Breast Cancer Incidence Among US Women Aged 20 to 49 Years by Race, Stage, and Hormone Receptor Status

Estimated human intake of endogenous and exogenous hormones from beef in the United States

BACKGROUND

Endogenous and exogenous hormones may be present in beef. Human consumption of hormones has been linked to adverse health effects.

OBJECTIVE

To estimate daily intake of hormonal growth promotants (HGP) from beef consumed by the US population.

METHODS

We combined self-reported beef consumption information from a nationally-representative survey with concentrations of 12 HGP measured in 397 samples of retail beef/fat purchased in California. We defined typical, high, and maximum intake scenarios assuming self-reported consumed beef contained the mean, 95th percentile, and maximum concentrations of each HGP, respectively. We estimated distributions of usual (i.e., long-term) daily intake and short-term daily intake (µg/kg/day). We calculated the hazard quotient (HQ), or ratio of estimated intake to the World Health Organization's acceptable daily intake (ADI) for the HGP.

RESULTS

The highest estimated HQs were found for melengestrol acetate (MGA). For usual daily intake under the typical intake scenario, no HQ exceeded 0.02 (0.00047 µg MGA/kg/day). Under the maximum intake scenario, the highest HQ was 0.29 (0.0087 µg MGA/kg/day), corresponding to the 99th percentile of intake among young boys (ages 1-5). The highest short-term intake estimates for MGA under the maximum intake scenario were the 99th percentile of intake among young girls and boys, which equaled (HQ = 1.00) or exceeded (HQ = 1.29) the ADI for MGA, respectively.

IMPACT

Hormonal growth promotants (HGP) are used to increase beef production and have been linked to adverse reproductive effects. We estimated daily intake of MGA and several other HGP using US nationally-representative beef consumption data collected between 2015-2018 and HGP concentrations in retail beef. Estimated intake was highest for young children, but estimates were generally very low compared to current health-based intake limits. However, these limits are typically based on studies in adult animals, and further study of potential adverse effects during sensitive developmental periods, such as in early life, may be warranted to ensure recommended intake limits are health-protective.

[Generation X and millennials are at greater cancer risk than previous generations: Possible causes and implications]

The incidence of early-onset malignancy (EOM) diagnosed under the age of 50 has been increasing worldwide. In the USA, Generation X and the millennials are up to 2 times more likely to develop 17 of the 34 most common cancers than the baby boomers at any given age. Globally, the incidence of EOM increased by 79.1% between 1990 and 2019. Early-life exposure may be linked with EOM development and may forecast a greater disease burden in the future. Possible causes and consequences are discussed with regards to cancer prevention.

Factors Associated With Not Returning to Work Among Breast Cancer Survivors

BACKGROUND

Returning to work (RTW) is a crucial aspect of recovery for patients with breast cancer (BC), which indicates restored normalcy, financial stability, functional abilities, and an improved quality of life. However, associated factors related to not RTW among patients with BC remain unclear. In this study, we examined associated factors of not RTW among patients with BC.

METHODS

A cross-sectional study and convenience sampling were conducted in two hospitals in Indonesia to recruit eligible participants. Factors related to not RTW were collected and included symptoms of distress, loneliness, anxiety/depression, perceived social support, and frailty. A logistic regression model was performed to explore associated factors of not RTW.

FINDINGS

In total, 250 patients with BC were included in this study, and 148 of them experienced not RTW. Anxiety, loneliness, frailty, and social support emerged as significant factors associated with not RTW. BC patients who had a higher anxiety level (odds ratio [OR]: 5.30; 95% confidence interval [CI] [2.16, 12.98]), had high loneliness (OR: 3.15, 95% CI [1.29, 7.67]), or were frail (OR: 2.53; 95% CI [1.07, 5.98]) had a higher risk of not RTW. BC patients with lower social support (OR: 5.65; 95% CI [1.81, 17.63]) had a higher risk of not RTW.Conclusion/Applications to Practice:Occupational health professionals can offer early counseling, health education, and support strategies to patients with BC, assisting their preparations in terms of both physical and psychological functions for successfully RTW.

Culturally appropriate patient-provider communication methods for Black women with breast cancer: a scoping review

PURPOSE

Black women with breast cancer experience a 40% higher mortality rate compared to white women, and this disparity may be influenced by suboptimal patient-provider communication. Evidence has suggested that Black patients with breast cancer have unique informational needs, yet few studies focus on patient-provider communication for this community. The aim of this scoping review was to identify best practices for communicating breast cancer diagnosis and treatment options with Black women.

METHODS

Following PRISMA-ScR, a search strategy was developed and implemented in 4 databases and grey literature. Coders achieved reliability and independently screened articles by title and abstract, then full-text. Articles were included if they studied Black patients with breast cancer and reported on patient-provider communication. Outcomes of interest included patients' appraisals of their communication, and associated health outcomes.

RESULTS

A final sample of 27 studies were included. Black patients' positive appraisal of their providers was based on their interactions, rather than providers' perceived expertise. Patients had negative appraisal of communication when they received limited information regarding their treatment plan, side-effects, or possibility of disease recurrence. High-quality communication was associated with adherence to adjuvant therapy; low-quality communication was associated with treatment discontinuation or delay, and lower self-rating of physical well-being.

CONCLUSION

Patients' perceptions of their quality of communication with their healthcare providers was associated with their treatment decisions and health outcomes. Future research is needed to test interventions that optimize communication between Black breast cancer patients and their providers, including discussing navigating barriers to care.

Breast Cancer Risk, Screening, and Risk Reduction in Young Females

Screening and prevention strategies for breast cancer (BC) have focused on women over 40 years of age. While BC prevalence under 40 is low, affected patients have more aggressive cancers and a poorer prognosis. Those with identifiable risk factors may benefit from screening for early detection and prevention strategies. This paper reviews the current literature and guidelines regarding BC risk. Screening guidelines and prevention strategies are also reviewed, with a focus on females under the age of 40.

The Johns Hopkins Hope at Hopkins Clinic: supporting the comprehensive needs of individuals with metastatic breast cancer

PURPOSE

Individuals with metastatic breast cancer (MBC) may live with their disease for many years. We initiated the Johns Hopkins Hope at Hopkins Clinic to assess the needs and optimize the care of these patients.

PATIENTS AND METHODS

Patients with MBC who agreed to participate in the Clinic in addition to usual care completed patient-reported outcome (PRO) surveys. They met with a navigator and underwent core consults (cancer rehabilitation, integrative medicine, supportive and palliative care, social work, and nutrition), clinical trial eligibility assessment, and optional services based on PRO responses and selection from a Clinic Menu. A medical oncologist provided a Care Plan during a final consult. Participants were asked to complete 3- and 6-month follow-up PRO surveys. We report on initial Clinic implementation, participant characteristics, and baseline PROs.

RESULTS

From 11/2020 to 6/2022, 45 patients completed baseline surveys and participated in the Clinic. Median age was 58 (32-86); the majority (71%) were white and had estrogen receptor-positive (84%) tumors. Baseline physical and mental health were not good for ≥ 14 days of the past month for 22 and 10%, respectively. PROMIS measure scores were > 1 standard deviation worse than average for 32% for Physical Health, 16% for Mental Health, and 23% for Physical Function. PHQ-8 and GAD-7 scores suggested depression and anxiety for 22 and 7%, respectively. More than 80% of participants received specific recommendations from the core consultants. Only 20% of participants completed follow-up surveys.

CONCLUSION

Patients living with MBC have multiple needs. We used our results to implement routine PRO assessments and to expand services for patients with MBC. Our experience can serve as a model for coordinated care in other systems.

Association of Skeletal Muscle Mass and Muscle Quality at Diagnosis With Survival in Young Women With Breast Cancer: Retrospective Observational Study

BACKGROUND

Low skeletal muscle mass and poor muscle quality are associated with poor outcomes in women with breast cancer. However, gaps exist in our understanding of prognostic factors for young women (≤ 40 years), as they often have different body composition than older women. We evaluated pretreatment body composition measures in young women with breast cancer, including associations with overall survival (OS) and progression-free survival (PFS).

METHODS

The Young Women's Database at Levine Cancer Institute was queried for women aged 18 to 40 at diagnosis (2009-2018) of single primary breast cancer (N = 870); patients with Stage 0 and 4 were excluded. Deceased patients with pretreatment computed tomography (CT) scans were identified (N = 40) and matched (1:1) to patients presumed alive by age, diagnosis year, and disease characteristics. CT-derived body composition measures included skeletal muscle index (SMI) and intramuscular adipose tissue corrected (IMAT-C). Sarcopenia (low muscle mass) was defined as SMI<40.

RESULTS

Of 80 subjects, median age at diagnosis was 35 years. Median follow-up 8.6 years. Total 33% had low muscle mass (sarcopenic), and 56% had poor muscle quality (high IMAT-C). Independent of age, clinical disease stage, and primary insurer, high IMAT-C was associated with shorter PFS (HR 2.33, 95% CI 1.15-4.72; P = .020).

CONCLUSIONS

Poor muscle quality at diagnosis was associated with shorter progression-free survival in young women with breast cancer. Future research should determine the significance of changes in muscle quality throughout treatment.

Disparities in the incidence, mortality and disability-adjusted life years of 33 early-onset cancer groups globally, 2012-2021: a systematic analysis

BACKGROUND

The global cancer burden is rising, with early-onset cancers becoming more prevalent. We aimed to investigate the burden, trend and population disparity in 33 early-onset cancers from 2012 to 2021.

METHODS

Annual incidence, death, and disability-adjusted life years (DALY) numbers and rates for early-onset (15-49 years) cancer groups were calculated from Global Burden of Diseases (GBD) 2021 dataset, covering 2012-2021 across global, five SDI groupings, and 204 countries and territories. Estimated annual percentage change (EAPC) in the incidence, mortality and DALY rates was calculated to quantify temporal trends, while spearman correlation analysis was used to examine the correlation between rates, EAPC and SDI.

RESULTS

In 2021, there were 2.65 million new early-onset cancer cases excluding non-melanoma skin cancer (NMSC), resulting in 0.99 million deaths and 50.7 million DALYs. Breast, tracheal, bronchus and lung (TBL), cervical, colon and stomach cancers were the leading causes of DALYs. The DALY rate for early-onset cancer excluding NMSC changed from 65.7 million in 2012 to 67.0 million in 2021, with an estimated annual percentage change (EAPC) of -0.49%. While the DALY rate plateaued for females, it decreased by -0.95% for males. Ten of 33 cancer groups exhibited an EAPC > 0. The high SDI quintile had 1,100 DALYs per 100,000 caused by early-onset cancers excluding NMSC, with the highest declining trend in DALY and mortality rates, while the high-middle SDI quintile had the highest early-onset mortality rates. Rising trends in cancer incidence and mortality were especially notable among females in the middle, low-middle, and low SDI quintiles.

CONCLUSION

The global burden of early-onset cancer differs significantly by SDI quintile and gender. The increasing burden across multiple cancer groups poses a significant public health challenge. The rising burden of multiple cancer types is alarming, highlighting the need for increased policy support and targeted medical assistance to address the disparities in their impact.

The effectiveness of hand therapy for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists

BACKGROUND

Musculoskeletal problems, or aromatase inhibitor-associated musculoskeletal syndrome, in the hands and wrists is a known side effect of aromatase inhibitor medication, often prescribed for 5years or more for breast cancer survivors. No studies were found on the effectiveness of hand therapy for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists.

PURPOSE

The primary objective of this study is to determine the effectiveness of hand therapy on reducing hand and wrist pain, improving grip strength, improving upper extremity function, and improving health related quality of life in breast cancer survivors diagnosed with aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists.

STUDY DESIGN

Longitudinal case series.

METHODS

A pre-post design was used to compare the results of standardized testing from initial evaluation to discharge. Participants were evaluated using standard hand therapy methods. Outcome measurements studied were pain levels, grip strength, upper extremity function, and breast cancer health related quality of life, measured with a patient-reported outcome measure specific to this population. A multimodal client centered treatment plan was utilized with each participant. Frequency and duration of the treatment was determined through collaboration with the participant.

RESULTS

Thirty-two participants enrolled and 29 completed the study. Comparison of pre and post data for all four outcome measures revealed statistically significant improvements (p<0.05). Cohen's d analysis demonstrated large effect for pain, moderate effects for upper extremity function and health related quality of life, and low effect for grip strength. Trigger finger was noted to be present in 62.1% of participants.

CONCLUSIONS

This study demonstrates that hand therapy resulted in statistically and clinically significant improvement in pain, grip strength, upper extremity function, and health related quality of life. The results support the effectiveness of hand therapy for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists.

Impact of a Breast Cancer Diagnosis on Finances and Marital Status in Young Women

PURPOSE

A breast cancer diagnosis can impact every aspect of a woman's life, particularly for women diagnosed before age 45 when they are in the process of establishing stability in their personal and professional lives. This study investigated the impact of a breast cancer diagnosis on employment, finances, and personal relationships among young breast cancer survivors.

METHODS

We conducted descriptive statistical analysis of survey data from 315 women diagnosed with breast cancer before age 45. Surveys were administered electronically and included 40 questions on demographics asking about employment, insurance, income, and marital status at two time points: at diagnosis and at the time the survey was completed. Descriptive and regression analyses were conducted. The McNemar-Bowker Test of Symmetry was used to calculate the significance of changes in employment, insurance, income, and marital status at the two time points.

RESULTS

We found significant changes following diagnosis in employment and insurance. Prior to diagnosis, 68.6% of respondents were employed full time, compared to 52.4% following diagnosis - falling from 212 to 162 respondents. Individuals who were unable to work increased by 14.6% after diagnosis, rising from 4 to 49 respondents. The decline in full-time employment was highest among those with a diagnosis of Stage IV cancer (33.9%), with the number of full-time worker respondents falling from 79 to 41. We found a significant change in insurance (p < .001) with a decline in individuals with private or no insurance of 4.7% and 3.4%, respectively, while those with public insurance increased by 8.1%.

CONCLUSION

Our findings suggest that young breast cancer survivors are particularly vulnerable to changes in employment, with more than a tenfold increase in the number of young women who reported being unable to work following diagnosis. Our findings also indicate a significant shift from private to public insurance, particularly for individuals living with Stage IV cancer. These results point to opportunities to address the specific needs of young women diagnosed with breast cancer and improve their overall quality of life.

Racial Differences in ctDNA Profiles, Targeted Therapy Use, and Outcomes in Metastatic Breast Cancer

Importance

Black patients with metastatic breast cancer (mBC) have higher mortality rates than White patients despite advances in treatment.

Objectives

To examine whether Black patients with metastatic breast cancer have different genomic profiles compared with White patients and whether there are inequities in targeted treatment use between these groups.

Design, Setting, and Participants

This retrospective, population-based cohort study assessed adult patients with mBC who underwent genomic profiling at academic institutions in the US between January 1, 2015, and December 31, 2023. Data analysis was performed between July 2023 and July 2024. A validation cohort was also included.

Exposures

Targeted treatment use.

Main Outcomes and Measures

The main outcomes were differences in circulating tumor DNA profiles and use of phosphoinositide 3-kinase (PI3K), mammalian target of rapamycin (mTOR), and cyclin-dependent kinase 4/6 (CDK4/6) inhibitors between Black and White patients with metastatic breast cancer.

Results

The study sample included 1327 women with mBC (mean [SD] age, 58.0 [12.8] years; 140 Black and 1057 White). Black patients had a significantly higher rate of GATA3 single-nucleotide variants (odds ratio, 2.31; 95% CI, 1.17-4.54; P = .02) and CCND2 copy number variants (odds ratio, 4.63; 95% CI, 1.79-11.97; P = .002) on multivariate analysis. These differences were validated in a population-based evidence cohort of 27 224 patients. Black patients with PIK3CA single-nucleotide variants were significantly less likely to receive PI3K inhibitors than White patients (1 of 17 [5.9%] vs 45 of 156 [28.8%]; P = .04), whereas there was no difference in use of CDK4/6 and mTOR inhibitors, which do not require a targetable alteration. Black patients had a shorter overall survival from the time of circulating tumor DNA testing compared with White patients.

Conclusions and Relevance

This cohort study of patients with mBC found somatic differences, shorter overall survival, and targeted treatment disparities in PI3K inhibitor use in Black compared with White patients despite equal incidence of PIK3CA alterations. Researchers should consider these differences when designing future research and interventions to address the striking and persistent outcomes gap between Black and White patients with mBC.

Treatment Patterns and Outcomes of Young Female Early Breast Cancer in Taiwan

Young female early breast cancer (≤ 40 years) treatment presents unique challenges due to its aggressive features. Using data from the Taiwan Cancer Registry (2007-2017), this study investigated its clinical characteristics, treatment patterns, and prognostic factors. The proportion of young female breast cancer declined from 12% to 8% during the study period. Triple-negative (TN) breast cancer was more prevalent in younger patients, while hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative subtypes increased with age. Stages II and III were observed more frequently in older patients, whereas extremely young patients (20-29 years) exhibited compromised overall and recurrence-free survival. Subtype analysis revealed worse outcomes for TN and hormone receptor-negative/human epidermal growth factor receptor 2-positive (HER2+) cases. Treatment patterns showed that targeted therapy was more commonly administered to younger patients with HER2+, while endocrine therapy was used less frequently for HR+ cases, reflecting tolerability and treatment compliance challenges. Future research should focus on optimizing therapeutic strategies and addressing long-term survivorship to enhance care for young women with breast cancer.

Metronomic chemotherapy and breast cancer: a critical evaluation of its role in the new landscape of therapeutics

INTRODUCTION

Breast cancer (BC) remains a prevalent and challenging malignancy among women, with significant advancements in treatment strategies over the past decades. Traditional chemotherapy has been progressively supplemented by newer modalities, including Antibody-Drug Conjugates (ADCs), Immunotherapy (IO), and Targeted Therapies (TT). Despite these advancements, there remains a critical need for strategies that maintain efficacy while minimizing toxicity.

AREAS COVERED

This review delves into metronomic chemotherapy (MC), a novel approach involving the frequent administration of low-dose chemotherapy without prolonged breaks. We explore MC's impact across various breast cancer subtypes, such as Estrogen Receptor-Positive (ER+), HER2-Positive, and Triple-Negative Breast Cancer (TNBC). The literature reviewed highlights MC's mechanisms, including its anti-angiogenic, immunomodulatory, and antiproliferative effects, and its potential to improve treatment tolerability and address drug resistance.

EXPERT OPINION

MC represents a promising adjunct to existing therapies, particularly in advanced or resistant cases. Its unique dosing schedule could offer sustained antitumor activity with reduced toxicity, making it a viable option for long-term management. However, further research is warranted to establish optimal dosing regimens, identify predictive biomarkers, and delineate its role within combination treatment strategies. Clarifying these aspects could refine MC's application, potentially reshaping treatment paradigms and enhancing patient outcomes in breast cancer management.

Thymoquinone and Metabolic Reprogramming in Breast Cancer: A New Dimension From Proteomic Analysis

Thymoquinone (TQ) has shown antitumorigenic effects in breast cancer; however, its detailed impact on cell signaling mechanisms requires further investigation. This study aims to elucidate the molecular mechanisms behind TQ's antiproliferative effects in breast cancer by analyzing proteome-level changes. MCF-7 cells were treated with 15 µM TQ, the inhibitory concentration (IC50), for 48 h. Proteins from treated and untreated (control) groups were isolated and subjected to liquid chromatography-tandem mass spectrometry (LC-MS/MS) proteomic analysis. Identified proteins were functionally annotated, with hub proteins identified using Cytoscape software, and verification conducted through Western blot analysis. Label-free quantitation identified 629 master proteins, with 104 upregulated and 477 downregulated in TQ-treated samples compared to controls. Among these, 150 proteins showed dramatic regulation, including 11 upregulated and 139 downregulated proteins, with ribosomal proteins emerging as central. The heatmap demonstrated robust clustering of replicates. Functional annotations indicated that TQ significantly impacts crucial mechanisms such as carbon metabolism, amino acid biosynthesis, protein synthesis, and the citrate cycle, essential for metabolic reprogramming. This study identifies novel molecular targets associated with metabolic reprogramming, previously underexplored in TQ's effects, highlighting their pivotal role in TQ's anticancer mechanisms in breast cancer. These findings could lay the groundwork for developing future TQ-based therapies.

Trends in general surgeon operative practice patterns in a modern cohort

INTRODUCTION

Analyzing general surgeons' operative case mix can provide an update on contemporary practice patterns and inform pragmatic residency training.

METHODS

We performed a retrospective cohort study of general surgeons in Florida, Iowa, and Maryland, 2016-2020. Cases were identified using billing codes. The Cochran-Armitage test of trends was used to evaluate the proportion of practice devoted to specific case types and operative setting over time.

RESULTS

General surgeons (n ​= ​1300) performed 1,287,745 cases. The mean (±SD) annual volume per surgeon for all procedures was 356 (±250), with 198 (±152) general surgery operations, 57 (±142) endoscopic procedures, and 101 (±109) other cases. On average, surgeons operated on 7.1 (±2.6) different organ systems. Trends toward a lower proportion of general surgery operations, and a greater proportion of subspecialty procedures and surgery in the outpatient setting over time were demonstrated (p ​< ​0.001).

CONCLUSION

The practice pattern of the general surgeon continues to be heterogeneous, reflecting the persistent need for a broad training paradigm that permits specialization.

A Student-Informed Guide for Success on the OB/GYN Clerkship

The obstetrics and gynecology (OB/GYN) clerkship is a uniquely enriching and challenging rotation for medical students. Available literature prepares students for medicine and surgery clerkships, but few guides identify and discuss the unique characteristics of OB/GYN that impact student learning and performance during the clerkship. Here, we aim to highlight the specific clinical learning environments, emotionally sensitive experiences, and technical performance expectations that students should anticipate and be prepared for in the OB/GYN clerkship. We believe all students benefit from learning these skills to care for their future patients no matter their chosen specialty.

Impact of timing of pregnancy and genetic risk on local therapy choices for young women with breast cancer

BACKGROUND

It is unknown whether timing of pregnancy before, during, or after breast cancer (BC) is associated with surgical choices in young women with breast cancer.

METHODS

A retrospective chart review identified patients who had a pregnancy within 5 years prior to breast cancer diagnosis (PpBC), were pregnant during breast cancer diagnosis (PrBC), or had a pregnancy within 5 years after BC diagnosis (SPBC). Chi-square test and logistic regression analysis were used to compare surgical choice-unilateral surgery (ULS) or bilateral mastectomy (BM)-between groups.

RESULTS

Of 109 women, 36 (33.0 ​%) had PpBC, 18 (16.5 ​%) had PrBC, and 55 (50.5 ​%) had SPBC. 42.2 ​% had stage II BC and 31.2 ​% had triple negative BC (TNBC). 100 patients had genetic testing and 30 (30 ​%) had a germline pathogenic mutation. Overall, 49.5 ​% of women underwent BM, and this was similar between groups. On logistic regression, genetic mutation (OR 5.44, p ​= ​0.003) and ER-negative tumor subtype (TNBC OR 11.9, p ​= ​0.017; ER-/HER2+ OR 23.2, p ​= ​0.015) were associated with higher rates of BM.

CONCLUSION

In this study, approximately half of women with pregnancy within 5 years of BC diagnosis underwent BM. Genetic predisposition and ER-negative tumor subtype was predictive of this choice while timing of pregnancy was not.

Trends in the incidence and mutational landscape of advanced uterine cancer

OBJECTIVE

The aim of this study was to examine disparities in 20-year incidence trends and mutations in advanced-stage uterine cancer in the United States, given poor survival rates.

METHODS

Data were obtained from the United States Cancer Statistics for patients from 2001 to 2019 with International Federation of Gynecology and Obstetrics 2009 stage IVA and IVB uterine cancer. SEER∗Stat 8.3.9.2 and Joinpoint Regression Program 4.9.0.0 were used to calculate cancer incidence per 100,000 women, annual percentages, and average annual percent change (AAPC). The mutational landscape of advanced uterine cancer was explored using data from the Genomic Data Commons.

RESULTS

In United States Cancer Statistics, 75,450 patients with advanced uterine cancer were identified with an annual percentage increase of 2.63% between 2001 and 2019 and significantly higher rates in Black, Hispanic, and Asian patients compared with White patients (AAPC Black: 3.56%, AAPC Hispanic: 3.12%, and AAPC Asian 3.06% vs AAPC White: 2.07%, each p < .001). AAPC in patients with serous carcinomas increased by 6.32% in Black vs 3.91% in White patients (p < .001). Furthermore, AAPC was 3.0% for Black patients vs 0.7% for White patients with leiomyosarcoma (p < .001). In the Genomic Data Commons, TP53 mutations were more common, and PTEN was less common in Black vs White patients, older vs younger patients, advanced vs early stage, or high- vs low-risk histologic subtypes (p < .05). Mutations in BRCA1, BRCA2, POLE, and PMS2 were less common in high- vs low-risk histologic subtypes (p < .05).

CONCLUSION

Advanced-stage uterine cancer rates are rising in the United States, particularly affecting Black and Hispanic women. Molecular differences exist by age, race, stage, and histology.

Depression risk among breast cancer survivors: a nationwide cohort study in South Korea

BACKGROUND

Depression among breast cancer survivors is a significant concern affecting their long-term survivorship and quality of life. This study investigates the incidence of depression among breast cancer survivors and identifies associated risk factors.

METHODS

This retrospective cohort study used data from the Korean National Health Insurance Service database and included 59,340 breast cancer patients without a history of depression who underwent surgery between January 1, 2010, and December 31, 2016. They were individually matched 1:2 by age with a general population without cancer (n = 99,834). The mean follow-up period was 6.4 ± 2.6 years. Sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) were calculated considering death as a competing risk and adjusting for sociodemographic factors and comorbidities.

RESULTS

Breast cancer survivors with a mean (standard deviation) age of 51.5 (9.2) years had a 39% increased risk of depression compared to non-cancer controls (sHR 1.39, 95% CI 1.36-1.42). During the first year post-diagnosis, breast cancer survivors across all ages exhibited a significantly elevated risk of depression, with a sHR of 3.23 (95% CI 3.08-3.37). Notably, younger survivors had a sHR of 4.51 (95% CI 4.19-4.85), and older survivors had a sHR of 2.56 (95% CI 2.42-2.71). One year post-surgery, younger survivors (age ≤ 50 years) showed a 1.16-fold increase in depression risk (sHR 1.16, 95% CI 1.11-1.20), while older survivors (age > 50 years) showed no significant change in risk, which decreased over time. Use of anthracycline, taxane, or endocrine therapy was associated with an increased depression risk (sHR 1.17, 95% CI 1.13-1.22; sHR 1.12, 95% CI 1.07-1.16; and sHR 1.27, 95% CI 1.14-1.41, respectively), with endocrine therapy showing a 41% increased depression risk in older survivors (sHR 1.41, 95% CI 1.23-1.61).

CONCLUSION

This study demonstrates a significant association between breast cancer and depression, with a particularly heightened risk in younger survivors within the first year post-diagnosis. Special attention is needed to meticulously screen for depressive symptoms during the early follow-up years for breast cancer survivors who are premenopausal or have undergone chemotherapy and endocrine therapy.

Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Postoperative Complications in Patients with Breast Cancer

BACKGROUND

 Two common surgical approaches for breast cancer are breast-conserving surgery and mastectomy with implant-based breast reconstruction (MIBR). However, for large tumors, an alternative to MIBR is oncoplastic surgery with volume replacement (OPSVR). We performed a comprehensive analysis comparing OPSVR with MIBR, with our aim to focus on the 30-day postoperative complications between these two techniques.

METHODS

 We conducted a retrospective cohort study using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2020. Only breast cancer patients were included and were divided according to the surgical technique: OPSVR and MIBR. Logistic regression analysis was used to assess independent risk factors for total, surgical, and wound complications.

RESULTS

 A cohort of 8,403 breast cancer patients was analyzed. A total of 683 underwent OPSVR and 7,720 underwent MIBR. From 2005 to 2020, the adoption of OPSVR gradually increased over the years (p < 0.001), whereas MIBR decreased. OPSVR patients were older (57.04 vs. 51.89 years, p < 0.001), exhibited a higher body mass index (31.73 vs. 26.93, p < 0.001), had a greater prevalence of diabetes mellitus (11.0 vs. 5.0%, p < 0.001). They also had a higher ASA classification (2.33 vs. 2.15, p < 0.001), shorter operative time (173.39 vs. 216.20 minutes, p < 0.001), and a higher proportion of outpatient procedures (83.7 vs. 39.5%, p < 0.001). Outcome analysis demonstrated fewer total complications in the OPSVR patients (4.2 vs. 10.9%, p < 0.001), including lower rates of surgical complications (2.2 vs. 8.0%, p < 0.001) and wound complications (1.9 vs. 4.8%, p = 0.005) compared with MIBR patients. Multivariate analysis identified OPSVR as an independent protective factor for total, surgical, and wound complications.

CONCLUSION

 OPSVR has become a favorable technique for patients with breast cancer. Even in patients with higher comorbidities, OPSVR demonstrates safe and better outcomes when compared with MIBR. It should be considered a reasonable and safe breast surgical option in the appropriate patient.

Immunotherapy for hormone receptor‒positive HER2-negative breast cancer

Additional therapies are needed to improve outcomes in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer. Research on the potential role of immunotherapy, particularly programmed cell death protein 1/programmed cell death ligand 1 inhibitors, is rapidly expanding in both the early and metastatic settings with some preliminary evidence suggesting benefit when used as part of combination therapy. Several ongoing phase 3 studies should help define their future role in treating these patients.

RELT Is Upregulated in Breast Cancer and Induces Death in Breast Cancer Cells

BACKGROUND

Receptor Expressed in Lymphoid Tissues (RELT) is a TNFRSF member that has two paralogs, RELL1 and RELL2; the three proteins are collectively referred to as RELT family members (RELTfms).

METHODS

We sought to evaluate RELT expression in cancerous cells by using real-time PCR, western blotting, flow cytometry, and immunohistochemistry (IHC). The mechanism of RELT-induced cell death was assessed by western blotting, flow cytometry, luciferase assays, and morphology staining. RELT localization was detected through immunofluorescence and western blotting, and co-immunoprecipitation was used to test whether a mutated RELT interacts with the OXSR1 kinase.

RESULTS

RELT and RELL1 protein expression was significantly elevated in cell lines representing breast and lung cancer, whereas RELL2 protein expression was relatively consistent across different cell lines. The surface expression of RELT was highest in monocytes. IHC staining revealed increased RELT expression in malignant breast cancer biopsies compared to patient-matched benign tissue. RELTfm overexpression induced death in MDA-MB-231 (231) breast cancer cells, accompanied by increased phosphatidylserine externalization and Caspase-3/7 activation. The co-transfection of plasmids predicted to block the phosphorylation of RELT by the OXSR1 kinase did not abrogate RELT-induced apoptosis, indicating that the activation of p38 by RELT through the OXSR1 kinase is not required for RELT-induced cell death. Interestingly, nuclear localization of RELT was detected in 231 and HEK-293 cells.

CONCLUSIONS

These results demonstrate that RELT induces death in breast cancer cells through an apoptotic pathway that does not require OXSR1 phosphorylation and that RELT possesses the ability to translocate to the nucleus, a novel finding that warrants further investigation.

Comparative impact of the affordable care act on breast cancer outcomes among women in two US states

Introduction

Since the implementation of the Patient Protection and Affordable Care Act (ACA) and Medicaid expansion, states that adopted the policy have seen reduced uninsured rates. However, it is unclear whether increased healthcare access, particularly for minority and socioeconomically disadvantaged groups, has translated into measurable improvements in health outcomes.

Objective

Our study aims to evaluate the impact of the ACA and Medicaid expansion on breast cancer outcomes in Louisiana, which has implemented the policy, compared to Georgia, which has not, as of 2024.

Methodology

We conducted a retrospective study using SEER registry data from January 2011 to December 2021, including women aged 18-64 diagnosed with breast cancer. The impact of the ACA and Medicaid expansion on cancer-specific survival (CSS), overall survival (OS), and stage at presentation was evaluated. The cohort was divided into pre-ACA (2011-2015) and post-ACA (2017-2021) periods, with a one-year washout (2016). A difference-in-difference (DID) approach compared outcomes between Louisiana and Georgia.

Results

The study analyzed 62,381 women with breast cancer, with 32,220 cases in the pre-ACA period (51.7%) and 30,161 in the post-ACA period (48.3%). In Georgia, 43,279 women were included (52.3% pre-ACA vs. 47.7% post-ACA), while Louisiana had 19,102 women (50.1% pre-ACA vs. 49.9% post-ACA). Medicaid expansion in Louisiana was associated with a 0.26 percentage point reduction in overall deaths (95% CI: -10.9 to 10.4) and a 5.97 percentage point reduction in cancer-specific mortality (95% CI: -26.1 to 14.2). There was also no significant difference in disease stage at presentation compared to Georgia.

Conclusion

This study found no significant differences in overall mortality, cancer-specific mortality, or disease stage at presentation among women with breast cancer in Louisiana, which implemented Medicaid expansion in 2016, compared to Georgia, which has not expanded Medicaid.

Trends in breast cancer incidence by estrogen receptor status in the United States, 2004-2020

Divergent trends of breast cancer incidence by subtype have been reported in the United States and elsewhere; however, it remains unknown whether this trend has continued until the era of the COVID-19 pandemic. Using high-quality population-based cancer registry data, representing 83% of the US population, this study examined breast cancer incidence rates by estrogen receptor (ER) status in women aged 20-84 years from 2004 to 2020. The incidence rate of ER-positive cancer increased by 1.75% per year from 2004 to 2009 (95% confidence interval [CI] = 1.26%-3.15%) and has slowed to a 0.87% annual increase (95% CI = 0.41%-1.03%) from 2009 to 2019, followed by a 10.2% reduction from 2019 to 2020. Trends were generally similar across race and ethnicity, although young women (20-49 years), Asian or Pacific Islander, and Hispanic women experienced steady increases until 2019. The incidence rate of ER-negative cancer decreased by 3.13% annually (95% CI = -4.2% to -2.55%) from 2004 to 2012, and the decrease stabilized from 2012 to 2019 (annual percent change: 0.55%; 95% CI = -1.30% to 0.92%), followed by a 6.0% reduction from 2019 to 2020, with trends generally consistent by age and across racial and ethnic groups. The stabilization of the steep decline in ER-negative cancer suggests a departure from the encouraging trajectories projected in earlier studies. Coupled with the deceleration in the rise of ER-positive cancer, the latest trend signals a potential stabilization in the previous rise of the proportional burden of ER-positive cancer. Understanding the impact of the pandemic on each subtype of breast cancer individually may provide a more comprehensive insight into its long-term sequelae on survival and mortality.

Outcome of Patients with Pregnancy-Associated Breast Cancer Who Have Subsequent Pregnancies

BACKGROUND

After treatment of pregnancy-associated breast cancer (PABC), some women desire future pregnancy. While safety of pregnancy after breast cancer has been demonstrated, the same cannot be said about women with PABC.

OBJECTIVE

The aim of this study was to describe the incidence and outcomes of patients with PABC with subsequent pregnancies compared with those without another pregnancy.

METHODS

A retrospective chart review identified patients diagnosed with breast cancer during pregnancy or within 5 years postpartum between 2011 and 2023. Patients were then screened for further pregnancy. Clinicopathologic variables, oncologic outcomes, and pregnancy outcomes were recorded. The Chi-square test and t-test were used to compare patients with subsequent pregnancy with those without. Kaplan-Meier method and log-rank test were used to estimate 5-year disease-free survival (DFS).

RESULTS

Overall, 75 patients with PABC were identified, 58 of whom had PABC and no further pregnancies (NSP-PABC) and 17 with subsequent pregnancy (SP-PABC). Compared with patients with NSP-PABC, patients with SP-PABC were significantly younger (p = 0.015) and less likely to have prior pregnancies (p < 0.001). Overall median follow-up was 4.3 years. Calculated 5-year DFS rates were 86.2% and 89.0% for the SP-PABC and NSP-PABC groups, respectively (p = 0.76). Calculated 5-year overall survival was 100% and 90.7% for the SP-PABC and NSP-PABC groups, respectively (p = 0.22). Within the SP-PABC group, 14/17 patients had successful deliveries.

CONCLUSIONS

This study provides the first descriptions of patients with PABC and subsequent pregnancy. Additional investigation, likely with pooled analysis from multiple institutions, is necessary to determine the oncologic and obstetric safety of pregnancy following PABC.

Knowledge, Age, and Perceived Social Barriers Regarding Mammography Screening Among Immigrant Arab Women in the United States: A Predictive and Associative Analysis

Background: Ethnic minority women in the United States continue to experience racial disparities. Immigrant Arab women (IAW) underutilize mammography screening (MS) even compared with other ethnic minorities. This population still has gaps in knowledge regarding breast cancer (BC) and screening methods and encounters social barriers, highlighting the imperative role of the male figure and the family, which hinders screening. Materials and Methods: A cross-sectional design with an exploratory and predictive approach was employed to examine knowledge gaps and perceived social barriers associated with MS and to identify predictive factors of MS among IAW in California. The analysis included 316 women that met the eligibility criteria. Results: Familiarity with MS and awareness of screening recommendations were the specific areas of knowledge significantly associated with mammography uptake (odds ratio [OR] 15.4, 95% confidence interval [CI]: 5.6-40.8, p < 0.001) and (OR 12.07, 95% CI: 7-21, p < 0.001), respectively. Logistic regression revealed three MS predictors, the two knowledge areas and age. Perceived social barriers were significantly associated with age [F (3,312) = 4.684, p = 0.003]. There was a significant difference in social barriers between women in their 40s and those in their 60s (p = 0.002) and between women in their 50s and those in their 60s (p = 0.003), suggesting lower barriers among women in their 60s (M = 14.3). Living status was significantly associated with perceived social barriers [F (1,314) = 8.83, p = 0.003]. Conclusions: This study offered valuable insights for health care professionals, policymakers, and community organizations working to improve BC early detection in immigrant and ethnic women to reduce social disparities and reinforce social justice. Knowledge-deficit areas and social barriers must be analyzed and incorporated in awareness programs to improve screening practices of IAW.

Implications of breast density for breast cancer screening

ABSTRACT

Extremely dense breasts can be an independent risk factor for breast cancer. A new FDA rule requires that patients be notified of their breast density and the possible benefits of additional imaging to screen for breast cancer. Clinicians should be cognizant of the data about breast cancer risk, breast density, and recommendations to change screening techniques if patients, particularly premenopausal females, have extremely dense breasts but no other known risk factors.

Promoting breast health among female adolescents: a comparative analysis of the effects of two didactic tools on knowledge and practice regarding breast self-examination in Southwest Nigeria

BACKGROUND

Teaching effective methods for breast self-examination (BSE) to adolescent females is essential for promoting early detection and improving outcomes in breast cancer management. This study therefore aimed to compare two pedagogical tools for teaching BSE among adolescent females.

METHODS

A quasi-experimental design with a group for pre- and post-intervention tests was adopted. The sample included 970 female senior secondary school class I-III students. The Yamane formula was used to determine a sample size of 276. Pre- and post-intervention data were collected using an observation checklist for practice and a validated questionnaire with a Cronbach's alpha coefficient of 0.76 for knowledge of BSE. A proportionate stratified random sampling technique was used to determine the number of participants for each group. Among the 276 participants, 161 were taught the traditional method (TM), i.e., a lecture, and 115 were taught using the modern method (MM) by watching a podcast that contained BSE lessons. Post-intervention data were collected after six weeks. The data were analysed using descriptive and inferential statistics at a 5% level of significance to compare the effectiveness of the methods.

RESULTS

The findings of this study showed that the participants' mean ages across the two methods were 15.49 ± 1.65 and 15.43 ± 1.40 years for the traditional method (TM) and modern method (MM), respectively. Pre-intervention mean BSE knowledge scores in both the TM and MM groups were 8.19 ± 3.17 and 8.31 ± 2.39, respectively, and BSE practice scores were 7.17 ± 2.48 and 6.44 ± 2.75, respectively. Post-intervention knowledge mean scores in both the TM and MM groups increased to 13.75 ± 4.09 and 16.92 ± 2.91, respectively, and post-intervention practice scores increased to 13.06 ± 2.74 and 15.68 ± 3.12, respectively.

CONCLUSION

This study revealed that both teaching methods were effective at teaching breast self-examination among female adolescents; nevertheless, modern methods are more effective at teaching breast self-examination among female adolescents.

Trends in Cancer Incidence and Mortality in US Adolescents and Young Adults, 2016-2021

(1) Background: The incidence rate of early onset-cancer (<50) has increased since 1995. Among younger people, cancers in AYAs (aged 15-39 y) are often biologically distinct tumors from those treated in the pediatric and older adult population. The current study describes trends in the United States for the most recent years including the first year of the COVID-19 epidemic. We aimed to describe the recent incidence and mortality trends of cancers in AYAs (aged 15-39 y). (2) Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER 22) from 1 January 2016 to 31 December 2021. Age-adjusted incidence and mortality rates were assessed by SEER*Stat 8.4.3 for major cancer types by sex, race/ethnicity, age, and metropolitan/nonmetropolitan status. Time trends of age-adjusted incidence and mortality rates were examined by sex and metropolitan/nonmetropolitan status. (3) Results: Age-adjusted overall cancer incidence and mortality rates were stable during this study period. The age-adjusted incidence rates declined significantly for ependymoma, melanoma, carcinomas of lung, bronchus, and trachea, unspecified malignant neoplasms, and non-Hodgkin's lymphoma. Significant increases were found for gastrointestinal tract cancers and non-Kaposi sarcomas. The age-adjusted mortality rate decreased for acute myeloid leukemia, melanoma, carcinomas of liver and intrahepatic bile ducts, kidney and, in women, leukemia. For some cancers, rates differed by sex, race, ethnicity, and geography. Monitoring the rates and time trends of AYA cancer emphasizes the distinct health concern for this age group.

Core needle biopsy of breast tumours: comparison of diagnostic performance between surgery and radiology services at a national cancer centre in Latin America

Introduction

Breast pathology is a very common reason for medical attention. Tissue diagnosis is usually obtained with core needle biopsy which could be performed by breast surgeons or interventional radiologists. Our aim was to assess the comparison of diagnostic performance between the two services.

Methods

A retrospective, descriptive and cross-sectional study was carried out on patients who had breast pathology at Instituto Nacional de Enfermedades Neoplasicas in 2019. Descriptive analyses, sensitivity and specificity were calculated using the R program version 4.2.3.

Results

From 1,082 patients with breast tumours who underwent core needle biopsy (CNB) during 2019, 782 cases were included. Breast surgeons performed 462 CNBs and radiologists performed 320 CNBs. The 87.5% were palpable tumours and 525 breast carcinomas were identified in the final pathology. The diagnostic performance showed that the sensitivity and specificity were greater than 95% and 98%, respectively. The waiting time in both showed that >95% underwent a CNB before 2 months. The breast surgery service performed the majority of the biopsies in less than 1 week since the indication of the execution of the CNB compared to the radiology service (90% versus 36%).

Conclusion

Both hospital services, breast surgery and radiology, are efficient in determining an accurate diagnosis using CNB. However, the breast surgery service performs CNB in a shorter time interval. Breast surgical oncologists are encouraged to perform CNB if there are understaffed radiology services to expedite the diagnosis and treatment of breast cancer patients.

Immunotherapy in Breast Cancer

Breast cancer is a disease encompassing a spectrum of molecular subtypes and clinical presentations, each with distinct prognostic implications and treatment responses. Breast cancer has traditionally been considered an immunologically "cold" tumor, unresponsive to immunotherapy. However, clinical trials in recent years have found immunotherapy to be an efficacious therapeutic option for select patients. Breast cancer is categorized into different subtypes ranging from the most common positive hormone receptor (HR+), human epidermal growth factor receptor 2 (HER2)-negative type, to less frequent HER2- positive breast cancer and triple-negative breast cancer (TNBC), highlighting the necessity for tailored treatment strategies aimed at maximizing patient outcomes. Despite notable progress in early detection and new therapeutic modalities, breast cancer remains the second leading cause of cancer death in the USA. Moreover, in recent decades, breast cancer incidence rates have been increasing, especially in women younger than the age of 50. This has prompted the exploration of new therapeutic approaches to address this trend, offering new therapeutic prospects for breast cancer patients. Immunotherapy is a class of therapeutic agents that has revolutionized the treatment landscape of many cancers, namely melanoma, lung cancer, and gastroesophageal cancers, amongst others. Though belatedly, immunotherapy has entered the treatment armamentarium of breast cancer, with the approval of pembrolizumab in combination with chemotherapy in triple-negative breast cancer (TNBC) in the neoadjuvant and advanced settings, thereby paving the path for further research and integration of immune checkpoint inhibitors in other subtypes of breast cancer. Trials exploring various combination therapies to harness the power of immunotherapy in symbiosis with various chemotherapeutic agents are ongoing in hopes of improving response rates and prolonging survival for breast cancer patients. Biomarkers and precise patient selection for the utilization of immunotherapy remain cardinal and are currently under investigation, with some biomarkers showing promise, such as Program Death Lignat-1 (PDL-1) Combined Positive Score, Tumor Mutation Burden (TMB), and Tumor Infiltrating Lymphocytes (TILs). This review will present the current landscape of immunotherapy, particularly checkpoint inhibitors, in different types of breast cancer.

Navigating the Landscape of Cancer From Ancient Times to Modern Challenges: A Narrative Review

Cancer, a pervasive and multifaceted disease, has afflicted humanity since ancient times, as evidenced by early references in the Edwin Smith Papyrus and the Ebers Papyrus. Over centuries, our understanding and treatment of cancer have evolved significantly, transitioning from rudimentary remedies to advanced modalities like chemotherapy, radiation therapy, and precision medicine. Despite these advancements, cancer remains a major global health challenge. As of 2022, nearly 20 million new cancer cases and 10 million cancer-related deaths were reported worldwide. In India, the situation is particularly dire, with over 1.41 million new cases and more than 916,827 deaths in 2022, exacerbated by socioeconomic disparities, cultural stigmas, and healthcare barriers. This review traces the historical evolution of cancer treatment from ancient civilizations to modern times, highlighting key medical milestones and breakthroughs. It examines the global and Indian cancer burden, emphasizing the critical barriers to early diagnosis and effective treatment. These barriers include health system deficiencies, socioeconomic challenges, delayed diagnosis, low health literacy, and inadequate screening programs. The review was conducted through a comprehensive literature search using databases such as PubMed, Google Scholar, Journal Storage (JSTOR), and various other sources focusing on historical texts, epidemiological studies, and current medical research. The search aimed to gather a broad spectrum of perspectives and evidence to provide a well-rounded understanding of cancer's historical journey and current landscape.