The influence of aging on the early detection, diagnosis, and treatment of breast cancer

Alter between gut bacteria and blood metabolites and the anti-tumor effects of Faecalibacterium prausnitzii in breast cancer

Background

The aim was to evaluate the changes of 16S rDNA sequencing and LC-MS metabolomics in breast cancer and explore the growth inhibition of breast cancer cells by Faecalibacterium prausnitzii.

Results

Total 49 significantly different flora and 26 different metabolites were screened between two groups, and the correlation was calculated. Relative abudance of Firmicutes and Bacteroidetes were decreased, while relative abundance of verrucomicrobla, proteobacteria and actinobacteria was increased in breast cancer group. Differentially expressed metabolites were mainly enriched in pathways such as linoleic acid metabolism, retrograde endocannabinoid signaling, biosynthesis of unsaturated fatty acids, choline metabolism in cancer and arachidonic acid metabolism. Lipid upregulation was found in breast cancer patients, especially phosphorocholine. The abundance of Faecalibacterium was reduced in breast cancer patients, which was negatively correlated with various phosphorylcholines. Moreover, Faecalibacterium prausnitzii, the most well-known species in Faecalibacterium genus, could inhibit the secretion of interleukin-6 (IL-6) and the phosphorylation of Janus kinases 2 (JAK2)/signal transducers and activators of transcription 3 (STAT3) in breast cancer cells. Faecalibacterium prausnitzii also suppressed the proliferation and invasion and promoted the apoptosis of breast cancer cells, while these effects disappeared after adding recombinant human IL-6.

Conclusions

Flora-metabolites combined with the flora-bacteria (such as Faecalibacterium combined with phosphorocholine) might a new detection method for breast cancer. Faecalibacterium may be helpful for prevention of breast cancer. Faecalibacterium prausnitzii suppresses the growth of breast cancer cells through inhibition of IL-6/STAT3 pathway.

Breast cancer in South-Eastern European countries since 2000: Rising incidence and decreasing mortality at young and middle ages

BACKGROUND

Marked variations exist in the incidence and mortality trends of major cancers in South-Eastern European (SEE) countries which have now been detailed by age for breast cancer (BC) to seek clues for improvement.

METHODS

We brought together and analysed data from 14 cancer registries (CRs), situated in SEE countries or directly adjacent. Age-standardised rate at world standard (ASRw) and truncated incidence and mortality rates during 2000-2010 by year, and for four age groups, were calculated. Average annual percentage change of rates was estimated using Joinpoint regression.

RESULTS

Annual incidence rates increased significantly in countries and age groups, by 2-4% (15-39 years), 2-5% (40-49), 1-4% (50-69) and 1-6% (at 70+). Mortality rates decreased significantly in all age-groups in most countries, but increased up to 5% annually above age 55 in Ukraine, Serbia, Moldova and Cyprus. The BC data quality was evaluated by internationally agreed indicators which appeared suboptimal for Moldova, Bosnia and Herzegovina and Romania.

CONCLUSION

The observed variations of incidence trends reflect the influence of risk factors, as well as levels of early detection activities (screening). While mortality rates were mostly decreasing, probably due to improved cancer care and introduction of more effective systemic treatment regimens, the worrying increasing mortality trends in the 55-plus age groups in some countries have to be addressed by health professionals and policymakers. In order to assess and monitor the effects of cancer control activities in the region, the CRs need substantial investments.

Is Availability of Mammography Services at Federally Qualified Health Centers Associated with Breast Cancer Mortality-to-Incidence Ratios? An Ecological Analysis

OBJECTIVE

Mammography is the most effective method to detect breast cancer in its earliest stages, reducing the risk of breast cancer death. We investigated the relationship between accessibility of mammography services at Federally Qualified Health Centers (FQHCs) and mortality-to-incidence ratio (MIR) of breast cancer in each county in the United States.

METHODS

County-level breast cancer mortality and incidence rates in 2006-2010 were used to estimate MIRs. We compared breast cancer MIRs based on the density and availability of FQHC delivery sites with or without mammography services both in the county and in the neighboring counties.

RESULTS

The relationship between breast cancer MIRs and access to mammography services at FQHCs differed by race and county of residence. Breast cancer MIRs were lower in counties with mammography facilities or FQHC delivery sites than in counties without a mammography facility or FQHC delivery site. This trend was stronger in urban counties (p=0.01) and among whites (p=0.008). Counties with a high density of mammography facilities had lower breast cancer MIRs than other counties, specifically in urban counties (p=0.01) and among whites (p=0.01). Breast cancer MIR for blacks was the lowest in counties having mammography facilities; and was highest in counties without a mammography facility within the county or the neighboring counties (p=0.03).

CONCLUSIONS

Mammography services provided at FQHCs may have a positive impact on breast cancer MIRs. Expansion of services provided at the FQHCs and placement of FQHCs in additional underserved areas might help to reduce cancer disparities in the United States.

Disparities in use of gynecologic oncologists for women with ovarian cancer in the United States

OBJECTIVE

To examine disparities in utilization of gynecologic oncologists (GOs) across race and other sociodemographic factors for women with ovarian cancer.

DATA SOURCES

Obtained SEER-Medicare linked dataset for 4,233 non-Hispanic White, non-Hispanic African American, Hispanic of any race, and Non-Hispanic Asian women aged ≥ 66 years old diagnosed with ovarian cancer during 2000-2002 from 17 SEER registries. Physician specialty was identified by linking data to the AMA master file using Unique Physician Identification Numbers.

STUDY DESIGN

Retrospective claims data analysis for 1999-2006. Logistic regression models were used to analyze the association between GO utilization and race/ethnicity in the initial, continuing, and final phases of care.

PRINCIPAL FINDINGS

GO use decreased from the initial to final phase of care (51.4-28.8 percent). No racial/ethnic differences were found overall and by phase of cancer care. Women >70 years old and those with unstaged disease were less likely to receive GO care compared to their counterparts. GO use was lower in some SEER registries compared to the Atlanta registry.

CONCLUSIONS

GO use for the initial ovarian cancer treatment or for longer term care was low but not different across racial/ethnic groups. Future research should identify factors that affect GO utilization and understand why use of these specialists remains low.

Joinpoint regression analysis of female breast cancer mortality in Serbia 1991-2010

The aim of this descriptive epidemiologic study was to analyze the mortality trends of female breast cancer in Serbia (excluding Kosovo and Metohia) from 1991 to 2010. Average annual percentage of change and the corresponding 95% confidence interval (CI) was computed for trend using linear models assuming a Poisson distribution. The Serbian female population showed an increase in breast cancer mortality continuously from 1991 to 2010 (average annual percentage of change = + 0.9, 95% CI = 0.6-1.1). Breast cancer mortality declined in women aged 30-49 years but increased in women ≥50 years old. Decline in breast cancer mortality in young women was observed during the entire period and was significant in those 35-49 years old. In women 50-54 years old, a significant increase in breast cancer mortality during the period 1991-1997 was followed by significant decrease until 2010. In all older age groups, mortality rates significantly increased during all periods observed. The only exception was among women aged 65-69 years old in whom a small, non-significant decrease in breast cancer mortality was observed in the period 1991-1998, followed by significant increase until 2010. According to a comparability test, breast cancer mortality trends in 30-49, 50-69, and 70+ year age groups differed significantly (p < 0.01).

Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database

OBJECTIVE

To compare trends in breast cancer mortality within three pairs of neighbouring European countries in relation to implementation of screening.

DESIGN

Retrospective trend analysis.

SETTING

Three country pairs (Northern Ireland (United Kingdom) v Republic of Ireland, the Netherlands v Belgium and Flanders (Belgian region south of the Netherlands), and Sweden v Norway).

DATA SOURCES

WHO mortality database on cause of death and data sources on mammography screening, cancer treatment, and risk factors for breast cancer mortality.

MAIN OUTCOME MEASURES

Changes in breast cancer mortality calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in mortality for all ages began to change.

RESULTS

From 1989 to 2006, deaths from breast cancer decreased by 29% in Northern Ireland and by 26% in the Republic of Ireland; by 25% in the Netherlands and by 20% in Belgium and 25% in Flanders; and by 16% in Sweden and by 24% in Norway. The time trend and year of downward inflexion were similar between Northern Ireland and the Republic of Ireland and between the Netherlands and Flanders. In Sweden, mortality rates have steadily decreased since 1972, with no downward inflexion until 2006. Countries of each pair had similar healthcare services and prevalence of risk factors for breast cancer mortality but differing implementation of mammography screening, with a gap of about 10-15 years.

CONCLUSIONS

The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality.

Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database

OBJECTIVE

To examine changes in temporal trends in breast cancer mortality in women living in 30 European countries.

DESIGN

Retrospective trend analysis. Data source WHO mortality database on causes of deaths Subjects reviewed Female deaths from breast cancer from 1989 to 2006

MAIN OUTCOME MEASURES

Changes in breast cancer mortality for all women and by age group (<50, 50-69, and >or=70 years) calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in all age mortality began to change.

RESULTS

From 1989 to 2006, there was a median reduction in breast cancer mortality of 19%, ranging from a 45% reduction in Iceland to a 17% increase in Romania. Breast cancer mortality decreased by >or=20% in 15 countries, and the reduction tended to be greater in countries with higher mortality in 1987-9. England and Wales, Northern Ireland, and Scotland had the second, third, and fourth largest decreases of 35%, 29%, and 30%, respectively. In France, Finland, and Sweden, mortality decreased by 11%, 12%, and 16%, respectively. In central European countries mortality did not decline or even increased during the period. Downward mortality trends usually started between 1988 and 1996, and the persistent reduction from 1999 to 2006 indicates that these trends may continue. The median changes in the age groups were -37% (range -76% to -14%) in women aged <50, -21% (-40% to 14%) in 50-69 year olds, and -2% (-42% to 80%) in >or=70 year olds.

CONCLUSIONS

Changes in breast cancer mortality after 1988 varied widely between European countries, and the UK is among the countries with the largest reductions. Women aged <50 years showed the greatest reductions in mortality, also in countries where screening at that age is uncommon. The increasing mortality in some central European countries reflects avoidable mortality.

By invitation only - the case for breast cancer screening reminders for women over 69 years

BACKGROUND

Breast cancer is the leading cause of cancer death in women in Australia. Early detection provides the best chance of reducing mortality and morbidity from the disease. Mammographic screening is a population health strategy for the early detection of breast cancer in Australia. Recruitment strategies such as regular advertising and biannual screening invitations are exclusively targeted at women aged 50 - 69 years. Even though they can participate, women 70 years or over are not invited or actively encouraged to undertake screening. Research has found that a routine letter of invitation increases the number of women participating in breast cancer screening.

METHODS

Cancer data analysis and a literature and policy review was conducted to assess age specific breast cancer mortality rates and the legitimacy of rationale used to limit invitations for breast cancer screening to women younger than 70 years.

RESULTS

The proportion of women over 69 years participating in the BreastScreen program is significantly less than rate of screening in the target age range (50-69 years). Evidence and data indicate that common justifications for limiting screening reminders to the target age range including life expectancy, comorbidities, effectiveness, treatment and cost are, for many women, unreasonable.

CONCLUSION

There is now sufficient data to support a change in the targeted upper age range for breast cancer screening to improve the existing suboptimal surveillance in women aged over 69 years.