Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis

Henry S. Pennypacker's Contributions to Breast Cancer Detection: Developing a Behavioral Technology to Improve Breast Self-Exam Skills

Starting in the early 1970s, Henry S. Pennypacker and collaborators developed and validated a technology for assessing and training breast self-exam (BSE) skills that was eventually commercialized and widely disseminated. This article provides a brief synopsis of Pennypacker's research and highlights the connections among BSE, stimulus discrimination training, and signal detection theory. It also describes the role played by breast simulation models as a research tool that contributed to the identification and validation of effective BSE search strategies and eventually to the dissemination of a behaviorally based BSE training program to women and health-care workers. Commentary is provided on the impact of this research on the early detection and treatment of breast cancer. Finally, the focus on early detection skills is placed in the context of a larger body of research on the role of behavior and the application of behavior analytic interventions in improving health.

[Time intervals for diagnosis and treatment in breast cancer patients]

OBJECTIVE

To describe the delay in the diagnosis of breast cancer in primary care and to identify the patient, care process and disease variables involved in the delay to diagnosis and treatment.

DESIGN

Retrospective study with follow-up of a cohort of women with breast cancer, from the first symptoms to the start of treatment. SITE: In total 24 family medicine practices with information from both primary care and hospital settings.

PARTICIPANTS

446 women were evaluated (period 2014-2023).

MAIN MEASUREMENTS

Patient characteristics (age, history and comorbidity), care process (screening, consultation site and referral priority) and disease characteristics (stage, presentation and risk factors) were included. Time intervals considered included, among others, «primary care interval», «health system interval», «diagnosis interval» and «treatment interval».

RESULTS

The mean value of the «primary care interval» was 24.7days (median: 16); that of the «hospital care interval», 77.2days (median: 68); and that of the «health system interval», 93.6days (median: 83). Multiple linear regression showed a significantly shorter duration of the interval in women referred preferentially, in advanced stages, with a breast lump at presentation and with risk factors.

CONCLUSIONS

Most are diagnosed in early stages at the health centre. The duration of the «health system interval» is shorter in preferential referrals, when the form of presentation is a breast lump, with risk factors and in advanced stages.

Female healthcare undergraduates' scientific readiness for raising breast cancer awareness in Syrian conservative community

INTRODUCTION

Breast cancer is the most common and deadliest cancer in Syria, and early detection is crucial in managing it. This study aims to compare the knowledge levels of breast cancer risk factors, signs, and symptoms among female students in healthcare faculties (medicine, dentistry, and pharmacy) at Damascus University to identify existing disparities. The goal is to enhance breast cancer education and awareness across Syria by empowering healthcare students with insights.

METHODS

An online self-administered questionnaire was shared on social media for female students of healthcare faculties to respond to. A total of 589 participants were included after applying the inclusion criteria. The questionnaire collected sociodemographic characteristics and evaluated the knowledge of breast cancer (BC) using breast cancer awareness measure (BCAM). The scale evaluates three sections: general knowledge, symptoms, and risk factors. Comparisons were conducted among the three faculties to gauge variations in knowledge levels.

RESULTS

The majority of participants were aged between 21-23, the average of breast cancer knowledge among the whole sample was 24.7 ± 6.33 out of 40, with the internet and social media being the primary sources of information. Medical students had significantly higher knowledge scores compared to pharmacy and dentistry students. Higher faculty average grades were associated with higher knowledge scores, and there was a positive correlation between study years and breast cancer knowledge for medical and pharmacy students. There was no significant difference in breast cancer knowledge between participants with and without a medical relative or family history of breast cancer.

CONCLUSION

Breast cancer knowledge among female healthcare students in Damascus University is perfectible, which may not be enough to raise awareness. Awareness programs should be created to encourage leadership and accurate information dissemination, and professors should model good prevention practices.

Characteristics, Treatment, and Survival of Male Breast Cancer: A 21-year Retrospective Analysis at a Community Academic Institute in Central Illinois

Introduction: Male breast cancer is an uncommon disease, representing a fraction of all breast cancer diagnoses. This study examines the characteristics, treatment, and outcomes of males with breast cancer at a community academic institute in central Illinois.Methods: We retrospectively reviewed the medical records of male patients with breast cancer treated between 2000 and 2021. This review focuses on patient demographics, tumor characteristics, treatment modalities, and recurrence and survival rates. We evaluated the association of epidemiological factors and clinical outcomes with patient age, tumor stage, and grade, as well as tumor hormone receptor status.Results: Our study included 81 male patients, predominantly white, with a median age of 67 years. Most cases presented estrogen receptor-positive (96.1%) and progesterone receptor-positive (93.5%) tumors, while only 13.5% had HER-2 neu receptor-positive expression. Staging distribution was 34.6% at Stage I, 47.4% at Stage II, and 17.9% at Stages III/IV among 78 patients. Recurrence occurred in 20.8% of 77 patients, with a 5-year recurrence-free survival rate of 76.2%. The 5-year overall survival rate of all 81 patients was 63.4%. Age and disease stage were significantly associated with mortality (P = .041 and P = .0028, respectively).Conclusion: Our findings align with national trends in male breast cancer demographics and outcomes, with comparable survival statistics. Increased awareness and targeted research are critical to improving management and prognosis for this patient population. Further studies are necessary to elucidate the molecular basis of male breast cancer and to refine treatment guidelines.

A Case Report of Atypical Presentation of Metastatic Breast Cancer as Peri-Bronchial Mediastinal Lesion

Breast cancer is the most prevalent cancer among women worldwide. Despite significant advancements in breast cancer treatments over the past decade, late recurrence, a hallmark of breast cancer, remains a major challenge for oncologists. In this case report, we present an atypical presentation of late breast cancer recurrence as a peri-bronchial lesion manifesting as dysphagia 14 years after completing treatment for primary breast cancer. Radiological imaging revealed a peri-bronchial lesion and a subcutaneous nodule in the left mastectomy bed. This case posed a diagnostic dilemma for the attending physicians in distinguishing between late breast cancer recurrence and the possibility of two synchronous primary malignancies. The patient was ultimately diagnosed with metastatic breast cancer with histological confirmation. This case underscores the importance of correlating clinical presentation, radiological images, histopathology examinations and immunohistochemical results to ensure a comprehensive and accurate diagnosis.

Tumour biology and survival outcomes in young women with breast cancer: single-centre retrospective analysis

INTRODUCTION

Breast cancer is the most common malignancy worldwide. The disease is more severe in younger women and often confers a poorer prognosis. This study aimed to profile a cohort of young women with breast cancer and address whether aspects of their tumour biology were related to their long-term outcomes.

METHODS

The records of consecutive women aged 40 and under with a diagnosis of breast cancer at a single centre between 1 January 2010 and 30 December 2015 were analysed and a profile was created. They were followed up until 19 July 2023 (median 112 months, range 4-161), and the impact of oestrogen positivity (ER+), human epidermal growth factor 2 positivity (HER2+), tumour grade, axillary lymph node metastases and Ki67 value on overall survival and disease-free interval (DFI) was investigated.

RESULTS

One hundred and sixty-four patients were included. Younger patients typically presented with large, high-grade tumours with axillary lymph node metastases, and 83.2% of the cohort were alive at 5 years. ER+ tumours appeared to have a better 5-year survival: ER+/HER2- 86.3%, ER+/HER2+ 88.5%, ER-/HER2+ 71.4%, and triple-negative (ER-/HER2-) 70.8%. However, neither the log-rank test nor the Cox regression model found a significant effect of ER status and long-term survival (P = 0.485 and P = 0.158 respectively).

DISCUSSION

Young patients with breast cancer have a lower 5-year survival than the UK average for all ages, and patients in this single-centre study with ER+ tumours appeared to have better short-term but similar longer-term outcomes compared to ER- breast cancer.

Breast Cancer Awareness among Women

Breast cancer (BC) is the most common malignancy among women globally, with high mortality rates in India. Early detection of BC significantly increases survival rates and reduces mortality. Raising awareness about BC is crucial for educating the public about screening, symptoms, and treatment to help recognize early signs and seek prompt treatment. This article aims to describe a case of breast primary lymphedema and emphasizes the importance of public awareness regarding risk factors, clinical manifestations, and self-examination for early detection and mortality reduction.

Breast Cancer: The Psychological Impact of Diagnosis, Treatment, and Remission

Breast cancer affects millions of people worldwide. With physical manifestations being the predominant feature of management, healthcare professionals can overlook the psychological toll that the disease can have on the patients and their support network. This literature review examines the vast multi-factorial approach that must be taken when managing breast cancer patients from initial screening to diagnostic investigations, treatment, and remission. A literature search in PubMed from January 2000 to April 2024 was executed. Data sets in the studies filtered during the literature search were collected and analysed, looking not only at the data itself but also the entirety of the study. This included its limitations and possible biases. From screening, the possibility of cancer as a diagnosis can trigger mixed emotions including fear, depression, and anxiety. During diagnostic, patients may find themselves subject to fear of negative body image evaluation and fear of judgment. Medical professionals must be prepared to support the patient when they experience these feelings. The treatment stages can be the most difficult for the patient as side effects and complications of treatment can impact their lives in numerous ways, making management challenging. These include pain, sexual dysfunction, and alopecia. Overall, the analysis of the selected literature showed areas in clinical practice that can be optimised when providing psychological support for a patient's cancer diagnosis, management, and treatment. Being able to counsel prior to the presentation of these, and ideally prevent unnecessary cases of these can substantially increase a patient's quality of life during treatment. This literature review hopes to identify and promote awareness and further implementation of support systems by healthcare professionals.

Effect of monthly reminders by telephone message on women's beliefs and practice behaviours regarding breast self-examination: A randomized controlled study

AIMS

This study was conducted to examine the effect of monthly telephone message reminders after training on women's beliefs and practice behaviours regarding breast self-examination.

METHODS

This randomized controlled study was conducted with 83 women aged 20-69 years living in Turkey between September 2021 and July 2022. Women were randomly assigned (1:1) to the intervention (n = 41) or control group (n = 42), both groups received online breast self-examination training, and the intervention group received monthly reminders on their mobile phones for 3 months. Participants completed the Champion's Health Belief Model Scale and breast self-examination practice evaluation form at baseline and 3 months after intervention.

RESULTS

After the intervention, the mean scores of the benefits and self-efficacy subscales of Champion's Health Belief Model Scales were significantly higher in the intervention group compared to the control group, and the mean score of barriers was lower. The rate of performing breast self-exam regularly and at the appropriate time was higher in the intervention group. The rate of forgetting to perform breast self-examination was higher in control group.

CONCLUSION

A monthly reminder message may be recommended to increase women's belief in breast self-examination and increase regular practice.

Variations in Depression and Anxiety among Jordanian Women Undergoing Mastectomy and Reconstruction Surgery: Impact of Familial Support

INTRODUCTION

Depression and anxiety are common among breast cancer patients, due to the ongoing mental distress during illness. This study examines the impact of family support on depression and anxiety changes in Jordanian women undergoing mastectomy and reconstruction surgery.

METHODS

We conducted a cross-sectional study to investigate the effect between family support and depression/anxiety levels in women post-mastectomy in Jordan. Participants included breast cancer patients who had undergone mastectomy surgery, meeting specified inclusion criteria. We collected data on socio-demographic variables via a questionnaire between October 2023 and January 2024. Depression and anxiety levels were assessed using the Depression, Anxiety and Stress Scale - 21 Items (DASS-21), while social support was evaluated using the Social Support Survey.

RESULTS

A significantly negative correlation was observed between the DASS-21 score and social support, indicating that higher levels of social support were associated with lower levels of depression, anxiety, and stress (p-value: 0.001). Additionally, analyzing the correlation between physical therapy, social support (median scores: 76 vs. 90, p = 0.021), and DASS-21 (median scores: 25 vs. 11, p < 0.001) revealed significant findings. Specifically, individuals who had received physical therapy exhibited significantly lower DASS-21 scores and higher social support scores.

CONCLUSION

Our study underscores the significant role of family support in alleviating depression and anxiety levels among women with breast cancer. Strong family support emerges as a key factor in improving the emotional well-being of these individuals.

How "Breast Aware" are the Indian Women? A Study among the Women Visiting a Tertiary Care, Referral, and Teaching Hospital

INTRODUCTION

"Who will educate us" lamented a School Principal after she took part in our study and education session. There is palpable low breast cancer (BC) literacy with rising incidence and disproportionate mortality rates.

METHODOLOGY

Breast Cancer Awareness Measure (BCAM) developed by Cancer Research UK was administered to 944 women. BCAM measures knowledge, age-related risk, and reported frequency of breast checking and other components. A woman is BC aware if she identified five or more nonlump symptoms, age-related risk, and reported breast checking once a week/month. At the end, each participant was given "Be Breast Aware" education; what/how to look for demonstrated on a model.

RESULTS

2.8% health professionals. 3.1% BC survivors. 78.8% had lump knowledge and 55.3% had non-lump knowledge of BC, 10% had age-related risk knowledge. 24.3% check breasts once a week/month. 41.9% aware BC is common after 50 years. 14/944 (1.5%) had BC awareness. 59.9% had breast symptoms, but never consulted a doctor, 31.1% were embarrassed, and 29.4% were scared to consult. Nearly 43% heard of breast screening, 28.4% had mammography, 26.3% had ultrasound. About 44.1% knew family history risk. Those practicing breast checking looked for a size change (24.5%), nipple position (17.4%), discharge (22.1%), pain (32.5%), and lump (24.7%) in standing (17.8%), supine (8.5%) using finger pads (15.8%) fingertips (21.6%), using circular movements (16.4%), and pinching breast tissue (19.6%).

CONCLUSION

Health-care workers and BC survivors lack breast awareness which is alarming and indicates the need for BC awareness and post-BC treatment follow-up care education in these two groups and the general population. Some practice the wrong method (e.g., pinching tissue) of breast checking, which may lead to anxiety and unnecessary investigative costs. "Be Breast Aware" education based on the National Health Service 5-point plan given to 944 participants.

Time to Diagnosis and Presenting Symptoms of Patients Diagnosed With Cancer Through Emergency and Nonemergency Routes: A Large Retrospective Study From a High-Volume Center

PURPOSE

The symptoms with which a patient with cancer presents and the route taken to diagnosis (emergency v nonemergency) may affect the speed with which the diagnosis of cancer is made, thereby affecting outcomes. We examined time to diagnosis by symptom for cancers diagnosed through emergency and nonemergency routes (NERs).

METHODS

We performed a retrospective review of patients diagnosed with 10 solid cancers at Hospital Clínic of Barcelona between March 2013 and June 2023. Cancers were diagnosed through emergency presentation and admission (inpatient emergency route [IER]), emergency presentation and outpatient referral (outpatient emergency route [OER]), and primary care presentation and outpatient referral (NER). We assessed the effect of diagnostic routes on intervals to diagnosis for 19 cancer symptoms.

RESULTS

A total of 5,174 and 1,607 patients were diagnosed with cancer through emergency routes and NERs, respectively. Over 85% of patients presenting with alarm (localizing) symptoms such as hematuria through emergency routes were diagnosed with the expected cancer, whereas those with nonlocalizing symptoms such as abdominal pain had a more heterogeneous cancer-site composition. Median intervals were shorter for alarm than nonlocalizing symptoms and tended to be shorter in IERs than OERs. However, for most symptoms, intervals in both routes were invariably shorter than in the NER. For example, diagnostic intervals for hematuria and abdominal pain were 3 and 5 days shorter in IERs than OERs, but they were 5-8 and 17-22 days shorter than in the NER, respectively.

CONCLUSION

For patients with alarm symptoms, intervals were shorter than for those with nonlocalizing symptoms and, for most symptoms, intervals were shorter when patients were evaluated by emergency routes rather than NERs.

Evaluating the Role of Breast Ultrasound in Early Detection of Breast Cancer in Low- and Middle-Income Countries: A Comprehensive Narrative Review

Breast cancer, affecting both genders, but mostly females, exhibits shifting demographic patterns, with an increasing incidence in younger age groups. Early identification through mammography, clinical examinations, and breast self-exams enhances treatment efficacy, but challenges persist in low- and medium-income countries due to limited imaging resources. This review assesses the feasibility of employing breast ultrasound as the primary breast cancer screening method, particularly in resource-constrained regions. Following the PRISMA guidelines, this study examines 52 publications from the last five years. Breast ultrasound, distinct from mammography, offers advantages like radiation-free imaging, suitability for repeated screenings, and preference for younger populations. Real-time imaging and dense breast tissue evaluation enhance sensitivity, accessibility, and cost-effectiveness. However, limitations include reduced specificity, operator dependence, and challenges in detecting microcalcifications. Automatic breast ultrasound (ABUS) addresses some issues but faces constraints like potential inaccuracies and limited microcalcification detection. The analysis underscores the need for a comprehensive approach to breast cancer screening, emphasizing international collaboration and addressing limitations, especially in resource-constrained settings. Despite advancements, notably with ABUS, the primary goal is to contribute insights for optimizing breast cancer screening globally, improving outcomes, and mitigating the impact of this debilitating disease.

Abducens nerve palsy due to clivus metastasis in a patient with breast carcinoma: A rare case

INTRODUCTION

Breast cancer, comprising 25 % of all diagnosed cancers, predominantly affects women globally. While bone metastasis is common, occurrences at the clivus or skull base are rarely documented. Treatment varies from surgery in early stages to a multifaceted approach for advanced cases, incorporating chemotherapy, radiotherapy, and surgery based on staging and histology.

CLINICAL PRESENTATION

A 40-year-old female presented with a rapidly enlarging lump in her left breast and diplopia on right gaze. Histology was positive for invasive breast cancer (no special type) and Contrast-Enhanced Computed Tomography demonstrated metastatic deposits in multiple vertebrae and bilateral ilium. Further, magnetic resonance imaging of the brain and orbits revealed metastatic deposits in the clivus which extended up-to medial wall of the cavernous sinus, causing compression of the right abducens nerve. Multidisciplinary Tumor Board review recommended chemoradiotherapy.

DISCUSSION

Metastases from breast cancer can occur locally or to distant sites like lymph nodes, bones, lungs, liver, and brain. Unusual symptoms, such as new-onset diplopia, trigger further investigation. Although bone metastases occur in 50-65 % of cases, clivus metastasis is rare. Treatment aims at extending survival, symptom management, and enhancing quality of life through chemotherapy and radiotherapy. Outcomes hinge on metastatic burden and regional therapy responsiveness. Distant metastases substantially reduce the 5-year survival rate from 80 % to approximately 25 %, but cases often improve with regional interventions.

CONCLUSION

Although an extremely rare occurrence, clivus metastasis might be considered in patients with a history of malignancy, in particular, breast malignancy, presenting with new-onset sixth nerve palsy.

Efficiency Assessment of Breast Clinics for Patients Under 35: A Comparative Analysis of Targeted Models in a University Hospital

Despite the higher incidence of breast cancer in older age groups, it remains pertinent not to overlook breast cancer occurrence in those aged 35 years and below. Recent transitions toward targeted under-35 clinics in England aim to enhance efficiency and meet referral standards. Three models were planned, and we assessed the efficiency of each model. This study, conducted for five months within a single National Health Service (NHS) trust, analyzed data from the following clinics: the General One-Stop Clinic, the Under 35 One-Stop Clinic with ultrasound services (USS), and the Under 35 Clinic without USS services. Of the 300 patients recruited (100 consecutive patients from each clinic), 94.3% were female. The average age at presentation was 27.53 years. The most frequently encountered age group was between 26 and 30 years, and the majority of patients had palpable lumps (78, 51.6%). Out of 300 patients who attended the clinics, 151 had USS, and of these, 15 biopsies were performed. Fibroadenomas (32, 21.2%) and cysts (22, 14.6%) were the most common radiological findings. We found that more breast imaging was being undertaken for under-35 patients who attended the general one-stop clinics compared to the specific under-35 clinics. Targeted breast clinics for individuals 35 years and below offer an effective approach in terms of resource allocation and meeting cancer targets.

Synthesis, and In-silico Studies of Indole-chalcone Derivatives Targeting Estrogen Receptor Alpha (ER-α) for Breast Cancer

BACKGROUND

Breast cancer is the prominent reason of death in women worldwide, and the cases are increasing day by day. There are many FDA-approved drugs for treating breast cancer. Due to drug resistance, and problems in selectivity, there is a need to develop more effective agents with few side effects. Indole derivatives have demonstrated significant pharmacological potential as anti-breast cancer agents. Further, chalcone derivatives incorporating heterocyclic scaffolds play a significant role in medicine. Indole-chalcone-based compounds offer the potential for improved biological activity and enhanced drug-like properties. It prompted us to explore the synthesis of Indole-Chalcone derivatives targeting estrogen receptor alpha (ER-α) to discover potent anti-breast cancer agents.

OBJECTIVES

To synthesize indole-chalcone derivatives and study their binding interactions for ER-α protein by molecular docking for breast cancer treatment.

METHODS

In this study, indole-chalcone derivatives have been synthesized using conventional heating. With the help of Schrodinger software, molecular interaction as well as ADME (Adsorption, Distribution, Metabolism, and Excretion) studies of the compounds were conducted.

RESULTS

Among all the synthesized compounds, four compounds (1, 2, 3, and 4) showed better docking scores (-10.24 kcal/mol, -10.15 kcal/mol, -9.40 kcal/mol, -9.29 kcal/mol, respectively) than the standard tamoxifen (-8.43 kcal/mol).

CONCLUSION

From In-silico studies, we can conclude that four compounds from the synthesized series fit into the active site of ER-α. ADME properties of synthesized derivatives were found in the acceptable range. In the future, these compounds can be further explored for biological activity.

A remarkable response to palliative treatment in metastatic breast cancer: A case report and comprehensive literature review

The case report describes a patient with stage IV breast cancer which metastasized to the lungs. The patient's initial computed tomography (CT) scan revealed a malignant lesion in the upper outer quadrant of the left breast and multiple pulmonary nodules, suggesting pulmonary metastasis. After starting palliative chemotherapy with intravenous paclitaxel and subcutaneous injections of Herceptin, a follow-up CT scan 3 months after the initiation of treatment showed the disappearance of metastasis, and her cancer regressed to stage II breast cancer that could be surgically resected. This case report highlights the importance of timely and appropriate palliative treatment measures, which can lead to unexpected outcomes, such as the regression of metastatic lesions and the possibility of curative treatment in such advanced cancer.

Value of Molybdenum Target X-Ray and High-Frequency Color Doppler Flow Imaging in Early Diagnosis of Breast Carcinoma: A Comparative Analysis

Background

Breast carcinoma (BC) threatens the physical and mental health of women worldwide, and early diagnosis is important for improving patient outcomes and ensuring successful treatment.

Purpose

This research mainly aims to compare and analyze the value of molybdenum target X-ray and high-frequency color Doppler flow imaging (CDFI) in the early diagnosis of BC.

Methods

First, 102 patients with suspected early-stage BC (ESBC) admitted to Henan Provincial People's Hospital were examined by molybdenum target X-ray and CDFI. Based on the pathological findings, the diagnostic efficiency data of the two diagnostic modalities such as positive detection rate (PDR), positive predictive value (PPV), negative predictive value (NPV), sensitivity (SEN), specificity (SPE), and accuracy (ACC), as well as imaging information like masses, microcalcifications (MCs), axillary lymph node (LN) metastases, and blood flow signal or vascular sign abnormalities were analyzed.

Results

CDFI contributed to higher PDR, PRV, NPV, SEN, and ACC than molybdenum target X-ray in ESBC diagnosis, but similar SPE. The combined diagnosis of molybdenum target X-ray plus CDFI contributed to even higher PDR, PRV, NPV, SEN, and ACC than molybdenum target X-ray alone and higher ACC than CDFI. Imaging inspection revealed that the number of cases of masses, axillary LN metastases, and abnormalities in blood flow signals or vascular signs detected by CDFI was significantly higher than that by molybdenum target X-ray, while the number of MCs was significantly lower.

Conclusion

Molybdenum target X-ray plus CDFI is more effective in the diagnosis of ESBC and plays a complementary role in imaging examination, which can synergistically improve the diagnostic ACC of ESBC and is worthy of clinical promotion.

Sociodemographic disparities associated with advanced stages and distant metastatic breast cancers at diagnosis in Indonesia: a cross-sectional study

Background

The global health burden of breast cancer is increasing with 5-year survival rates being much shorter in low-income and middle-income countries. Sociodemographic and clinical disparities in early cancer detection affect long-term outcome.

Methods

The authors compared social, demographic, and pathological characteristics associated with metastatic and late stages of breast cancer diagnosis using data collected from a special registry developed by Perhimpunan Bedah Onkologi Indonesia (PERABOI) in 2015.

Results

Of 4959 patients recruited in this study, 995 women (20.1%) were diagnosed with metastatic breast cancer. Lower education status and living in rural areas were significantly associated with Stage IV at diagnosis [odds ratio (OR)=1.256, 95% CI=1.093-1.445, P=0.001; and OR=1.197, 95% CI=1.042-1.377, P=0.012; respectively). Main complaints other than lump (ulceration, breast pain, and discharge) and occupation as a housewife were also associated with the presentation of metastatic diseases (OR=2.598, 95% CI=2.538-3.448, P<0.001 and OR=1.264, 95% CI=1.056-1.567, P=0.030, respectively). Having lower education and living outside Java and Bali islands were associated with the diagnosis of late-stage breast cancers (OR=1.908, 95% CI=1.629-2.232, P<0.001 and OR=3.039, 95% CI=2.238-4.126, P<0.001; respectively). A higher proportion of breast cancer patients were relatively younger with bigger tumour size, positive axillary nodal involvement, and more frequent Human epidermal growth factor receptor 2 overexpression.

Conclusion

The authors identified sociodemographic disparities in the metastatic and late-stage diagnosis of breast cancers among Indonesian women. The subsequent action is required to reduce disparities faced by women with lower social and educational levels for early diagnosis and better healthcare access.

Macromorphometric Analysis of Metastatic Lesions in Bones due to Breast Cancer: Contribution to Human Identification

OBJECTIVE

This study aimed to report the metastatic lesions observed in identified skeletons whose deaths were caused by breast cancer complications to provide information and evidence that can be used in cases of human identification forensics.

METHODS

The research was conducted at the Centre for Forensic Anthropology Studies of the Faculty of Odontology of the University of Pernambuco (CEAF/FOP/UPE), Recife, Brazil. The data bank of the CEAF/FOP/UPE was searched for skeletons with the cause of death reported as due to breast cancer, resulting in five cases. The skeletons were arranged in anatomical positions and macroscopically inspected to register, describe and measure the lesions present to establish the macroscopic patterns of bone destruction caused by breast cancer.

RESULT

Of the five skeletons, two presented metastatic lesions. In the first, lesions were observed in a disseminated form, affecting almost all bones. The lesions were predominantly osteolytic and ellipsoid-shaped; however, mixed and circular lesions were also found. The second skeleton presented four lesions of mixed characteristics. The finding of bone lesions in the macroscopic analysis of skeletons may reveal a more advanced stage of the neoplasm, as well as its dissemination in areas little rich in hematopoietic tissue, such as the diaphyses of long bones, a situation widely observed in the first reported case.

CONCLUSION

Besides providing more excellent knowledge of their macroscopic presentation, bone metastatic lesions may act as an individualizing factor in human identification cases, narrowing the sample of possible victims.

Breast Cancer Awareness and Screening Among Menopaused Females in Al-Qassim Region

BACKGROUND

Breast cancer (BC) is one of the most prevalent types of cancer among women worldwide including those in Saudi Arabia. The risk of developing BC can be lowered by reducing risk factors through early screening and by women having full knowledge of this condition. The aim of this study is thus to evaluate knowledge of the importance of early screening and detection of BC among post-menopausal women in Saudi Arabia's Qassim region and to compare it with pre-menopausal women.

METHODOLOGY

A cross-sectional study was conducted among post-menopausal women in the Qassim region. Data were collected by using a pre-tested, pre-coded, validated self-administered online questionnaire. Data were analyzed using SPSS (Social Package of Statistical Science) Statistics version 23.0.

RESULTS

Data were collected from 1386 women who agreed to participate in this study, of which 484 women reported that their menstruation had stopped (34.9%). In general, it was found that 73.7% of the participants had adequate knowledge with a significant difference between pre-menopausal and post-menopausal women. Concerning knowledge of BC (p = 0.042), pre-menopausal women had a higher level of knowledge (75.5% had adequate knowledge compared with 70.5% of post-menopausal women). Considering the source of knowledge of the participants regarding BC, websites or social media is considered the main source for 71.8% of the participants, followed by family and friends (52.2%). Concerning the knowledge about the risk factors of BC, 26.4% of the participants reported that they did not know them, and 11.8% of the participants did not know any of the symptoms of BC.

CONCLUSION

In this study, the knowledge of post-menopausal women was found to be adequate; however, it is significantly lower than that of the pre-menopausal women. Educational level is a significant factor that affects the level of knowledge regarding BC risk factors and different modalities for diagnosis and approaches for management, and this indicates the importance of increasing interest in education in our society.

Lung cancer with breast metastasis: a case report and review of the literature

In this article, we present a rare case of breast metastasis of lung cancer. Chest computed tomography (CT) for a woman in her early 50s indicated right lung malignancy, multiple bone metastases, and an irregular mass in her right breast. Further inquiry into the case history revealed that the patient had been aware of the breast mass for 3 years, without respiratory symptoms. Biopsy of the breast mass suggested estrogen receptor (ER) (+), progesterone receptor (PR) (-), and human epidermal growth factor receptor 2 (HER2) (+ +) breast cancer. The patient was initially diagnosed with breast cancer with lung and bone metastasis. However, comprehensive breast cancer treatment was ineffective, and thyroid transcription factor-1 (TTF-1), napsin A, and cytokeratin 7 (CK7) were evaluated to better understand the origin of the cancer. To the best of our knowledge, this patient had the longest reported disease course from presentation with a breast lump as the first symptom to the final diagnosis of breast metastasis of lung cancer. To provide a better reference for differential diagnosis of ambiguous tumors, we also performed a systematic literature review.

Molecular docking appraisal of Dysphania ambrosioides phytochemicals as potential inhibitor of a key triple-negative breast cancer driver gene

Triple-negative breast cancer (TNBC) is a lethal and aggressive breast cancer subtype. It is characterized by the deficient expression of the three main receptors implicated in breast cancers, making it unresponsive to hormone therapy. Hence, an existing need to develop a targeted molecular therapy for TNBC. The PI3K/AKT/mTOR signaling pathway mediates critical cellular processes, including cell proliferation, survival, and angiogenesis. It is activated in approximately 10-21% of TNBCs, emphasizing the importance of this intracellular target in TNBC treatment. AKT is a prominent driver of the PI3K/AKT/mTOR pathway, validating it as a promising therapeutic target. Dysphania ambrosioides is an important ingredient of Nigeria's traditional herbal recipe for cancer treatment. Thus, our present study explores its anticancer properties through a structure-based virtual screening of 25 biologically active compounds domiciled in the plant. Interestingly, our molecular docking study identified several potent inhibitors of AKT 1 and 2 isoforms from D. ambrosioides. However, cynaroside and epicatechin gallate having a binding energy of - 9.9 and - 10.2 kcal/mol for AKT 1 and 2, respectively, demonstrate considerable drug-likeness than the reference drug (capivasertib), whose respective binding strengths for AKT 1 and 2 are - 9.5 and - 8.4 kcal/mol. Lastly, the molecular dynamics simulation experiment showed that the simulated complex systems of the best hits exhibit structural stability throughout the 50 ns run. Together, our computational modeling analysis suggests that these compounds could emerge as efficacious drug candidates in the treatment of TNBC. Nevertheless, further experimental, translational, and clinical research is required to establish an empirical clinical application.

Graphical Abstract

A structure-based virtual screening and simulation of Dysphania ambrosioides phytochemicals in the active pocket of AKT 1 and 2 isoforms.

Comparing Time to Diagnosis and Treatment Between Younger and Older Adults With Colorectal Cancer: A Population-Based Study

BACKGROUND & AIMS

Younger adults (aged <50 years) with colorectal cancer (CRC) may have prolonged delays to diagnosis and treatment that are associated with adverse outcomes. We compared delay intervals by age for patients with CRC in a large population.

METHODS

This was a population-based study of adults diagnosed with CRC in Ontario, Canada, from 2003 to 2018. We measured the time between presentation and diagnosis (diagnostic interval), diagnosis and treatment start (treatment interval), and the time from presentation to treatment (overall interval). We compared interval lengths between adults aged <50 years, 50 to 74 years, and 75 to 89 years using multivariable quantile regression.

RESULTS

Included were 90,225 patients with CRC. Of these, 6853 patients (7.6%) were aged <50 years. Younger patients were more likely to be women, present emergently, have stage IV disease, and have rectal cancer compared with middle-aged patients. Factors associated with significantly longer overall intervals included female sex (8.7 days; 95% confidence interval [CI], 6.6-10.9 days) and rectal cancer compared with proximal colon cancer (9.8 days; 95% CI, 7.4-2.2 days). After adjustment, adults aged <50 years had significantly longer diagnostic intervals (4.3 days; 95% CI. 1.3-7.3 days) and significantly shorter treatment intervals (-4.5 days; 95% CI, -5.3 to -3.7 days) compared with middle-aged patients. However, there was no significant difference in the overall interval (-0.6 days; 95% CI, -4.3 to 3.2 days). In stratified models, younger adults with stage IV disease who presented emergently and patients aged >75 years had longer overall intervals.

CONCLUSIONS

Younger adults present more often with stage IV CRC but have overall similar times from presentation to treatment as screening-eligible older adults.

Identification, characterization, and prognosis investigation of pivotal genes shared in different stages of breast cancer

One of the leading causes of death (20.1 per 100,000 women per year), breast cancer is the most prevalent cancer in females. Statistically, 95% of breast cancer are categorized as adenocarcinomas, and 55% of all patients may go into invasive phases; however, it can be successfully treated in approximately 70-80% of cases if diagnosed in the nascent stages. The emergence of breast tumor cells which are intensely resistant to conventional therapies, along with the high rate of metastasis occurrence, has highlighted the importance of finding novel strategies and treatments. One of the most advantageous schemes to alleviate this complication is to identify the common differentially expressed genes (DEGs) among primary and metastatic cancerous cells to use resultants for designing new therapeutic agents which are able to target both primary and metastatic breast tumor cells. In this study, the gene expression dataset with accession number GSE55715 was analyzed containing two primary tumor samples, three bone-metastatic samples, and three normal samples to distinguish the up- and down regulated genes in each stage compared to normal cells as control. In the next step, the common upregulated genes between the two experimental groups were detected by Venny online tool. Moreover, gene ontology, functions and pathways, gene-targeting microRNA, and influential metabolites were determined using EnrichR 2021 GO, KEGG pathways miRTarbase 2017, and HMDB 2021, respectively. Furthermore, elicited from STRING protein-protein interaction networks were imported to Cytoscape software to identify the hub genes. Then, identified hub genes were checked to validate the study using oncological databases. The results of the present article disclosed 1263 critical common DEGs (573 upregulated + 690 downregulated), including 35 hub genes that can be broadly used as new targets for cancer treatment and as biomarkers for cancer detection by evaluation of expression level. Besides, this study opens a new horizon to reveal unknown aspects of cancer signaling pathways by providing raw data evoked from in silico experiments. This study's outcomes can also be widely utilized in further lab research since it contains diverse information on common DEGs of varied stages and metastases of breast cancer, their functions, structures, interactions, and associations.

Vascular Endothelial Growth Factor Ligands and Receptors in Breast Cancer

Breast cancer (BC) is the most common malignancy responsible for the largest number of deaths in women worldwide. The risk of developing BC is predisposed by many factors such as age, presence of genetic mutations or body weight. The diagnosis is mostly made relatively late, which is why patients are exposed to radical surgical treatments, long-term chemotherapy and lower survival rates. There are no sufficiently sensitive and specific screening tests; therefore, researchers are still looking for new diagnostic biomarkers that would indicate the appearance of neoplastic changes in the initial stage of neoplasm. The VEGF family of proteins (VEGF-A, VEGF-B, VEGF-C, VEGF-D, EG-VEGF, PlGF) and their receptors are significant factors in the pathogenesis of BC. They play a significant role in the process of angiogenesis and lymphangiogenesis in both physiological and pathological conditions. The usefulness of these proteins as potential diagnostic biomarkers has been initially proven. Moreover, the blockage of VEGF-related pathways seems to be a valid therapeutic target. Recent studies have tried to describe novel strategies, including targeting pericytes, use of miRNAs and extracellular tumor-associated vesicles, immunotherapeutic drugs and nanotechnology. This indicates their possible contribution to the formation of breast cancer and their usefulness as potential biomarkers and therapeutic targets.

Breast cancer knowledge in Lebanese females with positive family history

Breast cancer is the most commonly diagnosed cancer in women and the second leading cause of cancer-related death worldwide. Positive family history increases the likelihood of developing this disease. As late-stage presentation and poor survival rates are associated with a lack of knowledge about breast cancer and its screening methods, this study aimed to evaluate the knowledge of Lebanese women with first-degree relatives who were diagnosed with breast cancer. In this cross-sectional study, 200 women with a positive family history accompanying their relatives to oncology clinics or the infusion center at the American University of Beirut Medical Center, completed an online survey after institutional review board approval was granted. Demographic information and answers to questions related to breast cancer risk factors, warning signs, and screening techniques were collected and analyzed using descriptive statistics and chi-square tests. Eighty-one percent of the study participants agreed that a history of breast cancer is associated with a higher disease risk. The smaller portions were aware of other potential risk factors, such as hormone replacement therapy, alcohol consumption, late menopause, early menarche, and overweight and sedentary lifestyles. Also, 93% to 96.5% of the participants recognized breast self-examination and mammography as useful tools for early detection. Furthermore, younger participants who reached university level and were employed had more insights into breast cancer. Breast cancer knowledge and early diagnosis are key elements in preventing late presentations and reducing the associated morbidity and mortality. Further educational and awareness campaigns should be conducted in Lebanon to improve women knowledge of breast cancer.

Observational analysis of clinical and pathological characteristics and their prognostic impact in Mexican patients with breast cancer: A multi-center study

Breast cancer is the most incidental and deadly neoplasm worldwide; in Mexico, very few epidemiologic reports have analyzed the pathological features and its impact on their clinical outcome. Here, we studied the relation between pathological features and the clinical presentation at diagnosis and their impact on the overall and progression-free survival of patients with breast cancer. For this purpose, we collected 199 clinical records of female patients, aged at least 18 years old (y/o), with breast cancer diagnosis confirmed by biopsy. We excluded patients with incomplete or conflicting clinical records. Afterward, we performed an analysis of overall and progression-free survival and associated risks. Our results showed an average age at diagnosis of 52 y/o (24-85), the most common features were: upper outer quadrant tumor (32%), invasive ductal carcinoma (76.8%), moderately differentiated (44.3%), early clinical stages (40.8%), asymptomatic patients (47.8%), luminal A subtype (47.8%). Median overall survival was not reached, but median progression-free survival was 32.2 months (29.75-34.64, CI 95%) associated risk were: clinical stage (p < 0.0001) symptomatic presentation (p = 0.009) and histologic grade (p = 0.02). Therefore, we concluded that symptom presence at diagnosis impacts progression-free survival, and palpable symptoms are related to an increased risk for mortality.

Diagnostic pathways for breast cancer in 10 International Cancer Benchmarking Partnership (ICBP) jurisdictions: an international comparative cohort study based on questionnaire and registry data

OBJECTIVES

A growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK.

SETTING

Primary care in 10 jurisdictions.

PARTICIPANT

Data were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data.

PRIMARY AND SECONDARY OUTCOME MEASURES

Patient, primary care, diagnostic and treatment intervals.

RESULTS

Overall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3-29 (Denmark and Sweden), 0-20 (seven jurisdictions and Ontario) and 8-29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15-39 (Norway, Victoria and Manitoba) and 4-78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario).

CONCLUSIONS

Large international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.

Oncologic necessity for the complete removal of residual microcalcifications after neoadjuvant chemotherapy for breast cancer

The surgical range of breast cancer that shows pathologic complete response (pCR) without change in microcalcifications after neoadjuvant chemotherapy (NAC) is controversial. This study examined whole breast specimens to evaluate the necessity of mastectomy in those cases. The viability of cancer cells around the residual microcalcification was assessed using prospectively collected breast samples to confirm the presence or absence of cancer cells. A total of 144 patients with breast cancer and diffuse microcalcifications were classified into the reduced mass with no change in residual microcalcification (RESMIN, n = 49) and non-RESMIN (n = 95) groups. Five specimens were prospectively evaluated to assess the presence of viable cancer cells around the microcalcification. Tumor responses to NAC were significantly better with high pCR rates in the RESMIN group (p = 0.005 and p = 0.002). The incidence of human epidermal growth factor receptor 2-positive and triple-negative breast cancers was significantly high in the RESMIN group (p = 0.007). Although five (10.2%) patients had locoregional recurrence in the RESMIN group, no local recurrence in the breast was reported. Although pCR was highly estimated, residual cancers, including ductal carcinoma in situ, remained in 80% cases. Therefore, given the weak scientific evidence available currently, complete removal of residual microcalcifications should be considered for oncologic safety.

Imaging Features of Breast Cancer Subtypes on Mammography and Ultrasonography: an Analysis of 479 Patients

To compare features of clinically defined subtypes of breast cancer on mammography (MG) and ultrasonography (USG). After obtaining approval from the institute ethics committee, a retrospective observational study was performed on biopsy-proven breast cancer patients who underwent baseline MG from 2016 to 2020. MG and USG features were evaluated and the patients were classified based on immunohistochemistry profile into luminal like (LL)-oestrogen receptor (ER)/progesterone receptor (PR) + , Her2neu-; basal like (BL)-ER/PR-, Her2neu-; Her2 like (HL)-Her2neu + . A total of 479 patients (mean age, 51.4 ± 11.7 years; all females) were included: LL-198 (41.3%), BL-121 (25.2%) and HL-160 (33.3%). On MG, round shape (21/115, 18.3%, p < 0.001); circumscribed (16/115, 13.9%, p < 0.001) and microlobulated margins (28/115, 24.4%) were associated with BL tumours. Associated suspicious calcifications (96/160, 60%, p < 0.001) and skin thickening or retraction (75/149, 50.3%, p < 0.001) were more common in HL. On USG, round shape (12/95, 12.8%, p = 0.005); circumscribed (8/94, 8.5%) and microlobulated margins (44/94, 46.8%) and posterior acoustic enhancement (7/95, 7.5%, p = 0.012) were associated with BL. The logistic regression analysis revealed that spiculated margins on MG favoured LL (OR: 8.5, p = 0.001); round shape (OR: 6.8), circumscribed (OR: 10.8) or microlobulated margins (OR: 3.5) (p < 0.001 for each) favoured BL; whereas associated features of calcifications (OR: 3.3) (p = 0.019) and skin retraction or thickening (OR: 1.8) (p < 0.001) favoured HL. On USG, circumscribed (OR: 5.9, p = 0.005) or microlobulated margins (OR: 3, p < 0.001) and posterior acoustic enhancement (OR: 9.5, p = 0.006) favoured BL. Clinically defined subtypes of breast cancer show significant differences in the imaging appearances on mammography and USG. BL tumours may not show the typical imaging features of malignancy, necessitating clinicopathological correlation for accurate diagnosis.

Perinatal outcomes of women with gestational breast cancer in Australia and New Zealand: A prospective population-based study

OBJECTIVE

To determine the epidemiology, clinical management, and outcomes of women with gestational breast cancer (GBC).

METHODS

A population-based prospective cohort study was conducted in Australia and New Zealand between 2013 and 2014 using the Australasian Maternity Outcomes Surveillance System (AMOSS). Women who gave birth with a primary diagnosis of breast cancer during pregnancy were included. Data were collected on demographic and pregnancy factors, GBC diagnosis, obstetric and cancer management, and perinatal outcomes. The main outcome measures were preterm birth, maternal complications, breastfeeding, and death.

RESULTS

Forty women with GBC (incidence 7.5/100 000 women giving birth) gave birth to 40 live-born babies. Thirty-three (82.5%) women had breast symptoms at diagnosis. Of 27 women diagnosed before 30 weeks' gestation, 85% had breast surgery and 67% had systemic therapy during pregnancy. In contrast, all 13 women diagnosed from 30 weeks had their cancer management delayed until postdelivery. There were 17 preterm deliveries; 15 were planned. Postpartum complications included the following: hemorrhage (n = 4), laparotomy (n = 1), and thrombocytopenia (n = 1). There was one late maternal death. Eighteen (45.0%) women initiated breastfeeding, including 12 of 23 women who had antenatal breast surgery. There were no perinatal deaths or congenital malformations, but 42.5% of babies were preterm, and 32.5% were admitted for higher-level neonatal care.

CONCLUSIONS

Gestational breast cancer diagnosed before 30 weeks' gestation was associated with surgical and systemic cancer care during pregnancy and planned preterm birth. In contrast, cancer treatment was deferred to postdelivery for women diagnosed from 30 weeks, reflecting the complexity of managing expectant mothers with GBC in multidisciplinary care settings.

Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis

BACKGROUND

Clinical delays may be important contributors to outcomes among younger adults (<50 years) with colorectal cancer (CRC). We aimed to describe delay intervals for younger adults with CRC using health administrative data to understand drivers of delay in this population.

METHODS

This was a population-based study of adults <50 diagnosed with CRC in Ontario, Canada from 2003 to 2018. Using administrative code-based algorithms (including billing codes), we identified four time points along the pathway to treatment-first presentation with a CRC-related symptom, first investigation, diagnosis date and treatment start. Intervals between these time points were calculated. Multivariable quantile regression was performed to explore associations between patient and disease factors with the median length of each interval.

RESULTS

6853 patients aged 15-49 were diagnosed with CRC and met the inclusion criteria. Males comprised 52% of the cohort, the median age was 45 years (IQR 40-47), and 25% had stage IV disease. The median time from presentation to treatment start (overall interval) was 109 days (IQR 55-218). Time between presentation and first investigation was short (median 5 days), as was time between diagnosis and treatment start (median 23 days). The greatest component of delay occurred between first investigation and diagnosis (median 78 days). Women, patients with distal tumours, and patients with earlier stage disease had significantly longer overall intervals.

CONCLUSIONS

Some younger CRC patients experience prolonged times from presentation to treatment, and time between first investigation to diagnosis was an important contributor. Access to endoscopy may be a target for intervention.

Epigenetic oncogenesis, biomarkers and emerging chemotherapeutics for breast cancer

Breast cancer remains one of the leading causes of cancer-related deaths globally and the most prominent among females, yet with limited effective therapeutic options. Most of the current medications are challenged by various factors including low efficacy, incessant resistance, immune evasion and frequent recurrence of the disease. Further understanding of the prognosis and identification of plausible therapeutic channels thus requires multimodal approaches. In this review, epigenetics studies of several pathways to BC oncogenesis via the inducement of oncogenic changes on relevant markers have been overviewed. Similarly, the counter-epigenetic mechanisms to reverse such changes as effective therapeutic strategies were surveyed. The epigenetic oncogenesis occurs through several pathways, notably, DNMT-mediated hypermethylation of DNA, dysregulated expression for ERα, HER2/ERBB and PR, histone modification, overexpression of transcription factors including the CDK9-cyclin T1 complex and suppression of tumour suppressor genes. Scientifically, the regulatory reversal of the mechanisms constitutes effective epigenetic approaches for mitigating BC initiation, progression and metastasis. These were exhibited at various experimental levels by classical chemotherapeutic agents including some repurposable drugs, endocrine inhibitors, monoclonal antibodies and miRNAs, natural products, metal complexes and nanoparticles. Dozens of the potential candidates are currently in clinical trials while others are still at preclinical experimental stages showing promising anti-BC efficacy. The review presents a model for a wider understanding of epigenetic oncogenic pathways to BC and reveals plausible channels for reversing the unpleasant changes through epigenetic modifications. It advances the science of therapeutic designs for ameliorating the global burden of BC upon further translational studies.

Jalil MA. Knowledge Level on Breast Cancer and Breast Self-Examination (BSE) Practice Among Female University Students

Introduction: Breast cancer is the most common cancer affecting women in Malaysia and therefore, it is important to recognize the early signs and symptoms of breast cancer. In addition, breast self?examination (BSE) also has been suggested as a valuable technique for the early diagnosis of breast cancer. Therefore, this study aimed to assess the level of knowledge on breast cancer and breast self-examination (BSE); and determine the practice of BSE among female student in International Islamic University Malaysia (IIUM), Kuantan, Pahang. Methods: A quantitative cross-sectional study with stratified random sampling method was conducted among 245 female students in IIUM Kuantan Campus, from April to May 2021. Data were gathered by using Google Forms platform which was available in English Language and were distributed to female undergraduate students. The questionnaire was adapted from three sets of questionnaires, Nimir et al., (2014), Erdem and Toktas (2016) and Tewabe and Mekuria (2019). Data analysis was done by using SPSS version 23.0. Results: Majority of the participants (98.0%) have high knowledge regarding the knowledge on risk factors, signs and symptoms of breast cancer and breast self-examination (BSE). The result also showed that 31.0% participants never performed BSE. Most of them reported that the reasons that they do not perform BSE are due to lack of knowledge (35.1%), forgetfulness (33.9%) and negligence (21.6%). Around 36.3% participants reported that they do not know the technique that use to perform BSE.Conclusion: Participants having high knowledge on breast cancer and BSE; however, the practice of BSE is still lacking. Therefore, BSE need to be more educate and promote its practice among young women for early detection of breast cancer and its prevention.

Expression of Poly(Adenosine Diphosphate-Ribose) Polymerase Protein in Breast Cancer

Background

The use of poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors for breast cancer (BC) therapy is the subject of debate, and there is an urgent need to understand much the expression and prognostic role of the PARP1 protein. In this study, we have compared the expression of PARP between BC and benign breast disease (BBD) patients and also analyzed the association of PARP expression with clinicopathological parameters in BC.

Methods

The study consists of 30 patients with newly diagnosed operable BC who were planned for surgery without neoadjuvant chemotherapy and 15 patients of BBD as a control between 2019 and 2021. Immunohistochemical analyses were performed prospectively on tissue samples. Anti-human PARP1 rabbit polyclonal antibody gives strong nuclear positivity. Internal control was the adipose tissue and the BBD acted as the external control. PARP1 expression was evaluated using the multiplicative quickscore method.

Results

The mean age for BC patients was 51.30 ± 10.694 years (range: 25-75 years) while BBD was below 30 years. Overexpression of PARP was present in 25 (83.3%) and weak expression in 5 (16.7%) of BC patients compared to BBD, only 2 (13.3%) patients demonstrated an overexpression of PARP, and 13 (86.6%) patients showed weak expression which showed significant association (P < 0.001). In BC, nuclear PARP (nPARP) overexpression was seen in 22 (73.3%) patients and weak expression of nPARP in 8 (26.7%), whereas 5 (16.7%) patients showed cytoplasmic overexpression. On comparing expression of PARP with clinicopathological parameters, PARP overexpression was significantly associated with older population (age >50 years) (P = 0.002), postmenopausal women (P = 0.029), higher TNM stage (Stage II and III) (P = 0.014), higher histological grade (grade 2) (P = 0.043), and presence of lymphovascular invasion (P = 0.015). Enhanced PARP1 expression is closely correlated with positive estrogen receptor status (P = 0.001) and PR status (P = 0.001). Overall PARP and nPARP overexpression was significantly associated with ER- (P = 0.006 and P = 0.008) and PR-positive (P = 0.006 and P = 0.008) patients. The PARP and nPARP overexpression was significantly associated with nontriple-negative BC patients (P = 0.001 and P = 0.001).

Conclusion

We have not come across any study in the literature to compare PARP expression in BC and BBD patients. On the basis of our observations, we concluded that PARP overexpression is a poor prognostic marker in BC.

Raafat B, Alamri S, Alghamdi AJ, Osman H, Ahmed RM, Almahwasi A, S. Alamri A, Ansari M. Distinction of Breast Masses from Benign to Malignant using Magnetic Resonance Imaging and Dynamic Contrast-Enhanced in Tertiary Care Hospitals of Taif, Saudi Arabia: A Retrospective Study

Background: Breast cancer is the most frequent cancer among women throughout the world. A range of noninvasive techniques have been employed for early prevention. In health-care practice, however, quality and sensitivity remained critical. Objective: The aim of this study is to see how well Breast Magnetic Resonance Imaging (MRIs) and Dynamic Contrast-Enhanced MRI (DCE-MRI) techniques can detect breast cancer and distinguish between malignant and benign lesions. Methods: A retrospective study was conducted at the Taif Hospitals, Saudi Arabia. The Picture Archiving and Communication System was used to acquire medical records and data from 50 individuals with probable breast cancer, and breast MRI pictures were analyzed. Breast Imaging Reporting and Data System (BI-RADS) radiologist reports and DCE-MRI kinetic curves were evaluated. Excel was also used to test the sensitivity and specificity of breast MRI. Results: According to the BI-RADS results, biopsies, and breast MRI data, 52 percent of 50 patients were categorized as benign, 24 percent as malignant, and 24 percent had no abnormalities. Biopsy revealed that 61.5 percent of the malignant lesions were benign, whereas 38.5 percent were appropriately identified as cancerous. The majority of malignant tumors were discovered in patients over the age of 50. The washout curve correctly identified 60% of the malignant lesions and 40% of the benign lesions. Our data demonstrated the usefulness of MRI in detecting breast cancers by analyzing BI-RADS and utilizing DCE-MRI. False-positive, on the other hand, can lead to unnecessary biopsies. Conclusion: Breast cancer is more common among women of their fifties and beyond. Biopsies, breast MRIs, and kinetic curve analysis can all be utilized to differentiate between benign and malignant breast masses with high sensitivity and specificity.

Evolving Evidence for the Optimization of Neoadjuvant Therapy in Triple-Negative Breast Cancer

Representing 15% to 20% of all invasive breast cancers, adjuvant systemic treatment for early-stage, high-risk triple-negative breast cancer (TNBC) is preferentially done in the neoadjuvant setting based on a chemotherapy backbone of anthracyclines and taxanes. Pathological complete response to neoadjuvant treatment constitutes the main objective, regarding its correlation with oncological outcomes. The optimal neoadjuvant regimen to achieve the highest rates of pathological complete response is still under investigation, with the increasing knowledge on the molecular pathways, genomic sequencing, and immunological profile of TNBC allowing for the development of a wide array of new therapeutic options. This review aims to summarize the current evidence and ongoing clinical trials of new therapeutic options for the neoadjuvant treatment of TNBC patients.

Impacto do tratamento oncológico na qualidade de vida de idosas com câncer de mama atendidas pelo Sistema Único de Saúde

Objetivos: avaliar a qualidade de vida (QV), as interações medicamentosas e a adesão ao tratamento em pacientes idosas com câncer de mama que realizaram tratamento oncológico pelo Sistema Único de Saúde (SUS).Métodos: coorte prospectiva, com seis meses de seguimento, que incluiu pacientes idosas com câncer de mama atendidas em Hospital Universitário de Porto Alegre e atendidas pelo SUS. Foram selecionadas mulheres com idade ≥ 60 anos, divididas em dois grupos (60-69 anos e ≥ 70 anos).Resultados: 38 pacientes foram incluídas nas análises sobre QV e adesão ao tratamento. Dentro da classificação molecular, os subtipos mais diagnosticados foram, Luminal B/Her2- (34,2%), Luminal A (26,3%), Luminal B/HER2+ (21,1%). Os sintomas físicos mais relacionados à doença, no momento do diagnóstico, foram insônia, rigidez musculoesquelética, preocupação com os outros e com o futuro. Em contrapartida, seis meses depois os resultados menos favoráveis foram fadiga, náusea e vômito, dispneia, dor, inapetência, constipação, diarreia, problemas financeiros, efeitos adversos da terapia sistêmica, sintomas nas mamas e braços e alopecia. Baixos níveis de adesão ao tratamento foram identificados em 67,6% das pacientes. A polifarmácia foi evidenciada em 60,6%, e foi observada ao menos uma interação medicamentosa potencial em 78,8% da amostra. A média de medicamentos utilizados foi de 7,24 (DP= 3,77).Conclusões: este estudo demonstrou a importância do acompanhamento da população idosa com câncer de mama que faz uso de tratamento quimioterápico, a fim de compreender as implicações da senescência, bem como melhorar as taxas de adesão à terapia e a qualidade de vida desta população.

Breast Cancer Genomics: Primary and Most Common Metastases

Specific genomic alterations have been found in primary breast cancer involving driver mutations that result in tumorigenesis. Metastatic breast cancer, which is uncommon at the time of disease onset, variably impacts patients throughout the course of their disease. Both the molecular profiles and diverse genomic pathways vary in the development and progression of metastatic breast cancer. From the most common metastatic site (bone), to the rare sites such as orbital, gynecologic, or pancreatic metastases, different levels of gene expression indicate the potential involvement of numerous genes in the development and spread of breast cancer. Knowledge of these alterations can, not only help predict future disease, but also lead to advancement in breast cancer treatments. This review discusses the somatic landscape of breast primary and metastatic tumors.

A case report of lymphedema as an unusual initial presentation of breast carcinoma

Breast carcinoma is one of the most common carcinomas among women around the world. Most of the women with breast carcinoma will present with signs and symptoms of breast problems to the health facility. Upper limb swelling is one of the rare initial presentations although it is rather common in patients as a sequelae of breast carcinoma treatment. We herein would like to report a case where a post-menopausal female presented with left upper limb swelling with initial history suggestive of traumatic injury of biceps muscle. Subsequent investigations of ultrasound, mammography, biopsy sample of the left breast found that the left upper limb swelling was due to a newly diagnosed invasive lobular carcinoma of the breast, staging of cT4cN2Mx which caused a rapidly progressing stage 2 lymphedema of the left upper limb. Lymphedema of the upper limb is a common complication of breast carcinoma treatment, especially those who require axillary lymph nodes clearance. Breast carcinoma with initial presentation of lymphedema of the upper limb is rare. Due to the rare presentation, diagnosis of breast carcinoma can be delayed. Clinicians should have high awareness to exclude breast cancer when a patient presents with unilateral upper limb swelling.

Integrated bioinformatics and statistical approaches to explore molecular biomarkers for breast cancer diagnosis, prognosis and therapies

Integrated bioinformatics and statistical approaches are now playing the vital role in identifying potential molecular biomarkers more accurately in presence of huge number of alternatives for disease diagnosis, prognosis and therapies by reducing time and cost compared to the wet-lab based experimental procedures. Breast cancer (BC) is one of the leading causes of cancer related deaths for women worldwide. Several dry-lab and wet-lab based studies have identified different sets of molecular biomarkers for BC. But they did not compare their results to each other so much either computationally or experimentally. In this study, an attempt was made to propose a set of molecular biomarkers that might be more effective for BC diagnosis, prognosis and therapies, by using the integrated bioinformatics and statistical approaches. At first, we identified 190 differentially expressed genes (DEGs) between BC and control samples by using the statistical LIMMA approach. Then we identified 13 DEGs (AKR1C1, IRF9, OAS1, OAS3, SLCO2A1, NT5E, NQO1, ANGPT1, FN1, ATF6B, HPGD, BCL11A, and TP53INP1) as the key genes (KGs) by protein-protein interaction (PPI) network analysis. Then we investigated the pathogenetic processes of DEGs highlighting KGs by GO terms and KEGG pathway enrichment analysis. Moreover, we disclosed the transcriptional and post-transcriptional regulatory factors of KGs by their interaction network analysis with the transcription factors (TFs) and micro-RNAs. Both supervised and unsupervised learning's including multivariate survival analysis results confirmed the strong prognostic power of the proposed KGs. Finally, we suggested KGs-guided computationally more effective seven candidate drugs (NVP-BHG712, Nilotinib, GSK2126458, YM201636, TG-02, CX-5461, AP-24534) compared to other published drugs by cross-validation with the state-of-the-art alternatives top-ranked independent receptor proteins. Thus, our findings might be played a vital role in breast cancer diagnosis, prognosis and therapies.

Microcalcification Discrimination in Mammography Using Deep Convolutional Neural Network: Towards Rapid and Early Breast Cancer Diagnosis

Breast cancer is among the most common types of cancer in women and under the cases of misdiagnosed, or delayed in treatment, the mortality risk is high. The existence of breast microcalcifications is common in breast cancer patients and they are an effective indicator for early sign of breast cancer. However, microcalcifications are often missed and wrongly classified during screening due to their small sizes and indirect scattering in mammogram images. Motivated by this issue, this project proposes an adaptive transfer learning deep convolutional neural network in segmenting breast mammogram images with calcifications cases for early breast cancer diagnosis and intervention. Mammogram images of breast microcalcifications are utilized to train several deep neural network models and their performance is compared. Image filtering of the region of interest images was conducted to remove possible artifacts and noises to enhance the quality of the images before the training. Different hyperparameters such as epoch, batch size, etc were tuned to obtain the best possible result. In addition, the performance of the proposed fine-tuned hyperparameter of ResNet50 is compared with another state-of-the-art machine learning network such as ResNet34, VGG16, and AlexNet. Confusion matrices were utilized for comparison. The result from this study shows that the proposed ResNet50 achieves the highest accuracy with a value of 97.58%, followed by ResNet34 of 97.35%, VGG16 96.97%, and finally AlexNet of 83.06%.

Women's awareness of breast cancer symptoms: a national cross-sectional study from Palestine

Background

Early diagnosis is crucial to reduce the morbidity and mortality associated with breast cancer (BC). Awareness of BC symptoms plays a key role in this. This study aimed to evaluate the Palestinian women’s awareness of BC symptoms and determine factors associated with good awareness.

Methods

This was a national cross-sectional study conducted from July 2019 to March 2020 in Palestine. Convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces located in 11 governorates. A translated-into-Arabic version of the validated BC awareness measure was utilized for data collection. The awareness level was categorized based on the number of symptoms recognized into: poor (0 to 4), fair (5 to 9), and good (10 to 13).

Results

Of 6269 approached, 5434 participants completed the questionnaire (response rate = 86.7%). A total of 5257 questionnaires were included in the analysis: 2551 from the Gaza Strip and 2706 from the West Bank and Jerusalem (WBJ). Participants living in the WBJ were more likely to be older, have higher monthly income, and suffer from more chronic diseases than participants living in the Gaza Strip.

The most frequently identified BC symptom was ‘lump or thickening in the breast’ (n = 4887, 92.9%) followed by ‘lump or thickening under the armpit’ (n = 4394, 83.6%). The least frequently identified symptoms were ‘pulling in of the nipple’ (n = 2665, 50.7%) and ‘change in the position of the nipple’ (n = 2710, 51.6%).

A total of 2191 participants (41.7%) demonstrated good awareness of BC symptoms. Participants from the Gaza Strip were more likely than participants from the WBJ to have good awareness (47.0.0% vs. 36.7%). On the multivariable analysis, being ≥ 40 years, completing a post-secondary education, knowing someone with cancer, and visiting hospitals and primary healthcare centers were all associated with an increase in the likelihood of having good awareness. However, living in the WBJ was associated with a decrease in the likelihood of having good awareness.

Conclusion

Less than half of women included in this study showed good awareness of BC symptoms. More targeted educational interventions are needed to promote Palestinian women’s awareness of BC symptoms to facilitate early diagnosis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13224-7.

Differences in breast cancer diagnosis by patient presentation in Ontario: a retrospective cohort study

BACKGROUND

In Ontario, patients with breast cancer typically receive their diagnoses through the Ontario Breast Screening Program (OBSP) after an abnormal screen, through screening initiated by a primary care provider or other referring physician, or through follow-up of symptoms by patients' primary care providers. We sought to explore the association of the route to diagnosis (screening within or outside the OBSP or via symptomatic presentation) with use of OBSP-affiliated breast assessment sites (O-BAS), wait times until diagnosis or treatment, health care use and overall survival for patients with breast cancer.

METHODS

In this retrospective cohort study, we used the Ontario Cancer Registry to identify adults (aged 18-105 yr) who received a diagnosis of breast cancer from 2013 to 2017. We excluded patients if they were not Ontario residents or had missing age or sex, or who died before diagnosis. We used logistic regression to evaluate factors associated with categorical variables (whether patients were or were not referred to an OBAS, whether patients were screened or symptomatic) and Cox proportional hazards regression to identify factors associated with all-cause mortality.

RESULTS

Of 51 460 patients with breast cancer, 42 598 (83%) received their diagnoses at an O-BAS. Patients whose cancer was first detected through the OBSP were more likely than symptomatic patients to be given a diagnosis at an O-BAS (adjusted odds ratio 1.68, 95% confidence interval [CI] 1.57 to 1.80). Patients screened by the OBSP were given their diagnoses 1 month earlier than symptomatic patients, but diagnosis at an O-BAS did not affect the time until either diagnosis or treatment. Patients referred to an O-BAS had significantly better overall survival than those who were not referred (adjusted hazard ratio 0.73, 95% CI 0.66 to 0.80).

INTERPRETATION

Patients screened through the OBSP were given their diagnoses earlier than symptomatic patients and were more likely to be referred to an O-BAS, which was associated with better survival. Our findings suggest that individuals with signs and symptoms of breast cancer would benefit from similar referral processes, oversight and standards to those used by the OBSP.

Factors Influencing Total Delay of Breast Cancer in Northeast of China

Objectives

Delay in diagnosis and treatment, called total delay, could probably result in lower survival rates in breast cancer patients. This study aimed to investigate the factors associated with the comprehensive delay behaviors and to evaluate its effect on outcomes in patients with breast cancer in Dalian, a northeast city of China.

Methods

A retrospective chart review was conducted using a cancer registry dataset including 298 patients. The Kaplan–Meier survival analysis was used to identify the threshold of total delay, dividing the patients into a group with significant uncertainty and a group without substantial delay. The factors associated with the significant total delay were investigated from the potential candidates, like income level and marital status, by using the chi-squared test. The difference of the clinicopathologic characteristics between the patients grouped by the significant total delay, like tumor size and lymph node metastasis, was also investigated to find out the effect of the total delay.

Results

A total of 238 charts were used for analysis. The mean age was 57.3. The median of total delays was 3.75 months. Thirty days was identified as a threshold, more than which the total delay can lead to worse survival. Patients’ marital status (p = 0.010), income levels (p = 0.003), smoking status (p = 0.031), initial visiting hospital level (p = 0.005), self-health care (p = 0.001), and self-concern about initial symptom (p ≈ 0.000) were identified as the independent predictors of the total delay. Metastasis (p ≈ 0.000) was identified as the significant result relating to the significant total delay.

Conclusions

A total delay of more than 30 days predicts worse survival in breast cancer patients in Dalian. Several factors, like patients’ marital status and income levels, can be considered to be relevant to the significant total delay. We recommend that these factors be used to predict the potential patients with the significant total delay in the clinical practice.

Epidemiology of Carcinoma Breast in Young Adolescence Women

Introduction The aim of this study was to compare epidemiological characteristics of breast cancer in young adolescent women (YAW) versus older women (OW). Methods This was a cross-sectional prospective observational study, conducted in Ward 3, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from September 2021 to February 2022. A total of 120 female patients were recruited in this study from the Outpatient Department of Jinnah Postgraduate Medical Center, out of which 22 patients were below the age of 40 years and 98 were above 40 years. For breast cancer diagnosis, we used the triple assessment method involving clinical examination, radiology, and histopathology. Diagnosed patients were further evaluated for hormonal status and metastatic workup. Results were noted on a performa, and differences between both age groups were analyzed. Results Out of 120 patients, 22 were younger than 40 years and 98 were older than 40 years. YAW used to present late after the appearance of symptoms. Patients of both age groups mostly presented with breast lumps (68.18% in YAW and 81.6% in OW). YAW presented with larger sizes of lumps and with more nodal involvement as compared to OW. BI-RADS IV (Breast Imaging Reporting and Data System Category IV) was the most commonly observed (27.27% in YAW and 48.97% in OW) mammographic finding in both age groups. Invasive ductal carcinoma was the most common histological type in both age groups (72.73% in YAW and 76.53% in OW). The triple-negative disease was more commonly found in YAW than OW (40.91% in YAW vs 21.43% in OW). We found that usually YAW presented at advanced stages (stages III and IV, 54.55%) and higher grades (grade III, 63.63%). Conclusion Breast cancer in young patients is rare but more aggressive with higher grades, advanced stages, and poor prognostic features. Heredity is mainly the risk factor in young breast cancer patients. There should be proper screening programs for high-risk group for early diagnosis and prompt treatment. Other age-specific concerns such as psychological impact of disease should be addressed as well.

Do presenting symptoms, use of pre-diagnostic endoscopy and risk of emergency cancer diagnosis vary by comorbidity burden and type in patients with colorectal cancer?

BACKGROUND

Cancer patients often have pre-existing comorbidities, which can influence timeliness of cancer diagnosis. We examined symptoms, investigations and emergency presentation (EP) risk among colorectal cancer (CRC) patients by comorbidity status.

METHODS

Using linked cancer registration, primary care and hospital records of 4836 CRC patients (2011-2015), and multivariate quantile and logistic regression, we examined variations in specialist investigations, diagnostic intervals and EP risk.

RESULTS

Among colon cancer patients, 46% had at least one pre-existing hospital-recorded comorbidity, most frequently cardiovascular disease (CVD, 18%). Comorbid versus non-comorbid cancer patients more frequently had records of anaemia (43% vs 38%), less frequently rectal bleeding/change in bowel habit (20% vs 27%), and longer intervals from symptom-to-first relevant test (median 136 vs 74 days). Comorbid patients were less likely investigated with colonoscopy/sigmoidoscopy, independently of symptoms (adjusted OR = 0.7[0.6, 0.9] for Charlson comorbidity score 1-2 and OR = 0.5 [0.4-0.7] for score 3+ versus 0. EP risk increased with comorbidity score 0, 1, 2, 3+: 23%, 35%, 33%, 47%; adjusted OR = 1.8 [1.4, 2.2]; 1.7 [1.3, 2.3]; 3.0 [2.3, 4.0]) and for patients with CVD (adjusted OR = 2.0 [1.5, 2.5]).

CONCLUSIONS

Comorbid individuals with as-yet-undiagnosed CRC often present with general rather than localising symptoms and are less likely promptly investigated with colonoscopy/sigmoidoscopy. Comorbidity is a risk factor for diagnostic delay and has potential, additionally to symptoms, as risk-stratifier for prioritising patients needing prompt assessment to reduce EP.

Novel Psychoactive Substances: The Razor's Edge between Therapeutical Potential and Psychoactive Recreational Misuse

BACKGROUND

Novel psychoactive substances (NPS) are compounds of natural and synthetic origin, similar to traditional drugs of abuse. NPS are involved in a contemporary trend whose origin lies in a thinner balance between legitimate therapeutic drug research and legislative control. The contemporary NPS trend resulted from the replacement of MDMA by synthetic cathinones in 'ecstasy' during the 2000s. The most common NPS are synthetic cannabinoids and synthetic cathinones. Interestingly, during the last 50 years, these two classes of NPS have been the object of scientific research for a set of health conditions.

METHODS

Searches were conducted in the online database PubMed using boolean equations.

RESULTS

Synthetic cannabinoids displayed protective and therapeutic effects for inflammatory, neurodegenerative and oncologic pathologies, activating the immune system and reducing inflammation. Synthetic cathinones act similarly to amphetamine-type stimulants and can be used for depression and chronic fatigue.

CONCLUSIONS

Despite the scientific advances in this field of research, pharmacological application of NPS is being jeopardized by fatalities associated with their recreational use. This review addresses the scientific achievements of these two classes of NPS and the toxicological data, ending with a reflection on Illicit and NPS control frames.