Archives of Breast Cancer
Volume:10 Issue: 3, Aug 2023

Green silver nanoparticles offer a reliable and secure alternative to drugs and prevent cancer. The floral part of Clitoria ternateais traditionallywell known for its application as a medicine and food in various cultures around the world. Phytochemicals of these floral extracts are enriched with various properties. Floral extracts can be utilized as an alternative that can target the proteins and other molecules involved in the progression of cancer.

Silver nanoparticles (CT-AgNPs) were synthesized from the extracts of blue flowers of Clitoria ternatea (CT). The synthesized CT-AgNPs were characterized by various physicochemical methods that revealed the size, shape, and stability of the nanoparticles. Docking was performed between the phytocompounds of Clitoria ternatea and apoptotic proteins involved in breast cancer such as APAF-1, BCL-2, and BAX, to determine the ability of phytocompounds present in the floral extract to control breast cancer by binding to the targets.

Based on the docking results, the binding energies ranged from -6.2 Kcal/mol to -7 Kcal/molwith Quercetin having the highest binding energies. Toxicity analysis of CT-AgNPs in Artermia naupliiand Vigna radiata seedlings confirmed that these nanoparticles were not toxic to both the model systems. Free radical scavenging activity assay revealed the antioxidant nature of CT-AgNPs was similar to that of standard ascorbic acid. In vitrocytotoxicity analysis using MCF-7 breast cancer cell lines revealed that CT-AgNPs were cytotoxic.

In vitroantioxidant and cytotoxicity analysis using MCF-7 breast cancer cell lines revealed that CT-AgNPs were potent antioxidant and cytotoxic, correlating with the results of in silicoanalysis and hence demonstrating the anticancer potential of Clitoria ternatea floral mediated nanoparticles.

The number of total mastectomy patients requesting breast reconstruction is increasing. However, many patients refuse this surgery because the procedures are too complex, too prone to complications, or even just because of the fear of breast implants and their long-term consequences. In this study, a comprehensive assessment of the results and complications of only fat grafting breast reconstruction is presented.

Between 2012 and 2021, 127 fat grafting breast reconstruction was performed in 117 patients who previously received total mastectomy. These included 70 cases of delayed breast reconstruction (DBR) and 57 "conversions," i.e., removal of a reconstructive implant replaced by iterative fat injections. The patients were fully informed about the procedure's risks and benefits before intervention. All the patients signed an informed consent.The procedure, complications, and results were analyzed on a regular basis every 3-6 months (average follow-up of 3 years).

Data from 117 patients with a mean age of 59 years (25-83) were included in this study. The mean body mass index was 23 (19-30). Seventy patients had received radiotherapy before mastectomy (55%). An average of 3.17 injections (2 to 7) with an average volume of 300 cc were required to finalize the breast reconstruction, with a total average injected volume of 933 cc. Simple fat transfers were performed on an outpatient basis except for bilateral or associated procedures. In 48 cases (40%), the patients received appropriate procedures on the contralateral breast to make it symmetrical. Complications happened in 10 percent of cases, mostly minor complications like fatty cysts or much-localized Cytosteatonecrosis though in a limited number of patients, more serious problems with hematomas, abscesses, diffuse Cytosteatonecrosis or very extensive lymphoceles appeared.

The findings of this study support fat transfer breast reconstruction as a safe procedure with acceptably low complications, even in patients who have received radiotherapy in their history. Furthermore, this procedure can be applied in an outpatient setting. It seems that the application and the indications of this easy and feasible procedure will be increased in the coming years.

Invasive breast cancer (IBC) has long been thought as non-immunogenic, but in recent decades it has been reported that tumour micro-environment (TME) in breast cancer encompasses tumor-infiltrating lymphocytes (TILs), which help in creating anti-tumor immune response. On the other hand, tumor buddings (TB) from the invasive front of the tumor contribute to invasion and metastasis. We aim to evaluate TILs and TB in IBC and to correlate them with known prognostic parameters.

In this retrospective study, 50 cases of IBC were included. TILs and TB were observed and graded in H&E Stained slides following standard guidelines. Associations of TILs and TB with known clinicopathological parameters were established by statistical methods.

The majority of cases were invasive breast carcinoma (IBC)-NST (78%). The cases with low TILs (involving <50% of stroma) had a significant correlation with positive lymph node metastasis (P = 0.017) and high-grade TB (P = 0.038). TB was associated with other adverse prognostic parameters such as tumor necrosis (P=0.043) and lympho-vascular invasion (LVI) (P=0.033) and large tumor size.

As tumor budding is associated with known poor prognostic factors such as necrosis, LVI and large tumor size, it can be regarded as a potential biomarker in predicting the aggressiveness of breast cancer. Low TILs are positively associated with invasion and lymph node metastasis of IBC. Thus, assessment of these protumor (TB) and antitumor (TILs) factors could be a promising approach for future research on breast cancer.

The phosphatidylinositol 3-kinases are known as a family of lipid kinases, playing a role in various cellular processes. A member of this family is PIK3CA which is frequently mutated in breast cancer. In this study, the association between H1047R, E542K and E545K mutations, and therapy resistance was investigated in Iranian breast cancer patients treated by Trastuzumab.

Resistance and sensitive groups were chosen from Iranian patients treated by Trastuzumab.A PCR-RFLP approach was designed for detecting the H1047R mutation. Mutationsinpositions ofcodons E542K and E545K were detected using PCR-based DNA Sanger sequencing assay. The overall survival and disease-free survival were assessed.

A significant relationship was observed between the presence and absence of H1047R mutation and the overall survival (P = 0.025).In addition, there was a significant relationship between the response to Trastuzumab and some clinicopathological features, including the age and the status of ER/PR receptors (P-value<0.05). E542K and E545K mutations were not observed in the patients.

It can be said that probably H1047R mutation is a prognostic marker in the Trastuzumab-based therapy resistant breast cancer. Further studies can be performed to evaluate this mutation before using Trastuzumab to predict the effectiveness of this treatment.

The breast cancer-screening program is defined asincludingwomen between 50 and 69 years old and aims to detect breast cancer in its early stages, which improves the survival outcome. The aim of this study is to explore the differences between female cancer patients at agesbetween 50 and 69 years old and those older than 69 years regarding the initial tumor stage, method of tumor detection, and conducted oncological treatment.

Between January 2017 and August 2020, we recruited all breast cancer female patients older than 69 years old who were diagnosed with breast cancer and planned to receive radiotherapy. A similar sample size of female patients between 50 and 69 years old, who were presented to receive radiotherapy at the defined time of the study, was used as a reference group to be compared with the studygroup.

We identified 132 female patients older than 69 years with breast cancer, who were presented in our department to receive radiotherapy. The controlgroup was represented by 131 female patients at the agesbetween 50 and 69 years old. The most common stage detected at the time of diagnosis in both groups was stage IA which represented29% ofthe studygroup and 41% ofthe controlled group. The incidence of Stage IV is significantly higher in the studygroup (9%) in comparison to the controlgroup(0.8%).

Stage IA is the most common tumor stage detected among female patients older than 69 years as well as those involved in the breast cancer-screening program. The incidence of metastatic disease is significantly higher among patients not involved in the screening program.

Concerning the prevalence and complications of breast cancer and its impact on the quality of life. This paper aims to study the effect of twin hearts meditation(as per Sui) on the quality of life among the patients with breast cancer under chemotherapy.

This randomized clinical trial was conducted on 102 breast cancer patients in two groups. The patients answered a demographic information survey and WHO quality of life short form before intervention. The patients in the experimental group received training on twin hearts meditation by the researcher for 30 minutes in the intervention stage, and the patients did meditation 3 times a week for one and half months.The quality of life of the patients was measured before and after the intervention in the experimental and control groups.The data were analysed using SPSS v.20, descriptive statistics, paired t and independent t tests at a P<0.05 significant level.

The results showed that before intervention, there was no significant difference between the mean of quality of life in the experimental (81.3 ± 7.1) and (77.9 ± 16.2) control groups (P=0.344), but after intervention there was a significant difference between the mean of quality of life in the experimental (88.9 ± 11.2) and (75.2 ± 14.9) control groups (P0.001).

Twin hearts meditation can improve the quality of life among the patients with breast cancer under chemotherapy. In this regard, it is suggested that twin hearts meditation be considered as a mind-body complementary medicine.

Outcomes of breast cancer are affected by ethnicity, age, socioeconomic status, religious affiliation, medical preferences and more. The purpose of this study was to examine the breast cancer experience through the lens of the Health Belief Model to uncover support successes, failures, differences in care, and its connection to behavioral and mental health in the diverse population of the Cayman Islands.

Twenty-five participants volunteered to engage in semi-structured interviews and qualified for this qualitative phenomenological study with a breast cancer diagnosis and treatment provided by the Cayman Islands healthcare networks. The interview questions informed the targeted research questions, and the resultant data was examined for meaningful thematic units that encompassed the breast cancer experience in the Cayman Islands.

The correlation between cultural identity and behavioral and mental health was evident in diagnosis and treatment. Participant behavior and action was influencedby the perceived threat of breast cancer, self-efficacy, belief in ability to face the challenges, and trust in treatment protocols and professionals. The results of this study emphasized the need for individualized, culturally sensitive care across age, socioeconomic status, ethnicity, and religion.

Significant concerns were identified in the need to support breast cancer thrivers in survivorship, managing expectations of self and others, finding meaning in individual experiences, supportingbehavioral health changes, managing and understanding the emotional and psychological experiences in breast cancer, and continuing efforts to support all segments of any population in the areas of prevention and early identification.

The PD-1/PD-L1 pathway represents an adaptive immune resistance mechanism that is exerted by tumor cells. The study was conducted to evaluate the expression of PD-L1 in breast carcinoma in India and to find out its correlation with prognostic parameters. Despite numerous studies, there is a lack of literature for such studies in Indian patients. Moreover, the results obtained from these studies have not been uniform.

A hospital-based cross-sectional study was conducted on 150 cases of breast carcinoma. The invasive cancer specimens were assessed for routine microscopy and classified into various histopathological subtypes. Bloom Richardson grading was done. Immunohistochemistry for surrogate molecularclassification as well as PD-L1 was performed. PD-L1 expression was then compared with several prognostic parameters such as tumor subtype, tumor grade, surrogate molecular classification and pTNM stage. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P value of <0.05 was considered statistically significant.

PD-L1 was positive in 14.67% of patients with score 1 in 6% and score 2 in 8.67% of patients. The PD-L1 expression showed a positive correlation with the tumor of higher grades (grade3). It was significantly higher among IBC with medullary features as compared to IBC-NST, IBC with papillary features and the Lobular type. PD-L1 showed a significant association with surrogate molecular classification as well. Its expression was found to be the highest in Triple negative breast cancer subtype as compared to tumors showing ER/PR positivity (p<0.05). However, there was no significant association between PD-L1 and TNM staging.

This study revealed asignificant association between PD-L1 several prognostic factors such as higher tumor grade (grade3), Triple Negative breast cancer, and IBC with the medullary pattern subtype. The association between PD-L1 and such prognostic parameters signifies its role in tumor mechanism and makes it a potential target for immunotherapy especially in Triple Negative breast cancer cases which lack specific targeted therapies. Moreover, paucity of literature on PD-L1 in breast cancer patients in India and the data showing conflicting results make this study valuable. Our study shall be helpful in further adding to the knowledge of PD-L1 expression in breast cancer especially in Indian women.

Syzygium aromaticum, also known as clove, and its essential oil has already been proved to have antioxidant, anti-inflammatory and anticancer properties. Clove is used in various foods owing to its potent antimicrobial and antioxidant properties. Essential oil extracted fromclove has been used in traditional medicine for treating various ailments.

In silicoanalyses of phytocompounds of Syzygium aromaticum namely eugenol, B-caryophyllene, gallic acid, crategolic acid, kaempferol, quercetin, cinnamaldehyde, and oleanolic acid were docked with three apoptotic proteins involved in breast cancer, namely BCL-2, BAX and APAF-1 using AUTODOCK. In addition, flower bud extract of Syzygium aromaticumwas used for the synthesis of AgNPs (silver nanoparticles). The synthesized clove-silver nanoparticles were then characterized using various techniques such as Ultraviolet-visible spectrophotometry, FTIR, FESEM-EDX, DLS and zeta potential to determine theparticle size, shape, crystalline structure, and stability of CL-AgNPs and tested for its anticancer potential in MCF-7 cell lines.

In silicoanalysis predicted that phytochemicals of clove have good interactions with the apoptosis related proteins of breast cancer. In vitroassay confirmed the cytotoxic effect of the synthesized CL-AgNPs onbreast cancer cells using the MCF-7 cell line with the IC50 value of 58.64 μg/ml.

In vitroanalysis of the anticancer activity of CL-AgNPs in MCF-7 cell line supports the in silicostudy by proving active interactions between the phytochemicals of clove and target proteins of the breast cancer and hence Syzygium aromaticumhas been proved to possess potential anticancer property. Further researchis needed to consider clove-silver nanoparticles as a novel drug for treating breast cancer.

Invasive breast cancer (IBC) has long been thought as non-immunogenic, but in recent decades it has been reported that tumour micro-environment (TME) in breast cancer encompasses tumor-infiltrating lymphocytes (TILs), which help in creating anti-tumor immune response. On the other hand, tumor buddings (TB) from the invasive front of the tumor contribute to invasion and metastasis. We aim to evaluate TILs and TB in IBC and to correlate them with known prognostic parameters.

In this retrospective study, 50 cases of IBC were included. TILs and TB were observed and graded in H&E Stained slides following standard guidelines. Associations of TILs and TB with known clinicopathological parameters were established by statistical methods.

The majority of cases were invasive breast carcinoma (IBC)-NST (78%). The cases with low TILs (involving <50% of stroma) had a significant correlation with positive lymph node metastasis (P = 0.017) and high-grade TB (P = 0.038). TB was associated with other adverse prognostic parameters such as tumor necrosis (P=0.043) and lympho-vascular invasion (LVI) (P=0.033) and large tumor size.

As tumor budding is associated with known poor prognostic factors such as necrosis, LVI and large tumor size, it can be regarded as a potential biomarker in predicting the aggressiveness of breast cancer. Low TILs are positively associated with invasion and lymph node metastasis of IBC. Thus, assessment of these protumor (TB) and antitumor (TILs) factors could be a promising approach for future research on breast cancer.

Bone modifying agents are used throughout cancer care and their utilisation can optimise advanced stage cancer cases with bone metastases, by reducing skeletal-related events, treatment-induced bone loss and treatment hypercalcaemia. They are also used in patients with a curative intent such as early breast cancer, reducing recurrence and increasing survival rates. Medication-related osteonecrosis of the jaw (MRONJ) is a potential complication following bone modifying agents (BMAs). It represents exposed bone in the maxillofacial region which significantly compromises the quality of life for these patients. Dental disease is the most common initiating factor of MRONJ. We report a case in which MRONJ has dominated cancer care despite its successful treatment.

A 69-year-old female was diagnosed with a breast cancer (grade 1, infiltrating ductal carcinoma, pT1c pN1mi(sc) Mx), for which she was treated with a wide local excision and axillary lymph-node clearance. Seven years after initial presentation, the patient presented with metastatic disease involving the left supraclavicular fossa, bone, peritoneum, and liver. Her BMA regime included zoledronic acid intravenous (IV) every month for 12 months and switched to oral zoledronic acid for a subsequent year due to poor venous access. Two years after her diagnosis of metastatic disease, the patient presented with exposed bone in her anterior maxilla, which represented advanced stage MRONJ (AAOMS 3). The exposed bone in the maxilla was treated surgically by sequestrectomy and fistula closure. Three years later (12 years after initial breast cancer diagnosis), the patient was re-admitted with a cervical fascial space infection involving the right mandible. The patient developed another site of advanced-stage MRONJ (AAOMS 3) in the right mandible associated with an orocutaneous fistula. The patient had a marginal resection of her mandible, fistula closure and extraction of the remaining teeth under general anesthetic.

The practicing oncologist needs to be cognisant of the possibility of MRONJ in both the curative and palliative setting. Traditionally, oncology care has required a significant degree of self-reliance on patients to navigate dental treatment pathways. Integration of dental clinics into oncology pathways would help eliminate this need for self-reliance. MRONJ is an inevitable risk for a large cohort of oncology patients and active engagement of dental-oncology specialities will ensure optimal care for patients.

Extra-pulmonary small-cell neoplasms are rare, and treatment planning is challenging for clinicians. The lack of guideline-based management undermines and isolates patients for whom these cancers are not just rare but also real. Small-cell breast cancer (SCBC) is a rare, aggressive disease that accounts for less than 1% of all invasive breast cancers. Here, we report a case of SCBC and discuss the complexities of case management.

A 46-year-old patient presented with a self-detected right breast lump. Mammogram and ultrasound examination showed a 69x47mm dense lesion in the upper outer aspect of the right breast and a 17mm pathologic node in the inferior right axilla. The triple assessment demonstrated a localisedhigh-grade malignant neuroendocrine neoplasm. Management extrapolated from small cell lung cancer management and case reports, consisted of chemotherapy with carboplatin, and etoposide introduced with concurrent radiotherapy, followed by mastectomy with axillary lymph node dissection. A complete pathological response was obtained. Six months following her surgery, metastatic disease in the brain, chest wall, lymph nodes, and lungs developed. Rechallenge with carboplatin and etoposide led to a brief response, and subsequent immunotherapy was ineffective.

This case report highlights the challenges of rare tumour management. Establishing registries for these and other rare tumors would facilitate care, reduce patient uncertainty and assist in founding protocol-based care.