Early breast cancer

How asymptomatic are early cancer patients of five organs based on registry data in Japan

BACKGROUND

One reason for the low cancer screening rate in Japan is that people are not concerned about cancer if they do not have symptoms.

METHODS

The authors retrospectively analyzed 18,405 cancer patients using hospital-based cancer registry data collected between 2007 and 2013 at the 13 hospitals of Shimane Prefecture, Japan. The symptomatic rates of five cancers (stomach, colorectal, lung, breast, and cervix) at each stage and the time of early diagnosis were investigated. The early detection rates of symptomatic and asymptomatic individuals were investigated.

RESULTS

The percentages of symptomatic cases tended to increase with progressive stages. The odds ratio (OR) of stage IV compared with that of stage I was 12.23 for stomach, 7.21 for colorectal, 16.91 for lung, 10.30 for breast, and 51.62 for cervical cancer. The proportions of early symptomatic cases at the time of diagnosis were low. Compared with the percentage of early symptomatic cases of stomach cancer of 25.5%, the percentage of lung cancer was the lowest, at 8.2% (OR 0.26), and the percentage of breast cancer was the highest, at 30.2% (OR 1.26). The percentages of early symptomatic cases of colorectal and cervical cancer were 18.9% (OR 0.68) and 19.9% (OR 0.73), respectively. The early detection rates of the asymptomatic and symptomatic groups were 77.6 and 36.1%, respectively.

CONCLUSION

Cancer registry data indicate that early cancers are asymptomatic, and once symptoms appear, treatment may not be effective. Policy makers should inform people of the necessity of cancer screening before they have symptoms.

The association of physical activity and colorectal and breast cancer: The Fifth Korea National Health and Nutrition Examination Survey (2008-2011)

Therapeutic importance of physical activity during and after cancer treatment has been supported. To examine the patterns of physical activity according to the stages of breast and colorectal cancer survivor-ship in Korean, Korean National Health and Nutrition Examination Survey data from 2008 to 2011 were used. International Physical Activity Questionnaire (IPAQ) was utilized to estimate weekly time spent in vigorous- and moderate-intensity physical activity, and walking, and to calculate MET-minute/week. Depending on the survivorship, the subjects were categorized into “never diagnosed with cancer” (group 1), “0–4 yr since cancer diagnosis” (group 2), and “5 or more years since cancer diagnosis” (group 3), separately for colorectal and breast cancer. The associations between physical activity and the cancer survivorship were studied. Following results were obtained: (1) Breast cancer (n=10,167, mean age=48.55±16.27): The mean physical activity levels expressed in MET-minutes/week were 2,064.83, 1748.82, and 1998.36 in groups 1, 2, and 3, respectively. Even though cancer survivors tended to be less active compared to people without cancer, there were no statistically significant difference among the three groups. (2) Colorectal cancer (n=17,270, mean age=48.62): MET-minutes/week was 2064.30, 1084.83, and 709.04 36 in groups 1, 2, and 3, respectively. The differences were significant between group 1 and 2 (F=5.87, P=0.016) and group 1 and 3 (F=28.99, P<0.001). Despite potential therapeutic benefits of physical activity, colorectal cancer survivors were less active than people without cancer in Korea.

Breast contrast-enhanced ultrasound: is a scoring system feasible? A preliminary study in China

OBJECTIVES

Although many studies about breast contrast-enhanced ultrasound had been conducted, clear diagnostic criteria for evaluating enhancement patterns are still lacking. This study aims to identify significant indicators for breast contrast-enhanced ultrasound and to establish an initial scoring system.

MATERIALS AND METHODS

Totally 839 patients were included in the study. This study was divided into two parts. 364 patients were included in part 1 while 475 in part 2. Conventional ultrasound and contrast-enhanced ultrasound were used to examine each lesion. Only the cases in part 2 were also examined by elastography. In part 1, Logistic regression analysis was performed to predict significant variables. A 5-point scoring system was developed based on the results. In part 2, the scoring system was used to evaluate all the breast lesions. To evaluate the diagnostic efficacy of the new scoring system, it was compared with the system established for elastography and conventional ultrasound (BI-RADS).

RESULTS

Three independent variables, namely, lesion scope, margin, and shape were selected in the final step of the logistic regression analysis in part 1. In part 2, the area under the ROC (receiver operating characteristic) curve for the contrast-enhanced scoring system was 0.912. The difference in the diagnostic capabilities of the contrast-enhanced scoring system and elastography was not statistically significant (P = 0.17). The difference in the diagnostic capabilities of the contrast-enhanced scoring system and BI-RADS was statistically significant (P<0.001).

CONCLUSIONS

The contrast-enhanced patterns of benign and malignant breast tumors are different. The application of a 5-point scoring system for contrast-enhanced ultrasound is clinically promising.

Representations of nurses regarding sexuality of women treated for breast cancer in Brazil

The development of new treatments has improved survival and quality of life among cancer patients. Nurses are expected to answer questions and to provide orientation regarding patients' sexuality since it is an important aspect of life. The main objective of this paper is to understand the representations of sexuality among nurses working with women who survive breast cancer after diagnosis and during treatment assuming that their representations may affect communication with the patient. This is a qualitative study using an in-depth guideline which involved interviews with 28 nurses living and working in the southeast of Brazil. The narratives were submitted to a content analysis and categories of representations were identified and are discussed here. Several representations of sexuality were found in the nurses' discourses. Some of the nurses' representations may be expected to hinder their ability to provide helpful orientation regarding the sexual lives of these patients.

YB-1 drives preneoplastic progression: Insight into opportunities for cancer prevention

Surprisingly little is known about the underlying genetic events that trigger the progression of a normal cell into a cancerous cell. We recently developed a YB-1-driven model of pre-malignancy where we uncovered that the oncogene promotes genomic instability through cell cycle checkpoint slippage and centrosome amplification. In this research perspective, we describe a possible mechanism by which YB-1 instigates preneoplastic transformation. Using Kinex antibody microarrays with coverage of 800 proteins, we discovered that pre-malignant cells exhibit deregulated signal transduction along the HER2-MAPK-RSK axis. We will discuss the implications of these finding in regard to early intervention strategies.

Accelerated Partial Breast Irradiation (APBI): A review of available techniques

Breast conservation therapy (BCT) is the procedure of choice for the management of the early stage breast cancer. However, its utilization has not been maximized because of logistics issues associated with the protracted treatment involved with the radiation treatment. Accelerated Partial Breast Irradiation (APBI) is an approach that treats only the lumpectomy bed plus a 1-2 cm margin, rather than the whole breast. Hence because of the small volume of irradiation a higher dose can be delivered in a shorter period of time. There has been growing interest for APBI and various approaches have been developed under phase I-III clinical studies; these include multicatheter interstitial brachytherapy, balloon catheter brachytherapy, conformal external beam radiation therapy and intra-operative radiation therapy (IORT). Balloon-based brachytherapy approaches include Mammosite, Axxent electronic brachytherapy and Contura, Hybrid brachytherapy devices include SAVI and ClearPath. This paper reviews the different techniques, identifying the weaknesses and strength of each approach and proposes a direction for future research and development. It is evident that APBI will play a role in the management of a selected group of early breast cancer. However, the relative role of the different techniques is yet to be clearly identified.

Incidence trend for breast cancer among young women in Goiânia, Brazil

CONTEXT AND OBJECTIVE

It has been suggested that there has been a large increase in breast cancer incidence among young women over the last decade. The aim of this study was to describe the incidence of breast cancer among young women up to 39 years of age in Goiânia, between 1988 and 2003, and to compare this with other age groups.

DESIGN AND SETTING

Retrospective study using the database of the Population-based Cancer Registry of Goiânia, State of Goiás, Brazil.

METHODS

The incidence was calculated according to age groups: up to 39 years, 40 to 59 years and 60 years and over. Average annual percentage changes (AAPCs) were estimated for the different age groups using Poisson regression.

RESULTS

Over this period, 3,310 new cases were recorded. The standardized incidence was 2.89/100,000 in 1988 and increased to 6.37/100,000 in 2003 (R(2) = 0.52) for the group aged up to 39 years (p < 0.003). For the group from 40 to 59 years old, the incidence was 14.39/100,000 in 1988 and 41.70/100,000 in 2003 (R(2) = 0.85; p < 0.001). For the group aged 60 years and over, it was 17.62/100,000 and 28.49/100,000, respectively (R(2) = 0.67; p < 0.001). The AAPCs were 5.22%, 5.53% and 4.54% for the age groups up to 39, 40 to 59 and 60 years and over, respectively.

CONCLUSIONS

The incidence of breast cancer among young women in Goiânia has been increasing significantly, although this change was similar to the increase in other age groups.

High frequency of common DNA copy number abnormalities detected by bacterial artificial chromosome array comparative genomic hybridization in 24 breast cancer cell lines

Breast cancer is a widespread disease in Japan and across the world. Breast cancer cells, as well as most other types of cancer cells, have diverse chromosomal aberrations. Clarifying the character of these chromosomal aberrations should contribute to the development of more suitable therapies, along with the predictions of metastasis and prognosis. Twenty-four breast cancer cell lines were analyzed by bacterial artificial chromosome (BAC) array comparative genomic hybridization (CGH). The array slide contained duplicate spots of 4030 BAC clone DNAs covering the entire human genome with 1 Mbp resolution. In all 24 breast cancer cell lines, frequent and significant amplifications as well as deletions were detected by BAC array CGH. Common DNA copy number gains, detected in 60% (above 15 cell lines) of the 24 breast cancer cell lines were found in 76 BAC clones, located at 1q, 5p, 8q, 9p, 16p, 17q, and 20q. Moreover, common DNA copy number loss was detected in 136 BAC clones, located at 1q, 2q, 3p, 4p, 6q, 8p, 9p, 11p, 13q, 17p, 18q, 19p, Xp, and Xq. The DNA copy number abnormalities found included abnormality of the well-known oncogene cMYC (8q24.21); however, most of them were not reported to relate to breast cancer. BAC array CGH has great potential to detect DNA copy number abnormalities, and has revealed that breast cancer cell lines have substantial heterogeneity.

DCEMRI of breast lesions: is kinetic analysis equally effective for both mass and nonmass-like enhancement?

To perform a pilot study investigating whether the sensitivity and specificity of kinetic parameters can be improved by considering mass and nonmass breast lesions separately. The contrast media uptake and washout kinetics in benign and malignant breast lesions were analyzed using an empirical mathematical model (EMM), and model parameters were compared in lesions with mass-like and nonmass-like enhancement characteristics. 34 benign and 78 malignant breast lesions were selected for review. Dynamic MR protocol: 1 pre and 5 postcontrast images acquired in the coronal plane using a 3D T1-weighted SPGR with 68 s timing resolution. An experienced radiologist classified the type of enhancement as mass, nonmass, or focus, according to the BI-RADS lexicon. The kinetic curve obtained from a radiologist-drawn region within the lesion was analyzed quantitatively using a three parameter EMM. Several kinetic parameters were then derived from the EMM parameters: the initial slope (Slope(ini)), curvature at the peak (kappa(peak)), time to peak (T(peak)), initial area under the curve at 30 s (iAUC30), and the signal enhancement ratio (SER). The BI-RADS classification of the lesions yielded: 70 mass lesions, 38 nonmass, 4 focus. For mass lesions, the contrast uptake rate (alpha), contrast washout rate (beta), iAUC30, SER, Slope(ini), T(peak) and kappa(peak) differed substantially between benign and malignant lesions, and after correcting for multiple tests of significance SER and T(peak) demonstrated significance (p < 0.007). For nonmass lesions, we did not find statistically significant differences in any of the parameters for benign vs. malignant lesions (p > 0.5). Kinetic parameters could distinguish benign and malignant mass lesions effectively, but were not quite as useful in discriminating benign from malignant nonmass lesions. If the results of this pilot study are validated in a larger trial, we expect that to maximize diagnostic utility, it will be better to classify lesion morphology as mass or nonmass-like enhancement prior to kinetic analysis.

Biomarkers, regerons, and pathways to lethal cancer

Cancer is a disease of "outlaw" cells that become mutated in regulatory mechanisms. They have lost normal self controls and relationships to the whole organism. Cancers can progress by several pathways from a normal cell to malignant cancer, from bad to worse. Questions about advisability of treatment for some cancers arise from the possibility that they are arrested during progression and so never become lethal. Techniques could be developed to determine the degree of progression and possibility for successful treatment. This article is intended to suggest a way of looking at cancer. It is not a review so references to research articles are infrequent.

Variations in breast cancer incidence per decade of life (Goiânia, GO, Brazil): 16-year analysis

OBJECTIVE

To analyze the variation in breast cancer incidence, with stratification into ten-year age groups, 17 years after the nuclear accident in Goiânia.

METHODS

Between 1988 and 2003, 3312 new cases were recorded. The crude and standardized incidence rates were calculated. ANOVA was used to obtain the coefficient of determination (R2) for the incidence over the course of the years, and p-values were obtained both by linear and by polynomial regression.

RESULTS

The increases in crude and standardized incidence were statistically significant in all age groups, except for women between 20 and 29 years old. For the age group from 30 to 49 years, the increase in incidence was around 100% (p = 0.001), and from 50 to 59 years, 277% (p < 0.001). More modest increases of around 50% were observed in the age groups from 60 to 79 years (p = 0.013). For the women aged 80 years and over, the increase was 272% (p = 0.015).

CONCLUSIONS

There were significant increases in the crude and standardized incidence rates for breast cancer in the city of Goiânia. The women in the age group from 50 to 59 years were the ones who presented the highest increase in incidence. More wide-ranging epidemiological studies therefore become necessary for defining the factors that are possibly related to this excessive increase in breast cancer incidence, in certain specific segments of the female population.