Archives of Breast Cancer
Volume:1 Issue: 3, Nov 2014

October is recognized as The Breast Cancer Awareness Month when international campaigns are organized to raise research and development funds, enable patient support groups and more importantly encourage women to know the facts about their leading cause of cancer death.

Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) in early breast cancer patients as the first line surgical approach to axillary nodes. Further dissection is performed only when SLN is involved by tumor cells. However, in a significant proportion of patients, non-sentinel nodes are still not involved and axillary dissection has no additional therapeutic benefits. Selective axillary clearance has been considered to prevent unnecessary dissection. The purpose of this study was to define predictors of non-sentinel lymph node involvement in patients with positive SLNB. Patients with early stage breast cancer and positive SLNB who underwent ALNDin a referral hospital in Tehran, Iran between2010 and 2012 were recruited into the study. Relations between different clinico-pathological characteristics and involvement of non-sentinel nodes were investigated. From 139 patients who had positive SLNB and underwent ALND, only in 71 cases (51%) positive non-sentinel lymph nodes (NSLNs) were detected. In univariate analysis, there was no association between tumor size, lymphovascular invasion, ER, PR and HER-2 expression and NSLN metastasis. In contrast, presence of more than one SLN (P = 0.016) and a sentinel node ratio (SNR) more than 0.5 showed a significant association (P< 0.001). Only the latter remained as the significant predictor of NSLN involvement in mutltivariate analysis (P < 0.001, OR = 3.706). Based on our results, patients with a SNR more than 0.5 were more commonly diagnosed with NSLN metastasis. Thus, it is recommended that surgeons think twice before skipping ALND in this subgroup of patients.

Triple-negative breast cancer (TNBC) carries a poor prognosis and therapeutic options are limited to date. The aim of this study was to investigate to what extent the epidermal growth factor receptor (EGFR), vascular endothelial growth factor receptor 2 (VEGFR2), hypoxia inducible factor-1 alpha (HIF-1a) and insulin-like growth factor-1 receptor (IGF-1R) are expressed in TNBC and to determine if these expressions have a predictive role. Of 923 breast cancer patients who were treated and followed in Academic Center for Education, Culture and Research (ACECR) from 2006-2010, 104 of them had TNBC. Immunohistochemistry analyses were performed on tissue microarray blocks with antibodies for EGFR, VEGFR2, HIF-1a and IGF-1R. We analyzed tumor samples from 104 patients with classic primary invasive ductal carcinoma (IDC). Fifteen patients (14%) were in stage I, 46.6% in stage II, 30.1% in stage III and 5.8% in a metastatic stage (stage IV). The median overall survival (OS) was 48 months. EGFR was expressed in 15 (14%), VEGFR2 in 63 (61%), IGF-1R in 81 (78%) and HIF-1a in 57 (55%) samples. EGFR expression was significantly associated with poor outcome in terms of OS (P = 0.021, OR = 3.9). Among the four investigated tumor markers, only EGFR was significantly associated with survival of patients with TNBC.

Cancer/testis antigens (CTAs) are members of a group of proteins which are normally expressed in testis germ cells and to a lesser extent in the ovaries. According to recent reports about their aberrant and specific expression in some tumoral tissues, they may play a role as new candidates for targeted therapy. Therefore, the study of the expression pattern of these biomarkers and its relationship with clinical features of the patients is a subject of great interest. In this study, expressions of PIWIL2 and PL2L60 genes were studied by multiplex RT-PCR in 65 breast tissue samples including 30 invasive ductal carcinomas (IDC), 30 normal adjacent tissue samples and five normal breast tissue samples and 2 normal testicular tissue samples as positive controls. Beta Actin was considered as internal control. Results of gel electrophoresis analysis demonstrated no significant expression of target genes in any sample except testis. Simultaneously, Beta Actin was expressed in all the samples. The present study indicates lack of PIWIL2 and PL2L60 expression at mRNA level in breast cancer. Although cell lines can be used in cancer research, they are not representative of tumor tissues. More studies investigating the expression of these genes at protein level will help us decide whether to apply these candidate genes as tumor markers or not.

Many natural products from plants have been recognized to exert anticancer activity. In this study, ethanolic extracts of selected medicinal herbs from Iranian flora including Alyssum homolocarpum Fisch. (from seeds), Urtica dioica L. (from aerial parts), Cichorium intybus L. (from roots) and Solanum nigrum L. (from fruits), were evaluated for their cytotoxic effect on different cell lines. Cytotoxic effect of these extracts was studied on three different cancer cell lines; colon carcinoma (HT-29), colorectal adenocarcinoma (Caco-2) and breast ductal carcinoma (T47D). In addition, Swiss mouse embryo fibroblasts (NIH 3T3) were used as normal nonmalignant cells. MTT assay (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) was utilized for calculating the cytotoxicity of extracts on cell lines. Results showed the potent cytotoxic activity of U. dioica ethanolic extract against T47D cell line with IC50 value of 46.14±4.55 µg/ml. Other extracts showed poor activity with IC50>100 µg/ml. Cytotoxic activity recorded in the present study revealed high potential antiproliferative activity of U. dioica ethanolic extract against T47D cell line. The real IC50 values of this extract may be considerably lower than the IC50 measured in our study if its pharmacological active compounds become pure. The results emphasize the importance of studies on U. dioica ethanolic extract to characterize potential components as cytotoxic natural medicines.

Angiosarcoma can develop in all parts of the body containing blood vessels, including breast. Statistically, less than 10% of all angiosarcomas originate in the breast. Angiosarcoma accounts for less than 0.05% of breast primary cancers. Primary angiosarcoma develops without a history of treatment for breast cancer, whereas secondary angiosarcoma develops in patients who have already had treatments for other primary breast cancer. In review of the literature, primary angiosarcoma, particularly bilateral, is rare. In this study, we present a patient, a young woman, with primary bilateral angiosarcoma. Although breast angiosarcoma is rare, we should be aware of it, particularly in young women with breast mass that is hyperflow in Color Doppler ultrasound.