Archives of Breast Cancer
Volume:10 Issue: 2, May 2023

The use of mobile services for health promotion is rapidly increasing. The purpose of this paper is to review studies on using cell phone applications as an intervention to improve mental health in breast cancer patients and to provide an overview of their effectiveness.

A systematic search in PubMed, Scopus, Web of Science and PsycINFO was performed to retrieve relevant studies published from 2010 to 2020. The criteria for inclusion were any study conducted on breast cancer, written in English and on mental health. The meta-synthesis of the articles was conducted based on a predefined classification. Then from the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions, and results.

Overall, 81 papers were retrieved from databases, 46 articles were reviewed, and finally 7 articles were selected for analysis. We identified 7 RCT studies that utilized a mental health application as a mental health intervention in breast cancer patients. The results showed the effectiveness of mobile apps on stress, depression, anxiety, self-efficacy, social support, resiliency and coping with breast cancer in all the studies which were analyzed.

This study demonstrated the important role of mobile apps in promoting mental wellness of breast cancer patients. Mobile app interventions can be implemented to decrease depression through positive impacts on stress management, self-efficacy, resilience and breast cancer adaptation. We recommend that the role of mobile apps for the prevention and rehabilitation of mental health aspects in breast cancer patients should be examined through a blended delivery management approach in future studies.

In alignment with the World Health Organization’s Global Breast Cancer Initiative objectives, this rapid review sought to determine the extent to which breast cancer understanding is being researched globally in undergraduate student populations, and review recent findings, to inform policy makers and practitioners on the baseline level of student understanding by world region.

Four academic databases were searched, and 114 studies meeting the search criteria were assessed based upon Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines and comprehensiveness of coverage for the factors of interest. Finally, 33 were selected as representing quality research from all world regions producing recent research of this topic. Their findings were narratively synthesized.

The majority of recent research emanates from regions with accelerating breast cancer mortality rates, corresponding with lower economic resources, primarily within Africa and Asia. Most focus on breast cancer understanding in female participants, with little data available for males or minority gender groups. Disparity between medical and non-medical students’ breast cancer understanding is widely reported, though breast cancer understanding is found to be inadequate for most students. Interventions to improve breast cancer understanding indicate promising results, though a lack of standardized measures, together with inadequate reporting of effect sizes, makes meta-analysis of prevailing data challenging.

Evidence suggests undergraduate students’ breast cancer understanding globally is inadequate, showing the necessity of increased rigor in research design and reporting to facilitate reliable knowledge generation. Systematic reviews are recommended to widen the scope and depth of this rapid review in support of WHO targets.

 The aim of this study was to investigate the value of pre-treatment dynamic contrast-enhanced MRI (DCE-MRI) findings in predicting clinical and radiological response to treatment in patients with idiopathic granulomatous mastitis (IGM) receiving steroid therapy and to compare clinical and DCE-MRI results after treatment.

 Pre- and post-treatment MRI examinations of 86 patients (with a mean age of 33.8 years; range, 20–57 years) diagnosed with IGM between January 2014 and September 2022 were retrospectively evaluated. Lesion characteristics and longest diameter, number of involved quadrants, retroareolar involvement, and presence of fistula or lymphadenopathy were noted. Patients were categorized into clinical complete response (CCR), clinical non-response (CNR) groups based on clinical response and into radiological complete response (RCR) and radiological non-response (RNR) groups based on radiological response. 

 The analyses revealed no relationship between the lesion type (abscess, NME, abscess, and NME), presence of lymphadenopathy or fistula, number of involved quadrants, retroareolar involvement, and treatment response on pre-treatment MRI (p>0.05). The longest lesion diameter was smaller in the CCR group than in the CNR group (p = 0.02). After treatment, 40.7% (35/86) of the patients achieved RCR + CCR, while 16.3% (14/86) achieved RNR + CNR. On the other hand, 43% (37/86) of the patients achieved CCR + RNR.

 CCR is more common in patients with smaller lesions. Other pre-treatment MRI findings were not correlated with radiological or clinical response. A significant proportion of patients with CCR had residual lesions radiologically.

Human epidermal growth factor 2 (HER2) is known to be an important prognostic factor in breast cancer. Numerous studies have shown HER2+ breast cancers have reduced overall survival and recovery time, as well as the efficacy of anti-HER2 therapies along with chemotherapy in improving disease outcomes. For this reason, it is recommended that all patients with breast cancer should be evaluated for HER2 status. This study aimed to assess the HER2 gene amplification by the CISH method in evaluating the HER2 status in patients with immunohistochemistry (IHC) 2+ (equivocal) results.

This retrospective cross-sectional study examined HER2 status based on the Chromogenic in situ hybridization (CISH) method in 280 breast carcinoma samples with an initial 2+ (equivocal) score in IHC. The relationship between HER2 amplification and hormone receptors (estrogen and progesterone) and Ki67 level was also investigated.

In sixty samples (21.4%), the HER2 gene was amplified based on the CISH method. The majority (215, 76.8%) of the samples were negative and 5 (1.8%) samples were indeterminate. No significant relationship was observed between HER2 amplification, estrogen receptor (p=0.143), and Ki-67 protein level (p=0.977). There was a significant inverse relationship between HER2 amplification and progesterone receptor positivity (p=0.007).

These results demonstrate that CISH is a helpful method to assess HER2 status in equivocal breast cancer and is positive (amplified) in about 21.4% of them.

Fear of cancer recurrence (FCR) in cancer patients, including those with breast cancer is a special and highly conscious experience affecting emotional, cognitive and behavioral domains. This study examines the effect of cognitive emotion regulation on FCR with the mediation of illness perception and psychological well-being in breast cancer survivors in a structural model.

The population of this study included all women with breast cancer who were referred to Cancer Institute for their regular checkups in 2022. Overall, 300 patients were recruited based on convenience sampling. They completed the validated questionnaires online for FCR, cognitive emotion regulation, illness perception and psychological well-being. The proposed model was evaluated using structural equation modeling.

The findings indicated the model did fit the data. In addition to the direct effect of adaptive and maladaptive strategies of cognitive emotion regulation on FCR, the indirect effect of adaptive strategies on FCR through psychological well-being (β=0.148, p=0.001) and illness perception (β=0.233, p=0.001) was negative and significant. Furthermore, the indirect effect of maladaptive strategies on FCR through psychological well-being (β=0.109, p=0.001) and illness perception (β=0.212, p=0.001) was positive and significant. Therefore, psychological well-being and illness perception negatively and significantly mediated the effect of adaptive strategies on FCR and positively and significantly mediated the effect of maladaptive strategies on FCR.

Patients who possessed adaptive strategies of cognitive emotion regulation, less-threatening perception of illness and higher psychological well-being were exposed less to FCR. Psychological interventions for strengthening these factors in breast cancer survivors are suggested.

Breast cancer is one of the most common diseases among women worldwide. The triple negative subtype is the most aggressive, with low tumorfree survival and the worst clinical evolution, requiring the development of more effective and targeted therapies. The present study investigated the in vitro pharmacological effects of the association of BR2 peptide with 2-aminoethyl dihydrogen phosphate (2-AEH2P) on MDA-MB-231 and 4T1 triple-negative breast cancer cells.

The physical-chemical analysis of the peptide was performed using the Heliquest software, the cell viability was assessed using the MTT colorimeter method and the predictive pharmacological effect was evaluated using the Synergy Finder software.

The results showed the BR2 tumor penetration peptide and the 2- AEH2P+BR2 association significantly increased cytotoxicity in the MDA MB231 and 4T1 tumor lines, without compromising the viability of the normal fibroblastic cells. The results also showed that depending on the time and concentration, a synergistic effect was observed for the association with tumor cells, with a therapeutic window between 0.8 and 50µm for MDA-MB-231 tumor cells in 48h.

The results demonstrated in vivo antitumor and antiproliferative efficiency for MDA-MB-231 and 4T1 tumor cells with low toxicity for normal fibroblast cells, with MDA MB-231 cells being more sensitive to treatments.

Since the presence of sarcopenia in breast cancer patients is associated with increased postoperative complications, it is crucial to know its frequency in the prechemoteraphy period. It has been suggested that there are many factors associated with sarcopenia. This study focused on the frequency of sarcopenia over the pectoralis muscle area obtained in routine breast MRI among Turkish females who were newly diagnosed with breast cancer.

In a prospective study, pectoralis muscle was manually contoured bilaterally, and the cross-sectional area on breast MRI was calculated in newly diagnosed breast cancer patients. The 'Core slices' program was used while calculating SMI. We accepted 7.4 kg/m2 as the threshold value for sarcopenia.

Overall, 17 patients (17 %) were sarcopenic. The analysis regarding the detection of sarcopenia in the patient groups < 65 and ≥ 65 years of age was not statistically significant (P<0.156). The relationship between the groups with BMI < 25 and ≥ 25 sarcopenia was statistically significant (P<0.001). Sarcopenia was found significantly more frequently in patients with metastasis (P<0,0001).

This study recruited Turkish females who were newly diagnosed breast cancer. It is the first study in the literature to include the same race, gender, and malignancy in which sarcopenia was investigated. It was shown that breast MRI which is radiation-free can be used in the evaluation of sarcopenia in patients with breast cancer. Thisresult isimportant for being prepared for possible complications before treatment.

Data on breast cancer (BC) in northern Ghana is scant. The aim of this study was to provide data on the clinicopathological, prognostic and molecular characteristics of BC in females of northern Ghana.

Data on breast cancer patients (n = 1,913) in the Department of Pathology of the Tamale Teaching Hospital (TTH) was collected from 1st January, 2012 to 31st December, 2021 and analysed at four levels: introduction, clinicopathological features, prognostic stratification using the NPI score and the molecular subtypes of BC based on IHC Status. Associations between variables were determined by Fisher’s exact test.

There were 1,191 (62.3%) benign and 722 (37.7%) malignant tumors. A gradual rise in the relative proportions of the female BCs over the period was observed. The mean age (years) of BCs diagnosed in small to medium size samples was 47.7±16.0, and 36.4% were aged <40 years. The commonest clinical presentation of BC was a palpable breast lump (65.5%). Majority of the BC patients presented 3 months after the onset of the illness. Invasive ductal carcinoma was the commonest subtype of BC (78.0%), and the great majority (93.1%) had a combined (II & III) high histological grade (P<0.0001). Stratifying women diagnosed with BC into prognostic categories using the NPI, 15.4% had excellent prognosis, compared to 49.2% with poor prognosis.

The study identified breast cancer as a common breast disease among women in the study area with advanced clinico-pathological features at presentation, and therefore, poor prognosis even at the time of diagnosis.

The prognostic factors for breast cancer include pre-treatment staging, nodal and distant metastasis, hormone receptor status, ki67 index, and molecular subtype. For adequate treatment, [18F]FDG PET/CT is now being used to prognosticate the course and response of treatment in breast cancer patients. Our study aims to find the association between the metabolic activity of primary breast tumors as PET/CT SUV uptake and prognostic factors such as ER/PgR/Her2neu receptor status, molecular subtypes, ki67 labelling index, and nodal/distant metastasis.

A retrospective observational study at our tertiary care institute included 228 breast cancer patients from March 2017 to April 2021. Pre-treatment PET/CT imaging was done. The immunohistochemical analysis was performed on a biopsy/surgical specimen to determine the molecular subtype of breast cancer. Further, statistical analysis was performed to find the association between PET/CT findings with immunohistochemistry and, thus, molecular subtypes of breast cancers.

Significantly higher SUV max was seen in tumors with ER-negative (Mean SUVmax-11.6; P-value=0.002), PgR negative (Mean SUVmax-11.1; p value-0.0005), triple-negative receptor status (Mean SUVmax-13.7; P-value=0.004) and high Ki67 index (P-value=<0.01). Further Luminal A (Mean SUV max:6.0±5.5 & Median SUV max:3.9±3.6) and Luminal B (Mean SUV max: 8.9±4.9 & Median SUV max:7.6±4.0) subtypes showed lower SUV max as compared to Her2neu (Mean SUV max: 9.4±5.5 & Median SUV max:8.6±6.2) and TNBC (Mean SUV max: 13.7±12.4 & Median SUV max:10.0±7.6) subtypes. However, only a weak correlation was found for axillary nodal spread p-value – 0.02) and no significant correlation was seen for Her2 receptor status (Mean SUVmax-9.7; p value-0.178) and distant metastasis (P-value=0.26).

The values for different molecular subtypes can be used as Mean SUV or Median SUV uptake. However, owing to data skewing in practical scenarios, we suggest the use of median values with interquartile range for predicting the molecular subtypes of breast cancer on PET/CT imaging: Luminal A – Median SUV – 3.9 (IQR – 3.6); Luminal B – Median SUV – 7.6 (IQR – 4.0); Her2neu Enriched – Median SUV 8.6 (IQR - 6.2); Triple-negative breast cancer - Median SUV 10.0 (IQR - 7.6).

Cholesterol is an essential component of cell membranes whose local de novo biosynthesis may occur in response to additional cellular requirements, especially cell proliferation. In this study, we investigated: (1) the differential expression of the genes coding for the main enzymes involved in cholesterol biosynthesis (ACAT2, HMGCS1, HMGCR, FDFT1, SQLE, LSS, and NSDHL), or the proteins that control their activity (SREBF2, SCAP, and INSIG1), in patient-matched samples of breast cancer and adjacent histologically normal (HN) tissue; (2) their association with the expression of MKI67 or the histologic tumor grade (in particular, G2); (3) their association with recurrence-free survival (RFS).

Nonparametric rank-based models for longitudinal data were applied to assess the differential gene expression between the tumor and the adjacent HN tissue from the same patient or between the classes of tumor grade. Spearman’s rank correlation and Cox proportional hazard models were used to assess the correlation between the genes and their association with RFS.

Compared to the adjacent HN tissue, HMGCS1, HMGCR, SQLE, and NSDHL genes were more expressed in the tumor. Their expression progressively increased according to tumor grade and correlated positively with MKI67. ACAT2, HMGCR, and NSDHL genes were associated with a high risk of recurrence even when adjusted for age, tumor grade, or immunohistochemical Ki67.

The findings indicated that some genes involved in cholesterol biosynthesis were more expressed in cancerous tissue, correlated positively with tumor grade and MKI67 expression, and were associated with RFS, thus substantiating the relationship between de novo cholesterol biosynthesis and tumor aggressiveness.

Mucoepidermoid carcinoma (MEC) breast is a very rare triple negative breast cancer with relatively better overall prognosis, with histomorphological and immunohistochemical features similar to the salivary gland MEC. The literature suggests that it also carries molecular characteristics similar to the salivary gland MEC.

A 73-years-old woman presented with complaints of painful, foul smelling pus discharging mass in the right breast. The patient underwent therapeutic incision and drainage along with diagnostic biopsy. On histopathology, the diagnosis made was high grade MEC.

Primary MEC is a very rare triple negative breast cancer (TNBC) usually with much better survival outcome in comparison to other TNBCs. However, the index case had locally advanced disease with unique presentation leading to an alternative initial management

Primary non-Hodgkin’s lymphoma of the breast is an aggressive and rare disease with DLBCL (Diffuse Large B Cell Lymphoma) being the most common variant followed by Marginal zone lymphoma (MZL), follicular lymphoma (FL) and Burkitt’s lymphoma. Out of these, MZL and FL are less aggressive variants unless they undergo transformation. Primary breast lymphoma can mimic inflammatory breast cancer clinically due to peau d’orange appearance of the overlying skin. Association of primary breast lymphoma with TNF alpha inhibitors is rare but has been reported in the literature.

We present one such case where a 56-year-old lady presented with a breast lump and nipple retraction in her right breast for 6 weeks. The patient had a history of psoriatic arthritis and had been on Disease modifying anti-rheumatic drugs (DMARDS) for six years. TNF alpha inhibitor was started 3.5 years ago. Clinically, the case was highly suspicious for inflammatory breast cancer. Bilateral mammogram revealed 80mm irregular density in the right retro areolar region of breast; however, no discrete mass was identified on ultrasound examination. Core biopsy showed extranodal marginal zone lymphoma with features of impending transformation. The neoplastic cells were positive for CD45, CD20, PAX5 and BCL6. These cells were negative for AE1/AE3, CD5, CD10, MUM1 and cyclin D1. The patient was then started on R-CHOP (rituximab-cyclophosphamidehydroxydaunorubicin-oncovin-prednisone) chemotherapy regime for six cycles. TNF alpha inhibitor was stopped. The patient tolerated the chemotherapy regime well and no flare ups of psoriasis were noted.

There was rapid progression of breast tumour within a span of 6 weeks in a patient with no family history, no systemic lymphadenopathy and in a background of TNF alpha inhibitors. Based on these findings and the published literature, a probable association of primary breast lymphomas with TNF alpha inhibitors is likely. Although this causal association may be minimal, more research should be done to consolidate the findings.

Primary Cutaneous Apocrine Adenocarcinoma (PCAA) is a rare cutaneous malignancy that arises from areas rich in apocrine glands, particularly the axilla. There are less than 200 cases described in the literature. However, none has been reported in patients with Klinefelter syndrome, who are known to have an increased risk of breast cancer,

We present a 66-year-old man with a significant family history of breast cancer who developed a right axillary mass initially thought to be hidradenitis suppurativa. On physical examination, he had bilateral gynecomastia. Laboratory workup was significant for hyper-gonadotrophic hypogonadism. Mammography showed bilateral gynecomastia with no radiologic evidence of malignancy in the breast, while magnetic resonance imaging of the breast revealed two suspicious masses seen in the right breast. Excision biopsy of the right axillary mass revealed a high-grade invasive adenocarcinoma involving the dermis and subcutis; the cells had prominent nucleoli vesicular chromatin pattern and voluminous eosinophilic cytoplasm consistent with primary cutaneous apocrine adenocarcinoma. Immunohistochemistry was positive for GATA-3, GCDFP-15, E-cadherin, ER Positive, PR negative, HER 2 by IHC 3 +, and androgen receptor-positive 100 %. Positron emission tomography showed mildly hypermetabolic asymmetric gynecomastia, right greater than left, but no abnormal hypermetabolic activity to suggest malignancy. Karyotype confirmed 47 XXY chromosomes which on. The patient underwent bilateral mastectomy due to his preference; excised breast tissue was negative for malignancy.

We presented the first case report of PCAA of axillary in Klinefelter syndrome. Awareness of this association and differentiation from breast carcinoma should be undertaken.