of Medicine (IOM) issued a report recommending that all cancer survivors receive a customized survivorship care plan (SCP) to increase survivors’ understanding of diagnoses, long-term treatment effects, and ideas for improving overall health. Therefore, the purpose of this study was to compare a tailored SCP program (POST) to treatment as usual (TAU) on patient ratings of quality and content of discussion with providers at the end of their breast cancer treatment.

Two hundred participants were randomized to receive either the POST treatment (n=100) or TAU (n=100) at their last treatment visit. Women were presented with a checklist of 29 survivorship topics and indicated whether their healthcare provider discussed it at their last visit. They were also asked to rate overall quality of discussion (QOD) with their providers and across several QOD subscales.

Analyses indicated that on average, POST women endorsed 20 out of the 29 topics compared to 14 topics endorsed by TAU. Additionally, POST women reported a better QOD overall and across all subscales.

POST women remembered discussing more survivorship topics and reported better discussions with their providers. As a practical implication, cancer survivors should receive an individualized SCP to ensure that patients feel well informed of their road to survivorship.

Fibroadenomas (FAs) are common benign breast tumors which account for 68% of all breast masses. They can be divided into simple and complex FAs. Though unusual, FAs can harbor invasive or in situ carcinomas, as well as high risk lesions such as lobular carcinoma in situ (LCIS) as we present in this case report.

In this case report, we are presenting a rare case of LCIS within a FA with a brief description of presentation, classification and radiological features.

Carcinomas within FAs remain a diagnostic challenge. Despite being considered benign, FAs should still be closely monitored by ultrasound (US) as they can still harbor in situ or invasive carcinomas or high-risk lesions, including LCIS. Radiologists should always be aware and consider these as part of their differential diagnosis whenever benign looking masses have atypical features or presentation. The current management of LCIS detected within FA is still similar to LCIS found elsewhere in the breast.

Encapsulated papillary carcinoma (EPC) of the breast has a favorable prognosis. High-grade EPCs, triple-negative or HER-2-positive, are dealt with as invasive carcinomas. Breast metastasis associated with serous carcinoma is a late-stage event. The discrimination between the two diagnoses can be very challenging.

A 79-year-old woman with a history of well controlled high-grade serous papillary carcinoma of the peritoneum went through a total left mastectomy and sentinel lymph node biopsy (SLNB) because of an invasive carcinoma in her left breast. In the lab, a peripheral nodular mass of 4cm was found. Microscopically, large intracystic papillary stalks, with high nuclear grade, surrounded by collagenous tissue were identified compatible with invasive encapsulated papillary carcinoma with positive estrogen receptor. A few months later, the patient was diagnosed with a supraclavicular cervical mass, which on fine needle biopsy (FNB) was indicative of metastatic serous papillary carcinoma. Immunohistochemical stains were similar in breast and previously treated peritoneal tumor showed ER+, PAX8+, p53+ (wild type) and high Ki-67 (80%). WT1 was positive only in peritoneal serous carcinoma. GATA-3 was weakly, scarcely expressed in both specimens. The findings pointed to metastatic serous papillary carcinoma (SPC) in the breast, mimicking primary carcinoma of the EPC type.

Pathology of breast metastases and distinction from primary breast cancers is done by a combination of morphological and IHC features. In our case, the lack of clinical history, the type of surgical approach (mastectomy and SLNB), the solitary lesion, the EPC pattern of growth and the diffuse ER+ staining, were indicative of primary breast lesion. Various morphologic growth patterns of metastatic PSC have been described, among which EPC-like needs to be considered.