Archives of Breast Cancer
Volume:11 Issue: 2, May 2024

Breast carcinoma exhibits heterogeneity in terms of morphology, molecular, treatment response, and clinical outcomes. The objective of the study was to classify the various malignant breast cancer cases based on their immunohistochemical characteristics and understand their association and behavior, which may be useful for predicting treatment and prognosis.

In this study, 12808 malignant breast cancer cases were studied based on hormone receptor IHC biomarkers, age, gender, histological type, grade and molecular classifiers.

The mean age of patients was 53.63+13.08 years, around 45.43% were grade 3 tumors, and the invasive duct carcinoma of non-specified type was the most common type seen. ER positivity was 83.89% in grade 1, 69.9% in grade 2, and 36.86% in grade 3 tumors, and the overall PR and Her-2 positivity was 47.06% and 18.67%, respectively. A relatively higher percentage of Triple Negative cases was seen, followed by 25.43% Luminal A cases. There was a significant association between molecular subtypes with respect to age, gender, Scarff Bloom Richardson grade, and histological type. Overall, grade 3 tumor cases were most common, the majority of which were Triple Negative. Maximum cases of triple negative tumors were seen among women, being mostly concentrated in younger age group i.e. <40 years.

Immunohistochemistry for hormone receptor positivity remains the mainstay of diagnosis and molecular sub-classification. The hormone response of tumors is important prognostically, and in predicting the treatment outcomes. Going further, molecular analysis and gene expression studies can further augment the histopathological diagnosis to assist strategies of targeted therapy and precision medicine, resulting in better patient outcomes.

Depression is a significant mental health issue that hinders the recovery of breast cancer patients. The comorbidity of depressive disorders and breast cancer is a complex medical condition. This study aims to examine depression among breast cancer patients in Nigeria.

A scoping review approach was used to explore four databases: Google Scholar, PubMed, Medline, and Scopus. Relevant search terms were used, resulting in 50 records. After removing the articles that did not meet the eligibility requirements, 12 records were included in the study.

Depression is commonly experienced by Nigerian breast cancer patients and they are likely to have a lower quality of life, which hinders the recovery process. Psychological interventions such as CBT, psychoeducation, rational emotive behavioral intervention, mHealth and cognitive restructuring were effective in reducing depressive symptoms among Nigerian breast cancer patients.

Depression is a major mental health problem among breast cancer patients in Nigeria. CBT, psychoeducation, mHealth, rational emotive behavioral therapy and cognitive restructuring interventions have been found to be effective psychological methods for treating depression in this patient group. Further studies are needed in the northern parts of the country, as most of the reviewed studies were conducted in the southern parts.

Approximately 8% of breast cancers originate within the central ducts near the nipple-areolar complex(NAC), which has revealed higher rates of occult involvement than previously thought. Precise preoperative imaging to assess NAC and subjacent tumor involvement has become critical to identify candidates for nipple-sparing mastectomy (NSM) while ensuring oncological safety. The aim of our study is to determine whether Magnetic Resonance Imaging (MRI) could be used for the detection of subtle neoplastic infiltration.

Electronic databases including PubMed, Scopus, Web of Science, and EMBASE were systematically searched to identify all relevant studies published before 2024 on diagnostic performance of MRI in malignant extension to the nipple. The keywords included MRI, NAC, breast cancer, NSM, True Positive (TP), True Negative (TN), False Positive (FP), False Negative (FN) were extracted for analysis. Finally, 5 articles were selected for our meta-analysis. STATA version 15 was used to analysis data.

Our meta-analysis showed a pooled sensitivity of 85%(95% CI: 77%-91%)with low heterogeneity(I2 = 00.00%), and a pooled specificity of 82% (95% CI: 49%- 95%), with significant heterogeneity(I2 = 98%). The pooled positive diagnostic likelihood ratio(pDLR) was 4.6(95% CI: 1.3-16.6, I2 = 96.66%), and the negative diagnostic likelihood ratio(nDLR) was 0.18(95% CI: 0.10-0.33, I2 = 50.06%).

Diagnostic MRI characteristics such as NAC enhancement, non-mass enhancement (NME) type, mass size (greater than 20 mm), and tumor-to-nipple distance (TND) were assocaited with the presence of NAC involement. Because of high diagnostic accuracy, MRI imaging can be used as a helpful tool for NAC diagnosis.

The purpose of this mixed methods study was to examine what factors may influence emotional suppression and expression in breast cancer patients and how coping styles relate to beliefs about physician-driven referrals to therapy.

A mixed method research design was used consisting of quantitative methods including a demographics survey, the Courtald Emotional Control Scale and treatment preference questionnaires followed by optional participation in a semi-structured interview.

Demographic variables including age, marital status, income, and experience of psychotherapy prior to breast cancer diagnosis are statically significant factors that influence CECS scores and coping styles. Participants universally believed that there should be some level of psychotherapy referrals for supportive mental health care during and after the treatment process.

Participants who fell into either category of emotional suppressor or emotional expresser believed that there should be physician driven referrals to therapy during the breast cancer treatment process. Both those identified as suppressors and expressers indicated high rates of concealing one’s true emotional experience. This highlights the need for psychological therapy referrals to be integrated as a best practice, regardless of patient’s identified coping style or demographic identities. We suggest that all breast cancer patients be screened at multiple points and offered a referral by every member of their treatment team regardless of how they seem to cope. We also suggest that future research focus on the most efficient and holistic ways to decrease barriers to receiving psychological support during and after breast cancer treatment.

The rapid advent of artificial intelligence (AI) and machine learning (ML) in the healthcare sector offers new horizons for patient education and has the potential to redefine patient-provider interactions. Our research aimed to gauge the efficacy of ChatGPT-4 in delivering accurate, current, and safe medical guidance on breast reconstruction, and benchmark its responses against other established patient information channels.

We presented ChatGPT-4 with six frequently posed questions about breast reconstruction. The model's replies were critically assessed by a committee of experienced plastic and reconstructive surgeons. To ensure the precision of the information, its responses were further cross-referenced against two major medical databases.

The results revealed that ChatGPT-4 produced well-articulated, factually sound, and holistic answers to the presented inquiries. However, the platform showed constraints in offering tailored guidance and occasionally cited outdated or irrelevant references. Notably, the system consistently advocated for professional consultation for nuanced information.

ChatGPT-4 has emerged as a potential supplementary resource in patient education concerning breast reconstruction. Nevertheless, to harness its full potential and ensure its seamless integration into healthcare, further refinements and advancements in AI tools are paramount. The study underscores the importance of continuous evaluation and enhancement for AI solutions in the evolving landscape of patient education.

Drug resistance is a major challenge in cancer chemotherapy.

By adopting an appropriately timed strategy, we generated MCF-7 cell sublines resistant to serial doses of doxorubicin (DOX). Our higher-dose sublines showed more stability in resistance and were, therefore, subjected to further analyses. We tested the consistency of drug resistance by comparing sublines with control groups for growth and migration capacities. Molecular analyses monitored expression changes, CD44/CD24 ratios, and DOX binding to key molecules. The reverting impact of shikonin (SHKN) and metformin (MTFN) on DOX resistance was examined.

The resistant sublines grew parallel to or even faster than WT MCF-7 cells and showed a larger and more rounded morphology. The consistency of their drug resistance and invasive potential was demonstrated over time using serial doses of DOX. Real-time PCR revealed upregulation of genes involved in cell growth and survival, drug resistance, migration/invasion, and epithelial-mesenchymal transition and, conversely, downregulation of pro-apoptotic, anti-chemoresistance, and tumor suppressor genes. SHKN-MTFN co-treated resistant cells showed significantly lower CD44/CD24 ratios, less aggressiveness, and reduced survival and migration rates but enhanced apoptosis. SHKN’s affinity to CYP1A and TOP2A demonstrated the importance of these interactions and the compounds’ capacity to compete with DOX.

Acquisition of DOX resistance increases tumorigenic properties of cancer cells, whereas synergy between selective anti-tumorigenic compounds re-sensitizes resistant cells by reverting cellular pathways that favor or follow resistance. Our findings suggest that this reversal is supported by competing reactions that deprive DOX of binding to its target molecules.

This study investigates the effectiveness of mammographic screening for women aged 40 to 49 in Brazil's Steel Valley Region. Despite a Ministry of Health recommendation to start screenings at 50, 25% of breast cancer cases occur in the 40-49 age group.

The retrospective analysis, spanning 2008-2019 at Marcio Cunha Hospital, compared two groups: cancer diagnosed via screening mammography (277) and diagnostic mammography (229).

The results showed delayed diagnoses for non-screened women, with a 4.16 times higher mortality rate. Screening facilitated earlier detection of less malignant cancers (85.9% vs. 43.7%). Women diagnosed through screening were more likely to preserve their breasts (28.9% vs. 55.5% for Radical Breast Surgery and 71.1% vs. 28.9% for Breast-Sparing Surgery), and fewer axillary lymphadenectomies were performed. All statistical tests performed returned a P-value lower than 0.05, showing high statistical significance.

The findings support extending screening mammography access to all women over 40 in the Steel Valley region and underscore the need for broader-scale research in other areas. Recommendations include enhancing public awareness and establishing a breast cancer surveillance service.

The Breast Imaging-Reporting and Data System (BI-RADS), developed to standardize mammographic findings, categorizes 'probably benign' lesions as BI-RADS 3, aiming to reduce unnecessary biopsies from false positives, with a cancer likelihood of less than 2%. In some countries, screening programs have been expanded to include ultrasound alongside mammography, particularly in populations with predominantly dense breast tissue, leading to an increased detection of BI-RADS 3 lesions through this additional modality. This study examines the effectiveness of 6-month follow-ups for these ultrasound-identified BI-RADS 3 lesions.

We retrospectively analyzed 7,577 women who underwent mammography and ultrasound screening from January 2016 to December 2021. Of these, 2,907 were classified as BI-RADS 3 based on ultrasound findings. The study focused on 1,163 patients with normal mammography and assessed BI-RADS 3 from ultrasound findings, who completed a 24-month follow-up. Data analysis included assessing demographic data, breast cancer risk, imaging features, and pathological findings.

Among the 1,163 patients, the cancer detection of the entire cohort was 0.7%, with no cancers detected during the first six months. The cancer found at 6 months and 12-24 months were 0 and 0.17%, respectively (P<0.001). The median time for reassessment from BI-RADS 3 to BI-RADS 4 was 18.4 months. Upon the change of BI-RADS, spiculation and angular margins were the most predictive ultrasound features for malignancy. Lesion size growth alone was found insufficient as a biopsy criterion. A 28% growth cutoff distinguished between benign and malignant lesions better than a 20% cutoff.

A 12-month follow-up interval may be more appropriate than the traditional 6-month interval for average-risk patients with BI-RADS 3 lesions detected by screening ultrasound. Combining suspicious imaging features with size increases enhances diagnostic accuracy, providing a tailored follow-up approach based on individual risk profiles and imaging characteristics.

Cancer cells in lymph nodes can undergo metabolic changes, producing acidic byproducts. Our previous experimental results demonstrated significant pH differences between involved and free lymph nodes (LNs), potentially attributed to the release of these acidic byproducts. However, the accuracy of frozen sections is influenced by pathologists' expertise and limited response time. To address these limitations, we developed a simple pH sensing method.

We conduct a cross-sectional study on non-neoadjuvant breast cancer patients (n= 34) from Shohada Tjarish Hospital and Azar Surgical Clinic to check the agreement between the pH value of sentinel lymph nodes (SLNs) and their pathologic score. To assess the pH assay's validity in detecting metastasized cancer cells in lymph nodes, the sensitivity, specificity, and accuracy of the sensor were calculated using Permanent pathology of LNs as the reference standard.

The results showed that cancer SLNs had pH≤7, while free LNs had pH > 8 (P-value <0.001). The sensitivity and specificity of the data were 89% (95% CI (0.73-1.05)) and 82% (95% CI (0.64-1.00)), respectively.

Hence, in the absence of a frozen section, such a simple measurement may assist the surgeon in deciding whether to dissect more LNs or not.

Phantom breast syndrome (PBS) following mastectomy is believed to be a complex psychological reaction to mastectomy but studies on PBS are limited. The study aims to determine the prevalence of phantom breast syndrome and the impact of this syndrome on patients suffering from depression following mastectomy.

A total of 272 women who had undergone mastectomy were interviewed using a structured questionnaire related to phantom breast sensation and depression caused by its effect by using ‘’Hamilton Depression Scale’. SPSS Statistics v27 was used to analyze the data.

Out of 272 females, 7.4% of the participants in our study reported having phantom sensations following surgery, 64.7% had Phantom Breast Syndrome, 37.5% had mild, 5.1% moderate, and 0.7% severe depression according to ‘Hamilton Depression Scale’. Univariate logistic regression revealed that females under 45 have a higher likelihood of developing phantom breast syndrome compared to those over 45 (OR=2.012, P=0.038).

Females with depression have a higher likelihood of experiencing phantom breast syndrome compared to females without depression.

gene are potent to elevate breast cancer risk where rs920778 and rs1899663 are associated with the expression and function of the HOTAIR gene, and these SNPs were detected in the current study.

A cohort of nine sporadic cancer patients and five healthy controls were screened for selected HOTAIR variants using direct sequencing.

Among the patients, seven showed the TT genotype, with the other 2 showing the CT genotype for rs920778 C>T, while two healthy controls showed TT, with two others showing CT, and the remaining cases showed the CC genotypes. Among the cohort, the rs1899663 variant was not found in any patients and healthy controls.

In the study, the T allele of rs920778 was prominent among the sporadic breast cancer in the studied cohort, while only a wild allele (G) of rs1899663 was more prominent in the patients and healthy controls.

Bilateral breast hypertrophy, ranging from mild to severe, can lead to various complications, including pain, ulceration, infection, and psychological distress. Swift surgical intervention is often necessary to address the mechanical and psychological challenges associated with excessive breast weight. While treatment approaches for this condition are debated, recent advancements favor surgical strategies like mastectomies with reconstruction to improve clinical and psychological outcomes. We present a unique case of bilateral breast hypertrophy successfully managed through breast amputation and NAC (nipple-areolar complex) graft using wise patterns incision mammoplasty.

This report details the case of a 30-year-old female with hypothyroidism and lupus who experienced significant bilateral breast enlargement during her second pregnancy. The patient faced pain, hyperpigmentation, and limited mobility, along with abnormal laboratory findings. Bilateral reduction mammoplasty (breast amputation) was performed, leading to successful outcomes and improved quality of life for both the patient and her newborn. Follow-up assessments showed no recurrence or complications postoperatively.

This case highlights the challenges of managing breast hypertrophy in pregnant patients with autoimmune conditions. Early recognition and multidisciplinary management are crucial in such cases. The positive results of the interventions underscore the importance of timely and comprehensive care for patients facing similar conditions.

Pilomatrixoma is a benign adnexal tumor with differentiation towards the matrix of the hair follicle and occurs mostly in the head, neck, and upper extremities of the child. Pilomatrixoma of the breast is considered a very rare tumor.

Herein, we present a 47-year-old woman who was referred to the surgery ward for a palpable right breast mass. Imaging studies revealed a well-circumscribed lesion categorized as BIRADs3. Because clinically the lesion was large and had a stony hard consistency, the patient underwent surgery and intraoperative consultation was negative, revealing a well-defined lesion composed of basaloid cells, multinucleated giant cells admixed with bone trabeculae, and nests of ghost cells. Immunohistochemical (IHC) studies were done and the cells were positive for AE1/AE3, Beta-catenin, and BCL2 and negative for Mart1 and CD117. Based on H&E and IHC studies, pilomatrixoma of the breast tissue was confirmed.

Breast pilomatrixoma is a very rare benign neoplasm that could clinically mimic malignant neoplasm and should be considered in the differential diagnosis of breast masses.