Personalized early detection and prevention of breast cancer: ENVISION consensus statement

Perceptions of breast cancer risk after breast density notification in a population-based screening program

BACKGROUND

Despite increasing evidence to support risk-based breast cancer screening, individuals' understanding of personal risk is not well understood. This study compares women's perceptions of risk to their estimated risk, and examines factors associated with perceived risk, including breast density notification, within a population-based screening program.

METHODS

A survey of 5784 women measured their perceived risk via three questions: a number from 0 to 100 (numeric), a category from very low to very high (verbal), a comparative category relative to an average woman (comparative). Descriptive analyses assessed correlations between perceived risk variables and estimated risk (using the Gail Model), and modelled relationships using K-fold cross-validation. A Graded Response Model was used to obtain an index of unobserved (latent) overall perceived risk from the three questions. Multivariable modelling was used to investigate factors associated with overall perceived risk.

RESULTS

Most participants perceived themselves as being at neither high nor low risk, although perceived risk was higher than estimated risk, on average. All three perceived risk measures were positively correlated with each other and with estimated risk. Overall perceived risk was weakly associated with estimated risk (adjusted R2 = 0.12). Women who received multiple breast density notifications, were younger, or had a family history, perceived their risk as higher relative to respective reference groups. Those who identified as Asian perceived their risk as lower than those who identified as European/Caucasian.

CONCLUSION

Individuals' understanding of breast cancer risk is poor. New strategies are needed to improve education and awareness of personal risk.

Primary care providers' experience and satisfaction with personalised breast cancer screening risk communication: a descriptive cross-sectional study

OBJECTIVE

To describe primary care providers' (PCPs) experience and satisfaction with receiving risk communication documents on their patient's breast cancer (BC) risk assessment and proposed screening action plan.

DESIGN

Descriptive cross-sectional study.

SETTING

A survey was distributed to all 763 PCPs linked to 1642 women participating in the Personalized Risk Assessment for Prevention and Early Detection of Breast Cancer: Integration and Implementation (PERSPECTIVE I&I) research project in Quebec, approximately 1-4 months after the delivery of the risk communication documents. The recruitment phase took place from July 2021 to July 2022.

PARTICIPANTS

PCPs.

MAIN OUTCOME MEASURES

Descriptive analyses were conducted to report participants' experiences and satisfaction with receiving risk communication. Responses to two open-ended questions were subjected to content analysis.

RESULTS

A total of 168 PCPs answered the survey, from which 73% reported being women and 74% having more than 15 years of practice. Only 38% were familiar with the risk-based BC screening approach prior to receiving their patient risk category. A majority (86%) agreed with the screening approach and would recommend it to their patients if implemented at the population level. A majority of PCPs also reported understanding the information provided (92%) and expressed agreement with the proposed BC screening action plan (89%). Some PCPs recommended simplifying the materials, acknowledging the potential increase in workload and emphasising the need for careful planning of professional training efforts.

CONCLUSION

PCPs expressed positive attitudes towards a risk-based BC screening approach and were generally satisfied with the information provided. This study suggests that, if introduced in Canada in a manner similar to the PERSPECTIVE I&I project, risk-based BC screening would likely be supported by most PCPs. However, they emphasised the importance of addressing concerns such as professional training and the potential impact on workload if the approach were to be implemented at the population level. Future qualitative studies are needed to further explore the training needs of PCPs and to develop strategies for integrating this approach with the high workloads faced by PCPs.

Sensitivity of a deep-learning-based breast cancer risk prediction model

Objective.When it comes to the implementation of deep-learning based breast cancer risk (BCR) prediction models in clinical settings, it is important to be aware that these models could be sensitive to various factors, especially those arising from the acquisition process. In this work, we investigated how sensitive the state-of-the-art BCR prediction model is to realistic image alterations that can occur as a result of different positioning during the acquisition process.Approach.5076 mammograms (1269 exams, 650 participants) from the Slovenian and Belgium (University Hospital Leuven) Breast Cancer Screening Programs were collected. The Original MIRAI model was used for 1-5 year BCR estimation. First, BCR was predicted for the original mammograms, which were not changed. Then, a series of different image alteration techniques was performed, such as swapping left and right breasts, removing tissue below the inframammary fold, translations, cropping, rotations, registration and pectoral muscle removal. In addition, a subset of 81 exams, where at least one of the mammograms had to be retaken due to inadequate image quality, served as an approximation of a test-retest experiment. Bland-Altman plots were used to determine prediction bias and 95% limits of agreement (LOA). Additionally, the mean absolute difference in BCR (Mean AD) was calculated. The impact on the overall discrimination performance was evaluated with the AUC.Results.Swapping left and right breasts had no impact on the predicted BCR. The removal of skin tissue below the inframammary fold had minimal impact on the predicted BCR (1-5 year LOA: [-0.02, 0.01]). The model was sensitive to translation, rotation, registration, and cropping, where LOAs of up to ±0.1 were observed. Partial pectoral muscle removal did not have a major impact on predicted BCR, while complete removal of pectoral muscle introduced substantial prediction bias and LOAs (1 year LOA: [-0.07, 0.04], 5 year LOA: [-0.06, 0.03]). The approximation of a real test-retest experiment resulted in LOAs similar to those of simulated image alterations. None of the alterations impacted the overall BCR discrimination performance; the initial 1 year AUC (0.90 [0.88, 0.92]) and 5 year AUC (0.77 [0.75, 0.80]) remained unchanged.Significance.While tested image alterations do not impact overall BCR discrimination performance, substantial changes in predicted 1-5 year BCR can occur on an individual basis.

Systems epigenetic approach towards non-invasive breast cancer detection

No study has systematically compared the suitability of DNA methylation (DNAme) profiles in non-invasive samples for the detection of breast cancer (BC). We assess non-tumour DNAme in 1,100 cervical, buccal, and blood samples from BC cases and controls and find that cervical samples exhibit the largest nuber of differentially methylated sites, followed by buccal samples. No sites were significant in blood after FDR adjustment. Deriving DNAme-based classifiers for BC detection in each sample type (WID-buccal-, cervical-, or blood-BC), we achieve validation AUCs of 0.75, 0.66, and 0.51, respectively. Buccal and cervical BC-associated DNAme alterations distinguish between BC cases and controls in both surrogate and breast tissue (AUC > 0.88), yet individual sites and the directionality of methylation changes are not identical between these two sample types, and buccal sample DNAme aligns with breast methylation changes more closely. Pending additional validation, these insights may have the potential to improve non-invasive personalized BC prevention.

Key factors determination of hyperuricemia and association analysis among patients with breast cancer: results from NHANES data

Objectives

To explore the factors influencing hyperuricemia in breast cancer patients based on the National Health and Nutrition Examination Survey (NHANES) database.

Methods

The univariate and multivariate generalized linear regression were used to screen the influencing factors of hyperuricemia. Logistic and XGBoost algorithms were used to rank the importance of influencing factors. Receiver Operating Characteristic (ROC) curves and Decision Curve Analysis (DCA) curves were used to assess the predictive performance and clinical benefit. Trend analysis, Restricted cubic spline (RCS) analysis, and generalized additive model were used to explore the relationship between key factor and hyperuricemia.

Results

A total of 359 patients with breast cancer were included, of whom 99 patients had hyperuricemia. Among all variables collected, BMI, total calcium, creatinine, hypertension, and gout were found as independent factors of hyperuricemia (all p < 0.05). Among them, Both the 2 algorithms indicated that importance of creatinine on hyperuricemia ranked first. Further, BMI and creatinine levels had higher area under the curve than other variables (BMI: 0.626 [95%CI: 0.574-0.685]; creatinine: 0.722 [95%CI: 0.674-0.777]), but prediction performance difference between them was insignificant (P for Delong test = 0.051). DCA next indicated that creatinine achieved better clinical net benefit than BMI. Further, a detailed positive association between creatinine and hyperuricemia was determined (P for trend<0.001), with a linear relationship (P for non-linear = 0.428).

Conclusion

Creatinine was identified as the most important factor of hyperuricemia in breast cancer patients, as it had independent association with hyperuricemia and favorable prediction performance.

Personalized screening based on risk and density: prevalence data from the RIBBS study

PURPOSE

To present the prevalence screening results of the RIsk-Based Breast Screening (RIBBS) study (ClinicalTrials.gov NCT05675085), a quasi-experimental population-based study evaluating a personalized screening model for women aged 45-49. This model uses digital breast tomosynthesis (DBT) and stratifies participants by risk and breast density, incorporating tailored screening intervals with or without supplemental imaging (ultrasound, US, and breast MRI), with the goal of reducing advanced breast cancer (BC) incidence compared to annual digital mammography (DM).

MATERIALS AND METHODS

An interventional cohort of 10,269 women aged 45 was enrolled (January 2020-December 2021. Participants underwent DBT and completed a BC risk questionnaire. Volumetric breast density and lifetime risk were used to assign five subgroups to tailored screening regimens: low-risk low-density (LR-LD), low-risk high-density (LR-HD), intermediate-risk low-density (IR-LD), intermediate-risk high-density (IR-HD), and high-risk (HR). Screening performance was compared with an observational control cohort of 43,838 women undergoing annual DM.

RESULTS

Compared to LR-LD, intermediate-risk groups showed a 4.9- (IR-LD) and 4.6-fold (IR-HD) higher prevalence of BC, driven by a 7.1- and 7.1-fold higher prevalence of pT1c tumors. The interventional cohort had lower recall rate (rate ratio, 0.5), higher surgery rate (1.9) and increased prevalence of DCIS (2.9), pT1c (2.3) and grade 3 tumors (2.4), compared to controls.

CONCLUSION

The prevalence screening demonstrated the feasibility of using DBT and -in high-density subgroups- supplemental US. The stratification criteria effectively identified subpopulations with different BC prevalence. Increasing the detection rate of pT1c tumors is not sufficient but necessary to achieve a reduction in advanced BC incidence.

Defining next steps in the clinical implementation of polygenic scores: A landscape analysis of professional groups' perspectives

PURPOSE

Professional perspectives on polygenic scores (PGS) have surged in-line with significant research investment. It is unclear whether these perspectives are leading the health care sector toward a comprehensive implementation approach. This scoping review addresses this knowledge gap, analyzing available publications for concurring and discordant perspectives.

METHODS

Methodology followed the Arksey and O'Malley framework. Six databases were systematically searched alongside screening of professional websites. Descriptive and deductive content analyses were completed using the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change compilation.

RESULTS

A total of 28 perspectives were analyzed. Implementation was supportable if evidentiary thresholds for clinical utility could be met, with exceptions being in vitro fertilization and prenatal settings. Evidence base and relative advantage of PGS were the strongest determinants of implementation success, with resourcing also being emphasized. Key strategies included ongoing research, developing education materials, and facilitating relay of information. Attention was not paid to leadership nor to stakeholder interrelationships. There was no recommended framework to facilitate the clinical implementation of PGS.

CONCLUSION

The steps toward executing implementation remain vague. Commonalities in perspectives suggest value in a transferable approach. If PGS are to be successful, policy makers and leaders must consider effective resource allocation by addressing priority barriers and utilizing implementation methodologies. Continuing efforts to establish PGS clinical utility and value, guidelines and policies, and educational materials are needed.

Acceptability of risk-based breast cancer screening among professionals and healthcare providers from 6 countries contributing to the MyPeBS study

BACKGROUND

To evaluate the acceptability of a risk-based breast cancer screening (BCS) strategy among professionals involved in MyPeBS study in 6 countries.

METHODS

After qualitative interviews, a questionnaire was built with a Delphi method: to evaluate professionals' basic understanding, satisfaction and reactions to each stage of the trial, opinions on BCS and its future. The questionnaire was distributed by emailing 698 investigators, who forwarded it to all categories of professionals involved in trial recruitment (physicians, medical secretaries, nurses, and mammography technicians). Descriptive statistics were used to summarize views on acceptability.

RESULTS

Among the 198 respondents, most declared being at ease with the trial design and the concept of breast cancer risk estimation. They were mostly comfortable explaining the different trial steps, communicating risk estimation, and answering women's questions. Some professionals were not comfortable explaining high (7.1%) and low-risk categories (9%) and did not feel sufficiently trained (26.5%). Although professionals were mostly confident about risk-based approaches and the potential of this to improve breast cancer screening (93.5%), 58% called for further validation of the risk-models to predict risk before implementation in population-based programs. They expressed concerns about the complexity of this screening strategy, stressing the need to properly inform the public and to train professionals in delivering risk assessment.

CONCLUSION

This first study assessing the perspectives of professionals delivering risk-based BCS. As professional acceptability is key for successful implementation, training for all professionals and tools to help them communicate risk to women will be necessary to develop risk assessment in BCS.

TRIAL REGISTRATION

Study sponsor: Unicancer. My personalised breast screening (MyPeBS).

CLINICALTRIALS

gov (2018) available at https://www.

CLINICALTRIALS

gov/ct2/show/NCT03672331 .

Cancer burden in Europe: a systematic analysis of the GLOBOCAN database (2022)

BACKGROUND

Cancer remains a significant public health challenge in Europe, with substantial regional disparities in incidence, mortality, and access to healthcare. This study analyses cancer patterns across Eastern, Northern, Southern, and Western Europe in 2022, highlighting key public health implications and gaps in prevention and treatment.

METHODS

Using data from GLOBOCAN 2022, this study assessed total new cancer cases, age-standardized incidence and mortality rates (ASRs) per 100,000, and cumulative cancer risk at age 75. The top three cancers by sex and region were also analysed to identify trends and disparities.

RESULTS

In 2022, Europe recorded 4,471,422 new cancer cases (ASR 280 per 100,000), with a cumulative risk of 27.9% by age 75. Males accounted for 2,359,303 cases (ASR 319.6, cumulative risk 31.9%), while females had 2,112,119 cases (ASR 253.4, cumulative risk 24.7%). Northern and Western Europe had the highest incidence rates, with Denmark leading at 374.7 per 100,000 (cumulative risk 34.9%), likely due to advanced screening and healthcare. Conversely, Eastern Europe had the highest mortality, with 1,091,871 deaths (ASR 135.3), reflecting late diagnoses and limited access of treatment. Hungary exhibited the highest mortality rate (ASR 143.7, cumulative risk 15.8%), followed by Poland (ASR 133.1). Prostate and breast cancers were the most common in males and females, respectively. Lung cancer, despite a lower incidence (ASR 24.7), had the highest mortality (ASR 17.7), while pancreatic cancer showed high fatality (ASR 6.3, mortality ASR 5.6). Thyroid cancer had a relatively high incidence (ASR 7.5) but low mortality (ASR 0.21).

CONCLUSIONS

Significant regional disparities in cancer burden underscore the need for targeted public health strategies. Expanding cancer screening programs, strengthening smoking cessation and HPV vaccination efforts, and improving healthcare accessibility particularly in Eastern Europe are critical to reducing mortality and enhancing early detection. Differences in mortality-to-incidence ratios also highlight the role of healthcare infrastructure and timely interventions. Future research should explore the socioeconomic and environmental determinants driving these disparities to inform evidence-based cancer control policies across Europe.

Barriers and Facilitators to Delivering Multifactorial Risk Assessment and Communication for Personalized Breast Cancer Screening: A Qualitative Study Exploring Implementation in Canada

Many jurisdictions are considering a shift to risk-stratified breast cancer screening; however, evidence on the feasibility of implementing it on a population scale is needed. We conducted a prospective cohort study in the PERSPECTIVE I&I project to produce evidence on risk-stratified breast screening and recruited 3753 participants to undergo multifactorial risk assessment from 2019-2021. This qualitative study explored the perspectives of study personnel on barriers and facilitators to delivering multifactorial risk assessment and risk communication. One focus group and three one-on-one interviews were conducted and a thematic analysis conducted which identified five themes: (1) barriers and facilitators to recruitment for multifactorial risk assessment, (2) barriers and facilitators to completion of the risk factor questionnaire, (3) additional resources required to implement multifactorial risk assessment, (4) the need for a person-centered approach, and (5) and risk literacy. While risk assessment and communication processes were successful overall, key barriers were identified including challenges with collecting comprehensive breast cancer risk factor information and limited resources to execute data collection and risk communication activities on a large scale. Risk assessment and communication processes will need to be optimized for large-scale implementation to ensure they are efficient but robust and person-centered.

Navigating the risks: Stakeholder views on risk-based cervical cancer screening

BACKGROUND

The development of risk-based cancer screening programs requires a paradigm shift in existing practices and healthcare policies. Therefore, it is crucial to not only assess the effectiveness of new technologies and risk prediction models but also to analyze the acceptability of such programs among healthcare stakeholders. This study aims to assess the acceptability of risk-based cervical cancer screening (RB CCS) in Estonia from the perspectives of relevant stakeholders.

METHODS AND MATERIALS

This qualitative study employed semi-structured interviews with healthcare policy and service level stakeholders in Estonia. The Theoretical Framework of Acceptability guided the interview design, and the findings were charted using framework analysis based on the Consolidated Framework for Implementation Research.

RESULTS

17 interviews were conducted with stakeholders, including healthcare professionals, cancer registry representatives, technology specialists, policymakers, and health insurance providers. While stakeholders generally supported the concept and potential benefits of RB CCS, recognizing its capacity to improve screening outcomes and resource allocation, they raised significant concerns about feasibility, complexity, and ethical challenges. Doubts were expressed about the readiness of the healthcare system and population, particularly the current health information system's capacity to support risk-based approaches. The need for evidence-based and internationally validated screening models, comprehensive public communication, provider training, and collaborative discussions involving all relevant parties, including the public, was emphasized.

CONCLUSION

The favorable attitude towards RB CCS among stakeholders provides a strong foundation for advancing its development. However, a comprehensive strategy emphasizing the generation of robust evidence, strengthening healthcare infrastructure, prioritizing patient empowerment, and cultivating a collaborative environment built on trust is crucial.

Genetic discrimination in insurance and employment based on personalized risk stratification for breast cancer screening

Background

The Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) incorporates the effects of common genetic variants, from polygenic risk scores, pathogenic variants in major breast cancer (BC) susceptibility genes, lifestyle/hormonal risk factors, mammographic density, and cancer family history to predict risk levels of developing breast and ovarian cancer. While offering multifactorial risk assessment to the population could be a promising avenue for early detection of BC, obstacles to its implementation including fear of genetic discrimination (GD), could prevent individuals from undergoing screening.

Methods

The aim of our study was two-fold: determine the extent of legal protection in Canada available to protect information generated by risk prediction models such as the BOADICEA algorithm through a literature review, and then, assess individuals' knowledge of and concerns about GD in this context by collecting data through surveys.

Results

Our legal analysis highlighted that while Canadian employment and privacy laws provide a good level of protection against GD, it remains uncertain whether the Genetic Non-Discrimination Act (GNDA) would provide protection for BC risk levels generated by a risk prediction model. The survey results of 3,055 participants who consented to risk assessment in the PERSPECTIVE I&I project showed divergent perspectives of how the law would protect BC risk level in the context of employment and that a high number of participants did not feel that their risk level was protected from access and use by life insurers. Indeed, 49,1% of participants reckon that the level of breast cancer risk could have an impact on a woman's ability to buy insurance and 58,9% of participants reckon that a woman's insurance might be cancelled if important health information (including level of breast cancer risk) is not given when buying or renewing life or health insurance.

Conclusion

The results indicate that much work needs to be done to improve and clarify the extent of protection against GD in Canada and to inform the population of how the legal framework applies to risk levels generated by risk prediction models.

Polymerase Chain Reaction Chips for Biomarker Discovery and Validation in Drug Development

Polymerase chain reaction (PCR) chips are advanced, microfluidic platforms that have revolutionized biomarker discovery and validation because of their high sensitivity, specificity, and throughput levels. These chips miniaturize traditional PCR processes for the speed and precision of nucleic acid biomarker detection relevant to advancing drug development. Biomarkers, which are useful in helping to explain disease mechanisms, patient stratification, and therapeutic monitoring, are hard to identify and validate due to the complexity of biological systems and the limitations of traditional techniques. The challenges to which PCR chips respond include high-throughput capabilities coupled with real-time quantitative analysis, enabling researchers to identify novel biomarkers with greater accuracy and reproducibility. More recent design improvements of PCR chips have further expanded their functionality to also include digital and multiplex PCR technologies. Digital PCR chips are ideal for quantifying rare biomarkers, which is essential in oncology and infectious disease research. In contrast, multiplex PCR chips enable simultaneous analysis of multiple targets, therefore simplifying biomarker validation. Furthermore, single-cell PCR chips have made it possible to detect biomarkers at unprecedented resolution, hence revealing heterogeneity within cell populations. PCR chips are transforming drug development, enabling target identification, patient stratification, and therapeutic efficacy assessment. They play a major role in the development of companion diagnostics and, therefore, pave the way for personalized medicine, ensuring that the right patient receives the right treatment. While this tremendously promising technology has exhibited many challenges regarding its scalability, integration with other omics technologies, and conformity with regulatory requirements, many still prevail. Future breakthroughs in chip manufacturing, the integration of artificial intelligence, and multi-omics applications will further expand PCR chip capabilities. PCR chips will not only be important for the acceleration of drug discovery and development but also in raising the bar in improving patient outcomes and, hence, global health care as these technologies continue to mature.

Feasibility and acceptability of a personalised primary prevention strategy for women and men at high risk of breast and prostate cancer: the 3PC study protocol for a pilot randomised controlled trial

INTRODUCTION

Several primary prevention strategies, including chemoprevention, prophylactic surgery and lifestyle modifications, have been shown to reduce the risk of breast cancer (BC) and prostate cancer (Pca). However, the uptake of these preventive measures is considered suboptimal, limiting their impact on cancer prevention. A personalised primary prevention strategy has yet to be tested for cancer prevention. Therefore, we aim to determine the feasibility, acceptability and potential benefits and harms of this strategy in women and men at high risk of BC and Pca.

METHODS AND ANALYSIS

This is a two-arm, parallel-group mixed-methods pilot randomised controlled trial with a 1:1 allocation. The study aims to recruit 60 women and 60 men at high risk of BC and PCa in two specialised sites: the Breast Diseases Center and the Department of Urologic Oncology of the CHU de Québec-Université Laval, Canada. Assessments include intentions to uptake, actual uptake rates of primary preventive measures and decision regret. Feasibility and acceptability of the intervention and the study will be measured by quantifying the recruitment rate, appropriateness of randomisation process and satisfaction metrics. Data will be collected using mixed methods. Quantitative measures will be assessed at baseline and 6 months post randomisation. Quantitative analysis will include descriptive statistics for all variables of interest. Generalised linear mixed models with random intercepts will be used to assess the overall intervention effect. Semistructured interviews will be conducted at the end of follow-up, and a thematic analysis will be performed using NVivo to understand participants' perspectives.

ETHICS AND DISSEMINATION

The protocol was approved by the Institutional Review Board of CHU de Québec-Université Laval (4 October 2022; 2023-6315). The findings of the study will be published in a peer-reviewed journal and disseminated at national and international conferences and through social media.

TRIAL REGISTRATION NUMBER

The protocol for this study was registered with the International Clinical Trials Registry (ISRCTN15749766) https://doi.org/10.1186/ISRCTN15749766).

An integrative analysis of ASCL1 in breast cancer and inhibition of ASCL1 increases paclitaxel sensitivity by activating ferroptosis via the CREB1/GPX4 axis

Objective

Our previous study found that Achaete-scute complex homolog 1 (ASCL1) is involved in classifying BC subtypes with different prognostic and pathological characteristics. However, the biological role of ASCL1 in BC still remains largely unexplored. This study aims to elucidate the function of ASCL1 in BC using bioinformatics analyses, as well as in vitro and in vivo experimental approaches.

Methods

Data from the TCGA, GEO, and Human Protein Atlas databases were utilized to evaluate ASCL1 expression in BC and its association with patient prognosis. Genetic alterations in ASCL1 were assessed through the COSMIC and cBioPortal databases, while the TIMER2.0 database provided insights into the relationship between ASCL1 expression and key gene mutations in BC. The GDSC database was used to examine correlations between ASCL1 levels and sensitivity to standard chemotherapeutic agents. Associations between ASCL1 expression and cytokines, immunomodulatory factors, MHC molecules, and receptors were analyzed using Pearson and Spearman correlation methods. The TIP database was employed to investigate the connection between ASCL1 expression and immunoreactivity scores, and six computational approaches were applied to evaluate immune cell infiltration. Functional assays were conducted on BC cell lines MCF-7 and MDA-MB-231, and nude mouse models were used for in vivo studies.

Results

ASCL1 was found to be upregulated in BC and correlated with unfavorable prognosis and mutations in key oncogenes. Its expression was linked to immunomodulatory factors, immune cell infiltration, and immunoreactivity scores in the tumor microenvironment. Additionally, ASCL1 influenced tumor immune dynamics and chemosensitivity in BC. Overexpression of ASCL1 enhanced BC cell proliferation, migration and invasion, while its knockdown had the opposite effect. Notably, inhibition of ASCL1 increased BC cell sensitivity to paclitaxel both in vitro and in vivo. In addition, inhibition of ASCL1 activated ferroptosis in BC, including altered mitochondrial morphology, increased MDA and ROS levels, decreased GSH levels and reduced GSH/GSSG ratio. Mechanistically, inhibition of ASCL1 decreases the phosphorylation of CREB1, thus reducing the expression of GPX4. In summary, inhibition of ASCL1 increases paclitaxel sensitivity by activating ferroptosis via the CREB1/GPX4 axis.

Conclusions

ASCL1 exerts oncogenic effects in BC and represents a potential therapeutic target for intervention.

Performance of Digital Breast Tomosynthesis Versus Digital Mammography in Women With a Family History of Breast Cancer: A Systematic Review

BACKGROUND

There is limited evidence on the performance of digital breast tomosynthesis (DBT) in populations at increased risk of breast cancer. Our objective was to systematically review evidence on the performance of DBT versus digital mammography (DM) in women with a family history of breast cancer (FHBC).

METHODS

We searched 5 databases (2011-January 2024) for studies comparing DBT and DM in women with a FHBC that reported any measure of cancer detection, recall, sensitivity and specificity. Findings were presented using a descriptive and narrative approach. Risk of bias was assessed using QUADAS-2/C.

RESULTS

Five (4 screening, 1 diagnostic) studies were included (total 3089 DBT, 3024 DM) with most (4/5) being prospective including 1 RCT. All studies were assessed as being at high risk of bias or applicability concern. Four screening studies reported recall rate (range: DBT: 2.7%-4.5%, DM: 2.8%-11.5%) with 3 reporting DBT had lower rates than DM. Cancer detection rates (CDR) were reported in the same studies (DBT: 5.1-11.6 per 1000, DM: 3.8-8.3); 3 reported higher CDR for DBT (vs. DM), and 1 reported same CDR for both. Compared with DM, higher values for sensitivity, specificity and PPV for DBT were reported in 2 studies.

CONCLUSION

This review provides early evidence that DBT may outperform DM for screening women with a FHBC. Our findings support further evaluation of DBT in this population. However, summarized findings were based on few studies and participants, and high-quality studies with improved methodology are needed to address biases identified in our review.

The Interplay Between Obesity and Aging in Breast Cancer and Regulatory Function of MicroRNAs in This Pathway

Breast cancer (BC) is a significant contributor to cancer-related deaths in women, and it has complex connections with obesity and aging. This review explores the interaction between obesity and aging in relation to the development and progression of BC, focusing on the controlling role of microRNAs (miRNAs). Obesity, characterized by excess adipose tissue, contributes to a proinflammatory environment and metabolic dysregulation, which are important in tumor development. Aging, associated with cellular senescence and systemic changes, further exacerbates these conditions. miRNAs, small noncoding RNAs that regulate gene expression, play key roles in these processes, impacting pathways involved in cell proliferation, apoptosis, and cancer metastasis, either as tumor suppressors or oncogenes. Importantly, specific miRNAs are implicated in mediating the impact of obesity and aging on BC. Exploring the regulatory networks controlled by miRNAs provides valuable information on new targets for therapy and predictive markers, demonstrating the potential for using miRNA-based interventions to treat BC in obese and elderly individuals. This review emphasizes the importance of integrated research strategies to understand the complex connections between obesity, aging, and miRNA regulation in BC.

Antibody-drug conjugates targeting SSEA-4 inhibits growth and migration of SSEA-4 positive breast cancer cells

Although breast cancer treatment has evolved significantly in recent years, drug resistance remains a major challenge. To identify new targets for breast cancer, we found that stage-specific embryonic antigen 4 (SSEA-4) is expressed in all subtypes of breast cancer cell lines, and the increased expression of the associated enzymes β3GalT5 and ST3Gal2 correlates with poor recurrence-free survival (RFS) in breast cancer. We also found that SSEA-4 antibodies can be rapidly internalized into breast cancer cells, a property that makes SSEA-4 an attractive target for antibody-drug conjugates (ADCs). Furthermore, the SSEA-4 antibody conjugated to the anticancer agents showed efficacy against SSEA-4-positive breast cancer cells, including those resistant to PARP inhibitor, trastuzumab, and CDK7 inhibitor. In addition, SSEA-4 ADCs showed no efficacy in β3GalT5-knockout MDA-MB-231 cells, highlighting the essential role of SSEA-4 as the target antigen for ADCs activity. Our work shows that SSEA-4-ADCs could be a therapeutic option for breast cancers.

Molecular Engineering of Xanthene Dyes with 3D Multimodal-Imaging Ability to Guide Photothermal Therapy

Phototheranostics integrates light-based diagnostic techniques with therapeutic interventions, offering a non-invasive, precise, and swift approach for both disease detection and treatment. The efficacy of this approach hinges on the multimodal imaging potential and photothermal conversion efficiency (PCE) of phototheranostic agents (PTAs). Despite the promise, crafting multifunctional phototheranostic organic small molecules brims with challenges. In this research, four innovative xanthene-derived PTAs are synthesized by fine-tuning the donor-π-acceptor (D-π-A) system to strike a balance between radiative and nonradiative decay. The inherent robust photostability and intense fluorescence of the traditional xanthene core are preserved, meanwhile the addition of highly electron-withdrawing groups boosts the non-radiative decay rate to enhance PCE and photoacoustic imaging capabilities. Remarkably, one of the PTAs, DMBA, demonstrates an exceptional absolute fluorescence quantum yield of 2.46% in PBS, and when encapsulated into nanoparticles, it achieves a high PCE of 79.5%. Consequently, DMBA nanoparticles (DMBA-NPs) are effectively employed in fluorescence, 3D photoacoustic, and photothermal imaging-guiding tumor photothermal therapy. This represents the first instance of a multimodal phototheranostic xanthene agent achieving synergistic fluorescence and photoacoustic imaging for diagnostic purposes. Furthermore, this work paves the way for leveraging xanthene fluorophores as versatile tools in the development of multifunctional reagents.

Using a behaviour-change approach to support uptake of population genomic screening and management options for breast or prostate cancer

As the possibility of implementing population genomic screening programs for the risk of developing hereditary cancers in health systems increases, understanding how to support individuals who wish to have genomic screening is essential. This qualitative study aimed to link public perceived barriers to a) taking up the offer of population genomic screening for breast or prostate cancer risk and b) taking up risk-management options following their result, with possible theory-informed behaviour-change approaches that may support implementation. Ten focus groups were conducted with a total of 25 members of the Australian public to identify and then categorise barriers within the behaviour-change Capability, Opportunity, Motivation - Behaviour (COM-B) model. Ten COM-B categorised barriers were identified as perceived influences on an individual's intentions to take-up the offer, including Capability (e.g., low public awareness), Opportunity (e.g., inconvenient sample collection procedure) and Motivation (e.g., genomic screening not perceived as relevant to an individual). Ten barriers for taking up risk-management options included Motivation (e.g., concerns about adverse health impact) and Opportunity (e.g., social opportunity and cost incurred to the individual). Our findings demonstrate that a nuanced approach is required to support people to take-up the offer of population genomic screening and, where appropriate, to adopt risk-management options. Even amongst participants who were enthusiastic about a population genomic screening program, needs were varied, demanding a range of implementation strategies. Promulgating equitable uptake of genomic screening and management options for breast and prostate cancer risk will require a needs-based approach.

Diagnostic role of the neutrophil‑to‑lymphocyte ratio and the platelet‑to‑lymphocyte ratio in breast cancer: A systematic review and meta‑analysis

Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) may be indicative of breast cancer (BC); however, this remains inconclusive. With the aim to assess the current literature to evaluate the diagnostic roles of NLR PLR and LMR in BC, a systematic literature search was performed using the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, VIP database and China Biology Medicine disc databases up to August 29, 2023. The standardized mean deviation and 95% confidence intervals (CI) for each outcome was reported, and heterogeneity and publication bias were assessed. Overall, 39 studies were included in the present study. Pooled analysis with the random-effects model demonstrated that patients with BC had significantly higher NLR and PLR, and a lower LMR, compared with non-BC subjects. The pooled sensitivities of the NLR and PLR were 0.68 (95% CI, 0.59-0.75) and 0.55 (95% CI, 0.36-0.72), respectively, and the pooled specificities of the NLR and PLR were 0.75 (95% CI, 0.68-0.81) and 0.80 (95% CI, 0.51-0.94), respectively. However, the limited number of studies included hindered the evaluation of the diagnostic role of LMR. In summary, a higher NLR and PLR and lower LMR were associated with the presence of BC. NLR and PLR may be potential blood-based biomarkers for the differentiation of BC. Despite these findings, further studies are needed to validate their clinical applicability and practicality. International Prospective Register of Systematic Reviews registration no. CRD42024522226.

Polygenic score distribution differences across European ancestry populations: implications for breast cancer risk prediction

BACKGROUND

The 313-variant polygenic risk score (PRS313) provides a promising tool for clinical breast cancer risk prediction. However, evaluation of the PRS313 across different European populations which could influence risk estimation has not been performed.

METHODS

We explored the distribution of PRS313 across European populations using genotype data from 94,072 females without breast cancer diagnosis, of European-ancestry from 21 countries participating in the Breast Cancer Association Consortium (BCAC) and 223,316 females without breast cancer diagnosis from the UK Biobank. The mean PRS was calculated by country in the BCAC dataset and by country of birth in the UK Biobank. We explored different approaches to reduce the observed heterogeneity in the mean PRS across the countries, and investigated the implications of the distribution variability in risk prediction.

RESULTS

The mean PRS313 differed markedly across European countries, being highest in individuals from Greece and Italy and lowest in individuals from Ireland. Using the overall European PRS313 distribution to define risk categories, leads to overestimation and underestimation of risk in some individuals from these countries. Adjustment for principal components explained most of the observed heterogeneity in the mean PRS. The mean estimates derived when using an empirical Bayes approach were similar to the predicted means after principal component adjustment.

CONCLUSIONS

Our results demonstrate that PRS distribution differs even within European ancestry populations leading to underestimation or overestimation of risk in specific European countries, which could potentially influence clinical management of some individuals if is not appropriately accounted for. Population-specific PRS distributions may be used in breast cancer risk estimation to ensure predicted risks are correctly calibrated across risk categories.

Development and Validation of Dynamic 5-Year Breast Cancer Risk Model Using Repeated Mammograms

PURPOSE

Current image-based long-term risk prediction models do not fully use previous screening mammogram images. Dynamic prediction models have not been investigated for use in routine care.

METHODS

We analyzed a prospective WashU clinic-based cohort of 10,099 cancer-free women at entry (between November 3, 2008 and February 2012). Follow-up through 2020 identified 478 pathology-confirmed breast cancers (BCs). The cohort included 27% Black women. An external validation cohort (Emory) included 18,360 women screened from 2013, followed through 2020. This included 42% Black women and 332 pathology-confirmed BC excluding those diagnosed within 6 months of screening. We trained a dynamic model using repeated screening mammograms at WashU to predict 5-year risk. This opportunistic screening service presented a range of mammogram images for each woman. We applied the model to the external validation data to evaluate discrimination performance (AUC) and calibrated to US SEER.

RESULTS

Using 3 years of previous mammogram images available at the current screening visit, we obtained a 5-year AUC of 0.80 (95% CI, 0.78 to 0.83) in the external validation. This represents a significant improvement over the current visit mammogram AUC 0.74 (95% CI, 0.71 to 0.77; P < .01) in the same women. When calibrated, a risk ratio of 21.1 was observed comparing high (>4%) to very low (<0.3%) 5-year risk. The dynamic model classified 16% of the cohort as high risk among whom 61% of all BCs were diagnosed. The dynamic model performed comparably in Black and White women.

CONCLUSION

Adding previous screening mammogram images improves 5-year BC risk prediction beyond static models. It can identify women at high risk who might benefit from supplemental screening or risk-reduction strategies.

Adherence to melanoma screening and surveillance skin check schedules tailored to personal risk

Population-wide skin cancer screening is not currently recommended in most countries. Instead, most clinical guidelines incorporate risk-based recommendations for skin checks, despite limited evidence around implementation and adherence to recommendations in practice. We aimed to determine adherence to personal risk-tailored melanoma skin check schedules and explore reasons influencing adherence. Patients (with/without a previous melanoma) attending tertiary dermatology clinics at the Melanoma Institute Australia, Sydney, Australia, were invited to complete a melanoma risk assessment questionnaire via iPad and provided with personal risk information alongside a risk-tailored skin check schedule. Data were collected from the risk tool, clinician-recorded data on schedule deviations, and appointment booking system. Post-consultation, we conducted semi-structured interviews with patients and clinic staff. We used a convergent segregated mixed methods approach for analysis. Interviews were audio recorded, transcribed and data were analysed thematically. Participant data were analysed from clinic records (n = 247) and interviews (n = 29 patients, 11 staff). Overall, there was 62% adherence to risk-tailored skin check schedules. In cases of non-adherence, skin checks tended to occur more frequently than recommended. Decisions to deviate were similarly influenced by patients (44%) and clinicians (56%). Themes driving non-adherence among patients included anxiety and wanting autonomy around decision-making, and among clinicians included concerns around specific lesions and risk estimate accuracy. There was moderate adherence to a clinical service program of personal risk-tailored skin check recommendations. Further adherence may be gained by incorporating strategies to identify and assist patients with high levels of anxiety and supporting clinicians to communicate risk-based recommendations with patients.

Attitudes towards risk-stratified breast cancer screening in Denmark - a qualitative study

BACKGROUND

Today the prerequisites exist to initiate risk-stratified screening according to a woman's individual risk of breast cancer as opposed to existing one-size-fits-all age-based programmes. This presupposes that the women accept having their personal risk score estimated and their screening intervals changed accordingly. Risk-stratified screening has not yet been implemented in any country, but in the future many European countries will very likely move towards more personalized screening.

METHODS

This qualitative study among 46 women aged 50-69 years used an anthropological approach and interpretive description. Data was collected using semi-structured focus group interviews and telephone interviews. The interviews were analysed using systematic text condensation.

OBJECTIVE

The aim of this study was to explore Danish women's understanding of breast cancer risk and their attitudes towards the concept of risk-stratified breast cancer screening.

RESULTS

The women highly valued the current screening program, seeing regular mammograms as crucial for early detection. The women had good knowledge of the causes of breast cancer, but they had not given much thought to their own risk. They found a personalized screening approach more reliable than age-based screening, understanding that low risk is not the same as no risk just as high risk is not equal to ever developing breast cancer. Despite concerns about increased anxiety arising from knowing one's risk, they appreciated the possibility of more frequent screenings for high-risk individuals.

CONCLUSION

In general, the women showed acceptance of a new breast cancer screening concept estimating their personal risk score. Due to concerns about interval cancers and the prolonged screening intervals for women at low risk, offering more intensified screening for high-risk women may be less challenging than deescalating screening for low-risk women. Whether the expressed positive attitude and curious interest will translate into actual participation if implemented, remains to be investigated further in an ongoing Danish trial.

Natural Phycocyanin/Paclitaxel Micelle Delivery of Therapeutic P53 to Activate Apoptosis for HER2 or ER Positive Breast Cancer Therapy

The P53 gene is commonly mutated in breast cancer, protein based the gene as anticancer drugs could provide efficient and stable advantages by restoring the function of the wild-type P53 protein. In this study, we describe the creation and utilization of a micelle composed by natural phycocyanin and paclitaxel and grafting anti-HER2 (PPH), which effectively packages and transports recombinant P53 protein with anti-ER (PE), resulting in a new entity designated as PE@PPH, to address localization obstacles and modify cellular tropism to the cell membrane or nucleus. The results indicate that PE@PPH has strong antitumor properties, even at low doses of PTX both in vitro and in vivo. These findings suggest that PE@PPH could be an enhancing micelle for delivering therapeutic proteins and promoting protein functional recovery, particularly in addressing the challenges posed by tumor heterogeneity in breast cancer.

Skimmed milk intake reduces the risk of ER- breast cancer: a Mendelian randomization analysis

BACKGROUND

In prior observational investigations, it has been demonstrated that the consumption of milk is associated with the incidence of breast cancer (BC). Despite the existence of a two-sample Mendelian randomization (MR) that suggests a causal relationship between milk intake and breast cancer risk, the outcomes still lack a definitive conclusion. This ambiguity may be attributed to variables such as the variety of milk ingested, estrogen levels, the specific type of BC, and potential confounding factors. Therefore, our principal objective is to establish the causal association between the consumption of skimmed milk and full cream milk and the risk of different types of BC through the utilization of two-sample and two-step MR analyses.

METHODS

In this study, we analyzed single nucleotide polymorphisms associated with skimmed and full-cream milk consumption in a cohort of 360,806 individuals from European populations through genome-wide association studies. We conducted a two-sample MR analysis using three different methods: inverse variance weighting (IVW) was used as the main analysis, and MR-Egger and Weighted median were used as supplementary analyses to IVW. We also performed sensitivity analysis, which included leave-one-out analysis, Cochran's Q test to detect heterogeneity, and MR-Egger intercept analysis to detect potential biases caused by pleiotropy. We used two-step MR analysis to evaluate potential mediators of associations.

RESULTS

In the two-sample MR analysis, IVW analysis suggests a potential inverse causal relationship between skimmed milk and BC [OR 0.34, 95% CI (0.12-1.00), P = 0.05]. Subgroup analysis revealed that skimmed milk reduces the risk of estrogen receptor-negative (ER-) breast cancer [OR 0.18, 95% CI (0.04-0.90), P = 0.04], but not estrogen receptor-positive (ER+) breast cancer [OR 0.42, 95% CI (0.15-1.22), P = 0.11]. MR Egger reached similar results, that is, skimmed milk reduces the risk of ER- breast cancer [OR 0.006, 95% CI (0.00-0.70), P = 0.04], but not BC [OR 0.16, 95% CI (0.01-4.66), P = 0.30] and ER+ breast cancer [OR 0.50, 95% CI (0.02-12.61), P = 0.65]. Additionally, we found no causal relationship between full cream milk and BC (P > 0.05). In two-step MR analysis, we found evidence for a mediating role of BMI in the relationship between skimmed milk intake and ER-breast cancer risk.

CONCLUSION

Our findings strengthen the evidence for a protective effect of skimmed milk consumption on ER-breast cancer risk. Further two-step MR analyses suggest that this protective effect may partly result from body mass index (BMI). There is no evidence that full cream milk consumption affects the risk of BC.

Light-activated hypoxia-sensitive biomimetic decoy efficiently cascading photodynamic-chemo therapy for breast cancer

The hypoxic microenvironment within the tumor microenvironment of breast cancer imposes a challenge in overcoming chemotherapy resistance. In this investigation, we designed a novel strategy utilizing a light-controlled cascade targeting nanomedicine specifically tailored for enhanced immune therapy of breast cancer. Albumin nanoparticle was achieved by crosslinking, followed by loading TPZ and Ce6, and subsequent modification to enable selective binding with CD44 hyaluronic acid to form nanomedicine. Encouragingly, it was demonstrated the remarkable ability of the nanomedicine to effectively internalize into cellular entities, thereby inducing apoptosis in 4T1 cells efficiently in vitro when exposed to light irradiation. In vivo assessments showcased the exceptional aptitude of the nanomedicine not only for preferential accumulation within tumor tissues, but also for substantial suppression of tumor growth. Immune mechanisms have shown that nanomedicine treatment promoted the maturation of DCs in vivo, enhanced the proportion of CD8+ T cells in the spleen and tumor, and simultaneously upregulated the ratio of M1 macrophages favorable for anti-tumor effects. These outcomes collectively advance a fresh perspective for the clinical breast cancer therapy.

[Cancer prevention recommendations: Update 2024]

Cancer is one of the main causes of morbidity and mortality. Environmental factors along with lifestyle: tobacco and alcohol consumption, unhealthy diet and sedentary lifestyle and lack of physical activity, are some of the risk factors that have caused an increase in cancer. This article updates the evidence and recommendations for cancer prevention strategies through screening in asymptomatic patients, as well as early detection of signs and symptoms in medium-risk and high-risk populations.

Precision medicine in breast cancer (Review)

Precision medicine in breast cancer is a revolutionary approach that customizes diagnosis and treatment based on individual and tumor characteristics, departing from the traditional one-size-fits-all approach. Breast cancer is diverse, with various subtypes driven by distinct genetic mutations. Understanding this diversity is crucial for tailored treatment strategies that target specific vulnerabilities in each tumor. Genetic testing, particularly for mutations in breast cancer gene (BRCA) DNA repair-associated genes, helps assess hereditary risks and influences treatment decisions. Molecular subtyping guides personalized treatments, such as hormonal therapies for receptor-positive tumors and human epidermal growth factor receptor 2 (HER2)-targeted treatments. Targeted therapies, including those for HER2-positive and hormone receptor-positive breast cancers, offer more effective and precise interventions. Immunotherapy, especially checkpoint inhibitors, shows promise, particularly in certain subtypes such as triple-negative breast cancer, with ongoing research aiming to broaden its effectiveness. Integration of big data and artificial intelligence enhances personalized treatment strategies, while liquid biopsies provide real-time insights into tumor dynamics, aiding in treatment monitoring and modification. Challenges persist, including accessibility and tumor complexity, but emerging technologies and precision prevention offer hope for improved outcomes. Ultimately, precision medicine aims to optimize treatment efficacy, minimize adverse effects and enhance the quality of life for patients with breast cancer.

Discovery of novel CDK4/6 inhibitors from fungal secondary metabolites

The development of targeted therapies for breast cancer, particularly those focusing on cyclin-dependent kinases 4/6 (CDK4/6), has significantly improved patient outcomes. However, the currently approved CDK4/6 inhibitors are associated with various side effects, underscoring the need for novel compounds with enhanced efficacy and safety profiles. This study aimed to identify potential CDK4/6 inhibitors from MeFSAT, a database of fungal secondary metabolites using an in-silico screening approach. The virtual screening process incorporated drug-likeness filters, ADME and toxicity predictions, consensus molecular docking, and 200 ns molecular dynamics simulations. Out of 411 initial compounds, two molecules demonstrated favorable binding interactions and stability with the CDK4/6 protein complex. The MTT assay showed that MSID000025 had dose-dependent cytotoxicity against MCF7 breast cancer cells. This suggests that MSID000025 could be a good candidate CDK4/6 inhibitor for treating breast cancer. Our study highlights the potential of fungal secondary metabolites as a source of novel compounds for drug discovery. It provides a framework for identifying CDK4/6 inhibitors with improved therapeutic properties.

Validation of the Mirai model for predicting breast cancer risk in Mexican women

OBJECTIVES

To validate the performance of Mirai, a mammography-based deep learning model, in predicting breast cancer risk over a 1-5-year period in Mexican women.

METHODS

This retrospective single-center study included mammograms in Mexican women who underwent screening mammography between January 2014 and December 2016. For women with consecutive mammograms during the study period, only the initial mammogram was included. Pathology and imaging follow-up served as the reference standard. Model performance in the entire dataset was evaluated, including the concordance index (C-Index) and area under the receiver operating characteristic curve (AUC). Mirai's performance in terms of AUC was also evaluated between mammography systems (Hologic versus IMS). Clinical utility was evaluated by determining a cutoff point for Mirai's continuous risk index based on identifying the top 10% of patients in the high-risk category.

RESULTS

Of 3110 patients (median age 52.6 years ± 8.9), throughout the 5-year follow-up period, 3034 patients remained cancer-free, while 76 patients developed breast cancer. Mirai achieved a C-index of 0.63 (95% CI: 0.6-0.7) for the entire dataset. Mirai achieved a higher mean C-index in the Hologic subgroup (0.63 [95% CI: 0.5-0.7]) versus the IMS subgroup (0.55 [95% CI: 0.4-0.7]). With a Mirai index score > 0.029 (10% threshold) to identify high-risk individuals, the study revealed that individuals in the high-risk group had nearly three times the risk of developing breast cancer compared to those in the low-risk group.

CONCLUSIONS

Mirai has a moderate performance in predicting future breast cancer among Mexican women.

CRITICAL RELEVANCE STATEMENT

Prospective efforts should refine and apply the Mirai model, especially to minority populations and women aged between 30 and 40 years who are currently not targeted for routine screening.

KEY POINTS

The applicability of AI models to non-White, minority populations remains understudied. The Mirai model is linked to future cancer events in Mexican women. Further research is needed to enhance model performance and establish usage guidelines.

Understanding genetic variations associated with familial breast cancer

BACKGROUND

Breast cancer is the most frequent cancer among women. Genetics are the main risk factor for breast cancer. Statistics show that 15-25% of breast cancers are inherited among those with cancer-prone relatives. BRCA1, BRCA2, TP53, CDH1, PTEN, and STK11 are the most frequent genes for familial breast cancer, which occurs 80% of the time. In rare situations, moderate-penetrance gene mutations such CHEK2, BRIP1, ATM, and PALB2 contribute 2-3%.

METHODS

A search of the PubMed database was carried out spanning from 2005 to July 2024, yielding a total of 768 articles that delve into the realm of familial breast cancer, concerning genes and genetic syndromes. After exclusion 150 articles were included in the final review.

RESULTS

We report on a set of 20 familial breast cancer -associated genes into high, moderate, and low penetrance levels. Additionally, 10 genetic disorders were found to be linked with familial breast cancer.

CONCLUSION

Familial breast cancer has been linked to several genetic diseases and mutations, according to studies. Screening for genetic disorders is recommended by National Comprehensive Cancer Network recommendations. Evaluation of breast cancer candidate variations and risk loci may improve individual risk assessment. Only high- and moderate-risk gene variations have clinical guidelines, whereas low-risk gene variants require additional investigation. With increasing use of NGS technology, more linkage with rare genes is being discovered.

Cancer risk assessment of premalignant breast tissues from patients with BRCA mutations by genome profiling

Patients with germline pathogenic variants of BRCA1/2 genes have a particular predisposition to develop breast cancer. No clinical test has been developed to accurately and quantitatively evaluate their risk of developing breast cancer. We hypothesized that aberrant cell clonal expansion may be initiated in normal breast tissues without manifesting pathologic changes. To assess the prevalence of clonal expansion in the normal breast, we collected normal breast tissue from 24 breast cancer patients who had undergone surgical resection and 5 carriers of pathogenic BRCA1/2 variant who had undergone prophylactic mastectomy. Whole-exome sequencing (WES) was conducted in 97 specimens from 14 individuals, and TOP panel, a gene panel targeting 464 genes, was conducted in 321 specimens from 26 individuals, including 8 individuals with germline pathogenic variants of BRCA1/2 genes. Recurrent oncogenic mutations within PIK3CA, ARHGAP35, HRAS, and NF1 were identified in normal breast tissue at considerable variant allelic frequencies (VAF), suggesting clonal expansion. In addition, 937 normal breast tissues were evaluated using the Breast Cancer Panel (BCP) targeting 25 genes to determine the exact prevalence and distribution of clonal expansion. To assess the clonal expansion, we developed the clonality score, which is the mean value of clonal cell fractions for samples obtained from a given breast. The average clonality score in macroscopically normal breast tissue was 0.95 (0-2.46), with a significant difference between cases with and without a history of breast cancer of stage 2 or more advanced stage (p = 0.01). Additional WES on 42 samples with relatively large clone size (VAF > 3%) confirmed that these cell clones harbored multiple mutations (10.7 mutations/sample), and the number of existing mutations was consistent with the clone size (R = 0.50). The results suggest that clonal changes occur in normal breast tissue of women at high risk for breast cancer even before cancer is detected pathologically and/or radiologically, and the clonality score shows the potential to be a valid method of evaluating clonal expansion for cancer-risk assessment that provides appropriate preventive options for patients at high risk for breast cancer.

Breast Lesions in Qassim Region, Saudi Arabia: A Retrospective Study

INTRODUCTION

A breast lesion is an unusual development in the breast tissue that typically appears as a lump or swelling. It encompasses a wide range of disorders, from benign to malignant, posing significant health challenges globally.

METHODS

The study was a retrospective study conducted at King Fahad Specialist Hospital (KFSH), Buraidah, Qassim region in Saudi Arabia between March 10, 2017, and April 2, 2024. Data was cleaned, coded, and analyzed using SPSS version 27.

RESULTS

The results revealed that most (639 (79.7%)) patients had symptomatic clinical presentations, with breast lump (470 (73.5%)) being the main presenting symptom. The majority (565 (70.4%)) of the patients presented malignant conditions, while 237 (29.6%) presented benign conditions. Of the patients who presented benign conditions, more than half (131 (55.3%)) were fibroadenoma benign lesions. Stage IIB cancer was the most common, constituting 192 (33.9%) of the patients. No complications were reported in the majority (480 (85.0%)).

CONCLUSION

The study revealed a considerably high prevalence of malignant conditions among patients. Fibroadenoma was the most common breast lesion type, followed by intra-ductal papilloma and benign phyllodes. Age and BMI were found to be the risk factors that predicted the development of breast cancers. Knowledge and awareness of the prevalence, risk factors, and treatment of breast illnesses, as well as early screening and diagnosis, promote better patient outcomes and healthcare delivery.

Challenges and recommendations for the translation of biomarkers of aging

Biomarkers of aging (BOA) are quantitative parameters that predict biological age and ideally its changes in response to interventions. In recent years, many promising molecular and omic BOA have emerged with an enormous potential for translational geroscience and improving healthspan. However, clinical translation remains limited, in part due to the gap between preclinical research and the application of BOA in clinical research and other translational settings. We surveyed experts in these areas to better understand current challenges for the translation of aging biomarkers. We identified six key barriers to clinical translation and developed guidance for the field to overcome them. Core recommendations include linking BOA to clinically actionable insights, improving affordability and availability to broad populations and validation of biomarkers that are robust and responsive at the level of individuals. Our work provides key insights and practical recommendations to overcome barriers impeding clinical translation of BOA.

Evaluating Real World Health System Resource Utilization and Costs for a Risk-Based Breast Cancer Screening Approach in the Canadian PERSPECTIVE Integration and Implementation Project

BACKGROUND

A prospective cohort study was undertaken within the PERSPECTIVE I&I project to evaluate healthcare resource utilization and costs associated with breast cancer risk assessment and screening and overall costs stratified by risk level, in Ontario, Canada.

METHODS

From July 2019 to December 2022, 1997 females aged 50 to 70 years consented to risk assessment and received their breast cancer risk level and personalized screening action plan in Ontario. The mean costs for risk-stratified screening-related activities included risk assessment, screening and diagnostic costs. The GETCOST macro from the Institute of Clinical Evaluative Sciences (ICES) assessed the mean overall healthcare system costs.

RESULTS

For the 1997 participants, 83.3%, 14.4% and 2.3% were estimated to be average, higher than average, and high risk, respectively (median age (IQR): 60 [56-64] years). Stratification into the three risk levels was determined using the validated multifactorial CanRisk prediction tool that includes family history information, a polygenic risk score (PRS), breast density and established lifestyle/hormonal risk factors. The mean number of genetic counseling visits, mammograms and MRIs per individual increased with risk level. High-risk participants incurred the highest overall mean risk-stratified screening-related costs in 2022 CAD (±SD) at CAD 905 (±269) followed by CAD 580 (±192) and CAD 521 (±163) for higher-than-average and average-risk participants, respectively. Among the breast screening-related costs, the greatest cost burden across all risk groups was the risk assessment cost, followed by total diagnostic and screening costs. The mean overall healthcare cost per participant (±SD) was the highest for the average risk participants with CAD 6311 (±19,641), followed by higher than average risk with CAD 5391 (±8325) and high risk with CAD 5169 (±7676).

CONCLUSION

Although high-risk participants incurred the highest risk-stratified screening-related costs, their costs for overall healthcare utilization costs were similar to other risk levels. Our study underscored the importance of integrating risk stratification as part of the screening pathway to support breast cancer detection at an earlier and more treatable stage, thereby reducing costs and the overall burden on the healthcare system.

As a novel prognostic model for breast cancer, the identification and validation of telomere-related long noncoding RNA signatures

BACKGROUND

Telomeres are a critical component of chromosome integrity and are essential to the development of cancer and cellular senescence. The regulation of breast cancer by telomere-associated lncRNAs is not fully known, though. The goals of this study were to describe predictive telomere-related LncRNAs (TRL) in breast cancer and look into any possible biological roles for these RNAs.

METHODS

We obtained RNA-seq data, pertinent clinical data, and a list of telomere-associated genes from the cancer genome atlas and telomere gene database, respectively. We subjected differentially expressed TRLs to co-expression analysis and univariate Cox analysis to identify a prognostic TRL. Using LASSO regression analysis, we built a prognostic model with 14 TRLs. The accuracy of the model's prognostic predictions was evaluated through the utilization of Kaplan-Meier (K-M) analysis as well as receiver operating characteristic (ROC) curve analysis. Additionally, immunological infiltration and immune drug prediction were done using this model. Patients with breast cancer were divided into two subgroups using cluster analysis, with the latter analyzed further for variations in response to immunotherapy, immune infiltration, and overall survival, and finally, the expression of 14-LncRNAs was validated by RT-PCR.

RESULTS

We developed a risk model for the 14-TRL, and we used ROC curves to demonstrate how accurate the model is. The model may be a standalone prognostic predictor for patients with breast cancer, according to COX regression analysis. The immune infiltration and immunotherapy results indicated that the high-risk group had a low level of PD-1 sensitivity and a high number of macrophages infiltrating. In addition, we've discovered a number of small-molecule medicines with considerable for use in treating high-risk groups. The cluster 2 subtype showed the highest immune infiltration, the highest immune checkpoint expression, and the worst prognosis among the two subtypes defined by cluster analysis, which requires more attention and treatment.

CONCLUSION

As a possible biomarker, the proposed 14-TRL signature could be utilized to evaluate clinical outcomes and treatment efficacy in breast cancer patients.

Women's experiences of risk-stratified breast cancer screening in the MyPeBS trial: a qualitative comparative study across two European countries

OBJECTIVE

Risk-stratification should improve the benefits-to-harms ratio for breast screening, whereby higher-risk women receive additional screening and low-risk women are screened less. This study investigated the effects of healthcare context by comparing how women in England and France experienced risk-based breast screening.

METHODS AND MEASURES

Fifty-two women were purposively sampled from participants who underwent risk-based screening in the MyPeBS trial. Women received objectively-derived 5-year breast cancer risk estimates (low = < 1%, average = 1-1.66%, high = ≥ 1.67 to <6%, very-high-risk = ≥ 6%). This determined future trial-related screening schedules and prevention options. Semi-structured interviews were transcribed for thematic framework analysis.

RESULTS

Two overarching themes were produced: the importance of supported risk communication and accessibility of risk management. Overall, risk-based breast screening was viewed positively. However, trial procedures, especially in risk estimate provision, differed across sites. Women at increased risk were more reassured when appointments were with specialist healthcare professionals (HCP). When absent, this resulted in reduced satisfaction with risk communication and greater uncertainty about its personal relevance. Low-risk women's views on extended mammogram schedules seemed linked to how health services are organised differently.

CONCLUSIONS

Context is an important consideration regarding acceptability of healthcare innovations such as risk-stratified screening: it should not be assumed that findings from one country apply universally.

Exploring Therapeutic Challenges in Patients with HER2-Positive Breast Cancer-A Single-Center Experience

Breast cancer is one of the most common forms of neoplasia worldwide. The purpose of our observational study was to evaluate the status of HER2 overexpression among new cases of breast neoplasia with an impact on the natural history of breast cancer disease and therapeutic personalization according to staging. This study included 45 breast cancer patients which have an overexpression of HER2 through the mutation of the EGFR-ERBB2 receptor. Immunohistochemical staining was performed on sections of formalin-fixed paraffin-embedded breast tissue. The patients were evaluated demographically and therapeutically in all stages. The post-surgical histopathological examination revealed complete pathological responses in 19 patients and pathological responses with residual disease either at the tumor level or lymphatic or both variants in a percentage of 44% (15 cases). The disease-free interval (DFI) under anti-HER2 therapy was recorded in 41 patients, representing 91% of the study group. Anti-HER2 therapy in any therapeutic stage has shown increased efficiency in blocking these tyrosine kinase receptors, evidenced by the high percentage of complete pathological responses, as well as the considerable percentage (47%) of complete remissions and stationary disease, in relation to the HER2-positive patient group.

Molecular genetic investigation of hereditary breast and ovarian cancer patients in the Southern Transdanubian region: widening the mutation spectrum and searching for new pathogenic variants using next-generation methods

Hereditary breast and ovarian cancer is a well-known genetic condition, inherited mainly in an autosomal dominant way, which elevates the risk of developing malignancies at a young age in heterozygous carriers. Advances in new generation sequencing have enabled medical professionals to determine whether a patient is harbouring mutations in moderate- or high penetrance susceptibility genes. We conducted a retrospective analysis among 275 patients who underwent genetic counselling and multigene panel testing for hereditary breast and ovarian cancer syndrome in our department. From these patients 74.5% (205/275) were affected by some type of malignancy, while the remaining 25.5% (70/275) had a positive family history of different cancers, suggesting a genetic predisposition. These tests confirmed a genetic variant in 29.8% and 28.6% of these patient groups respectively. The results also mirrored our general knowledge concerning the genetic background of hereditary breast and ovarian cancer, as variants in either one of the BRCA1 and BRCA2 genes proved to be the most common cause among our patients with 41.5%. Our test also detected a novel mutation in the CDH1 gene and three patients with double heterozygosity in two different susceptibility genes. This study demonstrates the relevance of genetic counselling and non-BRCA gene sequencing among cancer patients and patients who fulfil the criteria for genetic testing, while also providing important details about the genetic profile of Hungarian patients.

Deep learning combined with attention mechanisms to assist radiologists in enhancing breast cancer diagnosis: a study on photoacoustic imaging

Accurate prediction of breast cancer (BC) is essential for effective treatment planning and improving patient outcomes. This study proposes a novel deep learning (DL) approach using photoacoustic (PA) imaging to enhance BC prediction accuracy. We enrolled 334 patients with breast lesions from Shenzhen People's Hospital between January 2022 and January 2024. Our method employs a ResNet50-based model combined with attention mechanisms to analyze photoacoustic ultrasound (PA-US) images. Experiments demonstrated that the PAUS-ResAM50 model achieved superior performance, with an AUC of 0.917 (95% CI: 0.884 -0.951), sensitivity of 0.750, accuracy of 0.854, and specificity of 0.920 in the training set. In the testing set, the model maintained high performance with an AUC of 0.870 (95% CI: 0.778-0.962), sensitivity of 0.786, specificity of 0.872, and accuracy of 0.836. Our model significantly outperformed other models, including PAUS-ResNet50, BMUS-ResAM50, and BMUS-ResNet50, as validated by the DeLong test (p < 0.05 for all comparisons). Additionally, the PAUS-ResAM50 model improved radiologists' diagnostic specificity without reducing sensitivity, highlighting its potential for clinical application. In conclusion, the PAUS-ResAM50 model demonstrates substantial promise for optimizing BC diagnosis and aiding radiologists in early detection of BC.

Effects of a 4week internetdelivered mindfulnessbased cancer recovery program on anxiety, depression, and mindfulness among patients with breast cancer

OBJECTIVES

The efficacy of monotherapy in alleviating psychological disorders like anxiety and depression among breast cancer patients is suboptimal, necessitating effective psychosocial interventions. Mindfulness-based interventions have been shown to mitigate anxiety-depression symptoms and encourage beneficial behaviors. The online mindfulness-based cancer recovery (MBCR) offers flexibility and guides practice across various settings, facilitating full patient engagement. This study amis to analyze the impact of a 4-week internet-delivered mindfulness-based cancer recovery program on anxiety, depression, and mindfulness among Chinese patients with breast cancer, and to evaluate the degree of satisfaction breast cancer patients experienced after participating in this program.

METHODS

This study utilized a two-armed, parallel, randomized controlled trial design. A total of 103 patients with breast cancer from June 2020 to January 2021 in the ward of Breast and Thyroid Surgery of a tertiary hospital in Changsha, Hunan Province were selected and randomly assigned to an intervention group (n=51) and a control group (n=52). The intervention group participated in an internet-delivered mindfulness-based cancer recovery program, which was delivered once a week for 4 weeks. Meanwhile, the control group received weekly group health education for 4 weeks. The outcomes of hospital anxiety and depression scale and mindfulness Attention Awareness Scale were evaluated at 3 distinct time points: Baseline (T1), postintervention (T2), and 1-month follow-up (T3). The satisfaction questionnaire of 4-week mindful cancer rehabilitation training program was used at T2 to evaluate patients' satisfaction with the intervention program. Generalized estimation equations were used to assess differences in anxiety, depression and mindfulness levels between groups before and after the intervention.

RESULTS

There were no statistically significant differences in demographic data and outcome index scores between the 2 groups at T1 (all P>0.05), indicating that the 2 groups were comparable. The generalized estimating equation analyses showed that the intervention group had significantly better improvement in outcomes compared to the control group, particularly for anxiety (T2 β=-1.30, 95% CI -1.87 to -0.72; T3 β=-2.78, 95% CI -3.51 to -2.05) and depression (T2 β=-1.92, 95% CI -2.78 to -1.06; T3 β=-2.96, 95% CI -4.05 to -1.87; all P<0.001). Moreover, the mindfulness score in the intervention group was significantly higher than that in the control group at T2 (β=3.23, 95% CI 0.73 to 5.72) and T3 (β=8.06, 95% CI 4.37 to 11.75; both P<0.05). In addition, patients in the intervention group were satisfied with the 4-week mindfulness-based cancer recovery intervention and teaching/learning activities used to implement the program.

CONCLUSIONS

In patients with breast cancer, the 4-week internet-delivered mindfulness-based cancer recovery program, as a low-threshold, short-term mental health intervention, has a positive effect on reducing anxiety and depression and improving mindfulness levels. This program holds great promise as a tool for clinical nursing practice, given the high satisfaction and applicability.

The relationship between demographic factors and known risk factors with breast cancer in women aged 30-69

Background

Breast cancer is one of the most important causes of cancer deaths in women. The present study was conducted to determine the relationship between demographic factors and known risk factors with breast cancer in women aged 30-69.

Method

This case-control study was conducted with two matched and unmatched control groups. Three hundred fifty women aged 30-69 with breast cancer, 350 age-matched women without cancer, and 350 not age-matched women were included in the study. Controls were selected from the records of women whose breast cancer screening results were normal. Study subjects were evaluated regarding the risk factors for breast cancer. The data collection tool was a checklist including the risk factors investigated in the integrated health system. The collected data were analyzed utilizing SPSS22 software at a significance level of less than 0.05.

Results

The average age in the case group was 46.63±11.77 years and 49.61±8.39 in the unmatched control group. The average age of marriage in the case group was 21.54±4.31, and the average age of women at first pregnancy in the case group was 24.06±3.39 years. In the case group, 163 people (46.57%) lived in the city, 221 people (63.14%) were over 40 years old, and 337 people (96.28%) were married. In multivariate analysis, the variable 'age of marriage' 0.821 (0.691-0.976) and 'age of first pregnancy' 1.213 (1.020-1.443) showed a significant relationship with breast cancer which were observed as predictors of breast cancer in comparison to the unmatched control group (P-value <0.05).

Conclusion

The age of the first pregnancy and the type of delivery were observed as predictors of breast cancer. Therefore, by performing breast cancer screening in women who are exposed to these risk factors, early diagnosis of the disease and increasing the speed of their treatment can be significantly helped.

Cancer Core Europe: Leveraging Institutional Synergies to Advance Oncology Research and Care Globally

Cancer Core Europe brings together the expertise, resources, and interests of seven leading cancer institutes committed to leveraging collective innovation and collaboration in precision oncology. Through targeted efforts addressing key medical challenges in cancer and partnerships with multiple stakeholders, the consortium seeks to advance cancer research and enhance equitable patient care.

A structured process for the validation of a decision-analytic model: application to a cost-effectiveness model for risk-stratified national breast screening

BACKGROUND

Decision-makers require knowledge of the strengths and weaknesses of decision-analytic models used to evaluate healthcare interventions to be able to confidently use the results of such models to inform policy. A number of aspects of model validity have previously been described, but no systematic approach to assessing the validity of a model has been proposed. This study aimed to consolidate the different aspects of model validity into a step-by-step approach to assessing the strengths and weaknesses of a decision-analytic model.

METHODS

A pre-defined set of steps were used to conduct the validation process of an exemplar early decision-analytic-model-based cost-effectiveness analysis of a risk-stratified national breast cancer screening programme [UK healthcare perspective; lifetime horizon; costs (£; 2021)]. Internal validation was assessed in terms of descriptive validity, technical validity and face validity. External validation was assessed in terms of operational validation, convergent validity (or corroboration) and predictive validity.

RESULTS

The results outline the findings of each step of internal and external validation of the early decision-analytic-model and present the validated model (called 'MANC-RISK-SCREEN'). The positive aspects in terms of meeting internal validation requirements are shown together with the remaining limitations of MANC-RISK-SCREEN.

CONCLUSION

Following a transparent and structured validation process, MANC-RISK-SCREEN has been shown to have satisfactory internal and external validity for use in informing resource allocation decision-making. We suggest that MANC-RISK-SCREEN can be used to assess the cost-effectiveness of exemplars of risk-stratified national breast cancer screening programmes (NBSP) from the UK perspective.

IMPLICATIONS

A step-by-step process for conducting the validation of a decision-analytic model was developed for future use by health economists. Using this approach may help researchers to fully demonstrate the strengths and limitations of their model to decision-makers.

A Mediation Analysis of Obesity and Adiponectin Association with Postmenopausal Breast Cancer Risk: A Nested Cohort Study in the International Breast Cancer Intervention Study II (IBIS-II) Prevention Trial

Obesity is a risk factor for postmenopausal breast cancer (BC), and evidence suggests a role for adiponectin in the relationship between obesity and BC. We investigated whether adiponectin or other biomarkers mediate the effect of body mass index (BMI) on postmenopausal BC risk in a cohort study nested in the IBIS-II Prevention Trial. We measured adiponectin, leptin, IGF-I, IGFBP-1, high-sensitivity C-reactive protein, glycemia, insulin, HOMA-IR index, and SHBG in baseline and 12-month serum samples from 123 cases and 302 matched controls in the placebo arm of the IBIS-II Prevention trial. We conducted the main mediation analysis considering baseline BMI as an exposure and the 12-month adiponectin increase as a mediator after adjustment for the Tyrer-Cuzick score and the lipid-lowering medications/supplements use. In the multivariable Cox model, both the 12-month adiponectin increase (HR, 0.60; 95%CI, 0.36-1.00) and BMI were associated with BC risk (HR, 1.05; 95%CI, 1.00-1.09), with a 40% reduction in women with a 12-month increase in adiponectin. A significantly higher cumulative hazard of BC events was observed in obese women (BMI > 30) with decreased adiponectin (p = 0.0087). No mediating effect of the adiponectin increase on the total effect of BMI on BC risk was observed (natural indirect effect: HR, 1.00; 95%CI, 0.98-1.02). Raising adiponectin levels might be an attractive target for postmenopausal BC prevention.

Implementing Multifactorial Risk Assessment with Polygenic Risk Scores for Personalized Breast Cancer Screening in the Population Setting: Challenges and Opportunities

Risk-stratified breast screening has been proposed as a strategy to overcome the limitations of age-based screening. A prospective cohort study was undertaken within the PERSPECTIVE I&I project, which will generate the first Canadian evidence on multifactorial breast cancer risk assessment in the population setting to inform the implementation of risk-stratified screening. Recruited females aged 40-69 unaffected by breast cancer, with a previous mammogram, underwent multifactorial breast cancer risk assessment. The adoption of multifactorial risk assessment, the effectiveness of methods for collecting risk factor information and the costs of risk assessment were examined. Associations between participant characteristics and study sites, as well as data collection methods, were assessed using logistic regression; all p-values are two-sided. Of the 4246 participants recruited, 88.4% completed a risk assessment, with 79.8%, 15.7% and 4.4% estimated at average, higher than average and high risk, respectively. The total per-participant cost for risk assessment was CAD 315. Participants who chose to provide risk factor information on paper/telephone (27.2%) vs. online were more likely to be older (p = 0.021), not born in Canada (p = 0.043), visible minorities (p = 0.01) and have a lower attained education (p < 0.0001) and perceived fair/poor health (p < 0.001). The 34.4% of participants requiring risk factor verification for missing/unusual values were more likely to be visible minorities (p = 0.009) and have a lower attained education (p ≤ 0.006). This study demonstrates the feasibility of risk assessment for risk-stratified screening at the population level. Implementation should incorporate an equity lens to ensure cancer-screening disparities are not widened.