Incidence, mortality, survival, and disease burden of breast cancer in China compared to other developed countries

Integrating RNA-seq and scRNA-seq to explore the prognostic features and immune landscape of exosome-related genes in breast cancer metastasis

OBJECTIVE

This study aims to explore the role of exosome-related genes in breast cancer (BRCA) metastasis by integrating RNA-seq and single-cell RNA-seq (scRNA-seq) data from BRCA samples and to develop a reliable prognostic model.

METHODS

Initially, a comprehensive analysis was conducted on exosome-related genes from the BRCA cohort in The Cancer Genome Atlas (TCGA) database. Three prognostic genes (JUP, CAPZA1 and ARVCF) were identified through univariate Cox regression and Lasso-Cox regression analyses, and a metastasis-related risk score model was established based on these genes. Immune cell infiltration, immune escape and drug sensitivity disparities between high- and low-risk groups were assessed using CIBERSORT and single-sample gene set enrichment analysis (ssGSEA) methods. High- and low-risk cell populations were discerned based on the expression of prognostic genes in BRCA scRNA-seq data.

RESULTS

M0 and M1 macrophages significantly promote the metastasis of breast cancer (BRCA). The developed prognostic model demonstrates good predictive performance for patient survival at 1, 3 and 5 years, with AUC values of 0.654, 0.602 and 0.635, respectively. Compared to the low-risk group, the high-risk group exhibits increased immune cell infiltration and higher levels of immune evasion. scRNA-seq data reveal that high-risk cells have significantly higher risk scores and exhibit notable differences in signalling pathways and intercellular communication patterns.

CONCLUSIONS

This study presents a novel risk score model based on exosome-related genes, validated by comprehensive analyses including differential expression, survival analysis and external dataset validation. The model's clinical significance is reinforced through its ability to stratify patients into high- and low-risk groups with distinct survival outcomes and immune landscape characteristics. The integration of RNA-seq and scRNA-seq data highlights the predictive accuracy of the model and underscores its potential for identifying novel therapeutic targets and improving patient prognosis.

GRB2 Promotes Malignant Behaviors of Breast Cancer by Modulating the Global Expression and Alternative Splicing Profiles in SK-BR-3 Cells Through Binding mRNA

PURPOSE

The flexible protein GRB2 interacts with HER1-4 on the cell surface and regulates the development of tumor cells; meanwhile, it is also an RBP that plays an important role in post-transcriptional regulation in eukaryotes, which affects every stage of mRNA synthesis, modification, splicing, and stabilization. Although some studies have found a connection between GRB2 and HER2-overexpression breast cancer, highlighting the potential of GRB2 as a novel biomarker that stimulates tumor growth, limited data were available to elaborate on their interaction mechanisms.

METHODS

In this research, we found 396 different gene expressions between the Grb2-knockdown group and the SK-BR-3 group by the RNA sequencing approach. After GRB2 was knocked down, 956 alternative splicing events occurred.

RESULTS

The fRIP-seq results showed that GRB2-binding reads were significantly enriched in the intron region, indicating that UUAGC and UUGGUUGG might be the binding motifs. An integration analysis of DEGs with the peak genes of fRIP-seq revealed that 63 genes possess GRB2 binding sites on their mRNAs or antisense RNAs. By integration analysis of AS events with the peak genes of fRIP-seq, 66 genes related to AS events were found.

CONCLUSIONS

Above, these AS events may be regulated by GRB2 to promote the progression of HER2-overexpression breast cancer.

Analysis of Ultrasound Features for Breast Cancers With Different Risk Categories and Evaluation of a New Predicting Method

OBJECTIVES

To explore pathology and ultrasound features of breast cancers with different risk categories. To establish and validate a nomogram primarily based on grayscale ultrasound features for non-invasive preoperative prediction of high-risk breast cancers and for rapid individual risk assessment and clinical decision making.

METHODS

A total of 685 breast malignant lesions were enrolled in this study. All lesions were classified according to the St. Gallen risk categories criteria. The pathology and ultrasound features were compared among different risk groups. A multifactorial Logistic model and a nomogram primarily based on grayscale ultrasound were established. Then prediction ability was evaluated.

RESULTS

In training cohort, the ultrasound features with significant differences were selected again through Lasso regression. Then, age, maximum diameter in ultrasound, posterior echo attenuation, spiculate margin and suspicious axillary lymph nodes were selected to establish the prediction model and nomogram. The areas under the curve in training cohort and internal test cohort were 0.833 and 0.827. Diagnostic sensitivity, specificity, accuracy, positive likelihood ratio and negative likelihood ratio were 75.6%, 76.6%, 76.4%, 41.4% and 93.5%, respectively.

CONCLUSIONS

Breast cancers with different risk categories exhibit distinct pathology and ultrasound features. The prediction model and nomogram have good and stable diagnostic efficiency.

A cross-sectional study of serum lipids, body mass index and age relationships with breast cancer risk

BACKGROUND

Globally, the most common malignancy in women today is breast cancer. Numerous factors affect the incidence of breast cancer; therefore, we examined the connections involving age, body mass index (BMI), serum lipid levels, and breast cancer risk in women.

METHODS

This was a cross-sectional analytical study. 382 female patients with a breast cancer diagnosis in this study, and 11842 healthy, age-matched females who were selected from physical examination centers in the same period. Univariate analysis was conducted first, after which factors with statistically significant differences were used to construct a multi-factor binary logistic regression equation. We explored associations across different ages, BMI, triglyceride (TG), and high-density lipoprotein-cholesterol (HDL-C) levels, and breast cancer risk.

RESULTS

Age, BMI, TG, and HDL-C were the risk factors that showed the most significant association with breast cancer. Age, BMI, low-density lipoprotein-cholesterol (LDL-C) and TG levels in the breast cancer group were higher than those in the control group, but HDL-C and total cholesterol (TC) levels were lower. As BMI and TG levels increased, the risk of developing breast cancer increased, and, as HDL-C levels decreased, the risk of developing breast cancer increased. Women aged ≥ 40 years old had an increased breast cancer risk. There were no significant variations in TC and LDL-C levels between groups.

CONCLUSIONS

In this study, a lower risk of breast cancer was linked to high HDL-C levels, while a higher risk of breast cancer was linked to high BMI and TG levels. Women aged ≥ 40 years old had an increased breast cancer risk.

Comparison of contrast-enhanced cone-beam breast CT, MRI, and mammography for breast cancer characterization

OBJECTIVES

To compare the consistency of contrast-enhanced cone-beam breast CT (CE-CBBCT), MRI and mammography regarding characterization of breast cancer.

METHODS

In this retrospective study, patients with breast cancer who underwent preoperative CE-CBBCT, MRI, and mammography between January 2017 and July 2022 were enrolled. Three experienced radiologists independently interpreted the characteristics of breast lesions on each imaging mode referring to BI-RADS, with a 4-week wash-out period. One of the three radiologists reviewed the CE-CBBCT images 4 weeks after the initial evaluation. Cross-modality consistency was calculated by Cohen's Kappa based on majority report. Inter-and intra-reader agreement were assessed using Fleiss and Cohen's Kappa, respectively. The association between imaging factors and consistency levels was analyzed using chi-square and Mann-Whitney U test.

RESULTS

A total of 214 malignant lesions identified in 207 patients were enrolled. CE-CBBCT showed almost perfect agreement with MRI on lesion type identification (Kappa = 0.865, 95% CI: 0.802-0.928), but fair agreement with mammography (Kappa = 0.287, 95% CI: 0.205-0.369). CE-CBBCT showed substantial agreement on characterization with MRI for both mass (Kappa = 0.752-0.824) and non-mass enhancement (NME) (Kappa = 0.702-0.729), and non-contrast-enhanced CBBCT (NCE-CBBCT) showed substantial agreement with mammography for calcification (Kappa = 0.717-0.777). Inter- (Kappa = 0.611-0.738) and intra-reader (Kappa = 0.757-0.887) agreement were substantial on CE-CBBCT interpretation. There was no statistically significant difference in imaging factors between different consistency levels (all p > 0.05).

CONCLUSIONS

CE-CBBCT showed high consistency on mass and NME characterization with MRI, and on calcification with mammography, indicating that CE-CBBCT could combine morphology, hemodynamic and calcification features, and the corresponding descriptors have the feasibility to describe CE-CBBCT characteristics of breast cancer.

KEY POINTS

Question Contrast-enhanced cone-beam breast CT (CE-CBBCT) is widely used in the diagnosis and assessment of breast cancer, but there is no standardized lexicon for image interpretation. Findings CE-CBBCT showed high consistency and comparable reproducibility with MRI and mammography for characterizing breast cancer lesions. Clinical relevance The findings prove that CE-CBBCT could combine morphology, hemodynamic, and calcification features and provide support for the feasibility of applying the BI-RADS descriptors of MRI and mammography to interpret contrast-enhanced cone-beam breast CT images in clinic.

Dietary self-management behavior and associated factors among breast cancer patients receiving chemotherapy: A latent profile analysis

PURPOSE

Breast cancer patients experience more gastrointestinal symptoms during chemotherapy than during the survival period post-treatment. This can interfere with daily dietary intake and increase the risk of malnutrition. This study aimed to evaluate the level and classification of dietary self-management behavior and the influence of self-care self-efficacy, outcome expectations, treatment self-regulation and perceived social support guided by "Integrated theory of Health Behavior Change".

METHODS

A multicenter cross-sectional study was conducted. The assessment tools included self-designed demographic and clinical instruments, Dietary Management Behavior Questionnaire, Strategies Used by People to Promote Health, Consideration of Future Consequences Scale-Food, the Treatment Self-regulation Questionnaire and Perceived Social Support Scale.

RESULTS

A total of 760 samples were analysed. The best-fitting model of the 4 classes was determined, with the lowest-to-highest scores as follows: Class 1-poor behavior group (17.84%), Class 2-medium behavior group (28.26%), Class 3-good behavior group (22.67%) and Class 4-excellent behavior group (31.23%). In the control group, being underweight (OR = 0.131), having no spouse (OR = 0.235), having a lower educational level (OR = 0.147-0.384), being premenopausal (OR = 0.220-0.255), having immediate consequence considerations (OR = 0.866-0.909) and receiving other support (OR = 0.830) were risk factors (all P < 0.05).

CONCLUSIONS

The performance of dietary self-management behavior needs to be improved. This study may provide a reference for determining key intervention populations that are underweight during premenopause, have no spouse and have lower education. Specific intervention content, including future consequence consideration, positive attitudes, decision-making, autonomous motivation, introjected regulation and friend support, should be added to improve the dietary practices during chemotherapy precisely.

LncRNA TCL6 regulates miR-876-5p/MYL2 axis to suppress breast cancer progression

We explored the influence of the TCL6/miR-876-5p axis on breast cancer cell proliferation and migration. Using The Cancer Genome Atlas (TCGA) database, we evaluated the expression of TCL6 in breast cancer patients and studied its effects on cell proliferation, migration, and the cell cycle in vitro. The regulatory effect of miR-876-5p on myosin light chain-2 (MYL2) 3' untranslated regions (3'UTR) was analyzed through luciferase reporter assays, and rescue experiments confirmed TCL6-driven upregulation of MYL2 via a competitive RNA binding mechanism. Furthermore, we used a mouse subcutaneous tumor model to assess the impact of TCL6 knockdown combined with immune checkpoint blockade therapy. Our results indicated that higher TCL6 expression correlated with a favorable prognosis in breast cancer patients. In vitro experiments showed that knockdown of TCL6 and MYL2 enhanced breast cancer cell proliferation and migration. The luciferase and rescue assays demonstrated that TCL6 interacted with miR-876-5p to upregulate MYL2, thereby inhibiting cell proliferation and migration. Both in vitro and in vivo studies revealed that overexpression of TCL6 suppressed tumor growth and improved the response to PD-1 immunotherapy in tumor-bearing mice. This research highlights the pivotal role of lncRNA TCL6 in breast cancer development via a ceRNA network involving miR-876-5p and MYL2, suggesting a novel molecular target for breast cancer therapy.

Nomogram Development for Assessing Oncotype DX Recurrence Scores in Breast Cancer: A Chinese Population Study

BACKGROUND

Breast cancer (BC) is the most prevalent cancer among women worldwide, with increasing incidence rates, particularly in China. Given the high costs of Oncotype DX (ODX) testing, which predicts recurrence scores (RSs) on the basis of gene expression, developing a nomogram utilizing clinicopathological variables may provide an accessible alternative for risk stratification.

METHODS

We conducted a retrospective analysis of 703 estrogen receptor (ER)-positive, HER2-negative T1-3N0M0 BC patients who underwent ODX testing at Qilu Hospital. A nomogram was developed using multivariate logistic regression to predict low and high RSs in the group. Model performance was validated by receiver operating characteristic curve, calibration curve, and decision curve analysis.

RESULTS

Multivariate analysis revealed that older age, lower histologic grade, a higher ER expression level, a higher proportion of cells expressing progesterone receptor, and a lower proportion of cells expressing Ki-67 were significantly associated with a patient being in the low-risk subgroup. A nomogram was then developed using these variables to predict the RS, with an area under the curve (AUC) of 0.811 (95% confidence interval [CI] = 0.772-0.850) in the development group and 0.794 (95% CI = 0.737-0.851) in the validation group. Calibration and decision curve analyses further confirmed the nomogram's clinical utility. Moreover, a comparison between the TAILORx-nomogram and our nomogram was conducted, which proved that our nomogram has better predictive accuracy and reliability in Chinese BC patients.

CONCLUSION

We present the first nomogram for predicting the RS in Chinese patients with BC on the basis of clinicopathological factors. This model could aid in identifying patients who may not need ODX testing and serve as a cost-effective alternative for those unable to access ODX, thereby optimizing treatment decisions and enhancing patient management in resource-limited settings.

Oncofertility Barriers in Nurses Caring for Women with Breast Cancer

Despite the importance of oncofertility care in supporting women coping with fertility challenges after breast cancer, the practice of oncofertility care among nurses remains suboptimal. There is an urgent need to investigate oncofertility barriers faced by nurses caring for women with breast cancer. A cross-sectional online study was conducted among registered nurses caring for women with breast cancer. A self-developed questionnaire and the Oncofertility Barriers Scale (OBS) were used to assess participants' characteristics and self-perceived barriers. A score ≥ 3 indicates a high level of oncofertility barriers requiring further attention. 372 nurses completed the survey, with 45.54% reporting a score of ≥ 3 on the OBS. Notably, 85% of participants reported high levels of barriers in at least one domain and 27.42% reported barriers in all six domains of the scale. The most commonly reported barrier was "Stereotype of cancer patients" (71%). Nurses without fertility training, those who did not read fertility-related guidelines, and those in departments lacking such guidelines reported significantly higher barriers (all p < 0.05). The prevalence of oncofertility barriers among nurses is high. Educational programs should be developed to address these barriers, improving the quality of oncofertility care for women with breast cancer.

Cancer situation in China: an analysis based on the global epidemiological data released in 2024

BACKGROUND

Cancer remains a major cause of mortality and a significant economic burden in China. Exploring the disparities in cancer patterns and control strategies between China and developed countries may offer valuable insights for policy formulation and enhance cancer management efforts. This study examined the incidence, mortality, and disability-adjusted life year (DALY) burden of cancer in China, and compared these metrics with those observed in the United States (US) and the United Kingdom (UK).

METHODS

Data on cancer incidence, mortality, and DALYs for China, the US, and the UK were sourced from the GLOBOCAN 2022 online database and the Global Burden of Disease 2021 study (GBD 2021). We utilized Joinpoint regression models to analyze trends in cancer incidence and mortality across these countries, calculating annual percent changes (APCs) and determining the optimal joinpoints.

RESULTS

In 2022, China recorded around 4,824,703 new cancer cases and 2,574,176 cancer-related deaths, contributing to 71,037,170 DALYs. China exhibited a lower cancer incidence rate compared to the US and the UK. Although cancer-related mortality in China is slightly lower than that in the UK, it is significantly higher than that in the US. Additionally, China experienced significantly higher DALY rates compared to both the US and UK. The cancer landscape in China was also undergoing significant changes, with a rapid rise in the incidence and burden of lung, colorectal, breast, cervical, and prostate cancers. Meanwhile, the incidence and burden of stomach cancer continued to decline. Although the incidence of liver and esophageal cancers was decreasing, the burden of liver cancer was increasing, while the burden of esophageal cancer remained largely unchanged.

CONCLUSIONS

The cancer profile of China is shifting from that of a developing country to one more typical of a developed country. The ongoing population aging and the rise in unhealthy lifestyles are expected to further escalate the cancer burden in China. Consequently, it is crucial for Chinese authorities to revise the national cancer control program, drawing on successful strategies from developed countries, while also accounting for the regional diversity in cancer types across China.

Cross-cultural adaptation of the simple Chinese version of the medication adherence reasons scale in patients undergoing adjuvant endocrine therapy for breast cancer

Adjuvant endocrine therapy (AET) is essential for improving survival and reducing mortality and recurrence rates in breast cancer (BrCa) patients. However, the adherence to AET among BrCa patients is poor, and there is no scale to measure adherence to AET or the reasons for non-adherence among BrCa patients in mainland China. The aim of this study was to assess the psychometric properties of the simple Chinese version of the Medication Adherence Reasons (MAR) scale in BrCa patients undergoing AET. This study utilized a cross-sectional research design with two phases: (1) translation and cross-cultural adaptation of the original English version of the MAR scale into simple Chinese and (2) validation of the simple Chinese version of the MAR scale (s-ChMAR scale) in BrCa patients. Instrument assessments included content validity, face validity, item analysis, construct validity, criterion-related validity and reliability testing. This study recruited participants using convenience sampling to investigate adherence to AET among BrCa patients. Inclusion criteria were: (a) female, (b) aged 18 years or older, (c) diagnosed with Stage I to III BrCa, (d) completed primary treatment for hormone receptor-positive BrCa and had been on AET for more than six months but less than five years, (e) proficient in Mandarin, and (f) provided informed consent. Exclusion criteria included psychiatric illness, cognitive impairment, or a diagnosis of another cancer type. The sample size for exploratory factor analysis (EFA) was determined based on a ratio of five to ten participants per scale item to ensure sufficient statistical power. Data were collected from a sample of 325 participants who received AET for over six months. All the items had a content validity index (CVI) of more than 0.80. Regarding construct validity, the s-ChMAR scale fit a four-dimensional model, the same as the original MAR scale tested in asthma patients. The s-ChMAR scale had good internal reliability (Cronbach's α = 0.896) and good stability (ICC = 0.837). In terms of quantifying non-adherence, the s-ChMAR scale identified a non-adherent participant rate of over 50%. The study findings support the reliability and validity of the s-ChMAR scale in measuring the non-adherence of Chinese BrCa patients to AET.

Epidemiology of breast cancer in Chinese women from 1990 to 2021: a systematic analysis and comparison with the global burden

BACKGROUND

Breast cancer is a major global public health concern and a major cause of cancer-related mortality. In 2020, 8.3% of the total breast cancer deaths worldwide were reported from China, which highlighted the need to understand the epidemiological trends of breast cancer within the country. Therefore, this study aimed to analyse the trends in the breast cancer burden in China from 1990 to 2021 and compare them with global trends to provide insights for future prevention and control strategies.

METHODS

Data were sourced from the Global Burden of Disease database 2021, which includes comprehensive information on the disease burden across 204 countries from 1990 to 2021. We analysed six key indicators: the mortality, prevalence, incidence, disability-adjusted life years, years lived with disability, and years of life lost. Age-standardized rates were analysed using the global age structure as a reference. Joinpoint regression was employed to assess the annual percentage change and average annual percentage change.

RESULTS

In 2021, 3.75 million prevalent breast cancer cases, with 385,837 new breast cancer cases and 88,106 deaths due to breast cancer, were reported from China. The crude rates of the prevalence, incidence, mortality, disability-adjusted life years, years lived with disability, and years of life lost significantly increased in 2021 compared with 1990. The age-standardized rates per 100,000 women were 355.72 for prevalence (+ 103.22% from 1990), 37.00 for incidence (107.40%), 8.24 for mortality (-8.24%), 281.54 for disability-adjusted life years (-6.68%), 25.86 for years lived with disability (110.24%), and 255.69 for years of life lost (-11.62%). The burden of breast cancer has notably increased among the women above 40 years of age, peaking between the ages of 50 and 59 years, and the proportion of cases in women under 40 years has decreased.

CONCLUSIONS

The age-standardized rate of the mortality, disability-adjusted life years, and years of life lost of breast cancer decreased slightly in China; however, the age-standardized rate of the incidence, prevalence, and years lived with disability exhibited an upward trend between 1990 and 2021, thereby highlighting the need to improve treatment outcomes and formulate better policies for the prevention and control of breast cancer in China.

Radiomic analysis of cohort-specific diagnostic errors in reading dense mammograms using artificial intelligence

OBJECTIVES

This study aims to investigate radiologists' interpretation errors when reading dense screening mammograms using a radiomics-based artificial intelligence approach.

METHODS

Thirty-six radiologists from China and Australia read 60 dense mammograms. For each cohort, we identified normal areas that looked suspicious of cancer and the malignant areas containing cancers. Then radiomic features were extracted from these identified areas and random forest models were trained to recognize the areas that were most frequently linked to diagnostic errors within each cohort. The performance of the model and discriminatory power of significant radiomic features were assessed.

RESULTS

We found that in the Chinese cohort, the AUC values for predicting false positives were 0.864 (CC) and 0.829 (MLO), while in the Australian cohort, they were 0.652 (CC) and 0.747 (MLO). For false negatives, the AUC values in the Chinese cohort were 0.677 (CC) and 0.673 (MLO), and in the Australian cohort, they were 0.600 (CC) and 0.505 (MLO). In both cohorts, regions with higher Gabor and maximum response filter outputs were more prone to false positives, while areas with significant intensity changes and coarse textures were more likely to yield false negatives.

CONCLUSIONS

This cohort-based pipeline proves effective in identifying common errors for specific reader cohorts based on image-derived radiomic features.

ADVANCES IN KNOWLEDGE

This study demonstrates that radiomics-based AI can effectively identify and predict radiologists' interpretation errors in dense mammograms, with distinct radiomic features linked to false positives and false negatives in Chinese and Australian cohorts.

Relationship between social support and self-care ability among patients with breast cancer during rehabilitation: The multiple mediating roles of resilience and depression

AIMS

To identify the multiple mediating effects of resilience and depression between social support and self-care ability among patients with breast cancer during rehabilitation to provide reference for developing and implementing targeted interventions.

DESIGN

A cross-sectional study reported according to the STROBE checklist.

METHODS

A convenience sample of 320 patients with breast cancer during rehabilitation was recruited from one hospital in China. Data were collected from April to August 2022 using a self-report questionnaire, including the demographic and clinical information, Appraisal of Self-Care Agency Scale-Revised, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale-10 item, and Patient Health Questionnaire-9. The mediation analysis was conducted using the SPSS Process macro.

RESULTS

Self-care ability was positively associated with social support (β = .229) and resilience (β = .290), and negatively associated with depression (β = -.208). The relationship between social support and self-care ability was mediated by resilience and depression, respectively, and together in serial. The multiple mediating effects accounted for 34.0% of the total effect of social support on self-care ability.

CONCLUSION

Our findings identify resilience and depression as multiple mediators between social support and self-care ability and highlight the important roles of social support, resilience and depression in improving self-care ability.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should pay great attention to the underlying mechanisms of how social support affects patients' self-care ability during breast cancer rehabilitation. Integrated intervention programmes targeted at enhancing social support, building resilience and alleviating depression might be beneficial to the improvement of self-care ability.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was applied to report the results.

Pivotal Role of miRNA-lncRNA Interactions in Human Diseases

New technologies have shown that most of the genome comprises transcripts that cannot code for proteins and are referred to as non-coding RNAs (ncRNAs). Some ncRNAs, like long non-coding RNAs (lncRNAs) and microRNAs (miRNAs), are of substantial interest because of their critical function in controlling genes and numerous biological activities. The expression levels and function of miRNAs and lncRNAs are rigorously monitored throughout developmental processes and the maintenance of physiological homeostasis. Due to their critical roles, any dysregulation or changes in their expression can significantly influence the pathogenesis of various human diseases. The interactions between miRNAs and lncRNAs have been found to influence gene expression in various ways. These interactions significantly influence the understanding of disease etiology, cellular processes, and potential therapeutic targets. Different experimental and in silico methods can be used to investigate miRNA-lncRNA interactions. By aiding the elucidation of miRNA-lncRNA interactions and deepening the understanding of post-transcriptional gene regulation, researchers can open a new window for designing hypotheses, conducting experiments, and discovering methods for diagnosing and treating complex human diseases. This review briefly summarizes miRNA and lncRNA functions, discusses their interaction mechanisms, and examines the experimental and computational methods used to study these interactions. Additionally, we highlight significant studies on lncRNA and miRNA interactions in various diseases from 2000 to 2024, using the academic research databases such as PubMed, Google Scholar, ScienceDirect, and Scopus.

Development and validation of the NCC-BC-A scale to assess patient-reported outcomes for breast cancer patients in China

Background

The commonly used international patient-reported outcome scales for breast cancer were developed before the advent of multiple targeted therapies and immunotherapies, rendering them potentially insufficient for current clinical practices. Therefore, it is necessary to develop a specific patient-reported outcome scale tailored for breast cancer patients in China to optimize the management model for these patients.

Methods

A comprehensive literature search was performed in the PubMed, Embase, Wanfang, and CNKI databases to extract dimensions and items for a potential patient-reported outcome scale. The Delphi method was used to modify, add, subtract, and adjust the language of items until the experts reached a consensus on the first draft. This draft was further refined using a cognitive test and a presurvey. The optimized scale was used for a formal survey, and the items were further analyzed and screened using metrics such as the coefficient of variation, correlation coefficient, internal item consistency, factor analysis, reliability, and validity.

Results

A total of 10,954 articles were analyzed, and 237 were used to create a pool of 277 patient-reported outcome items. Through two rounds of Delphi expert consultation, the experts' authority coefficients were 0.739 and 0.826. After a cognitive test, several items were adjusted to enhance understanding. Further adjustments were made following a presurvey of 200 advanced breast cancer patients, resulting in a 38-item patient-reported outcomes scale, termed NCC-BC-A. In the national formal survey, 588 advanced breast cancer patients participated. Principal component analysis showed good consistency among the items and sufficient difference between the dimensions. The results were normally distributed with good variation. The Cronbach's α coefficient of the scale was 0.925 and the test-retest reliability was 0.9041.

Conclusion

The NCC-BC-A scale has high validity and reliability. It comprehensively considered the characteristics of systemic treatment for breast cancer, and the specific context within China. Its implementation may help clinicians to pay more attention to quality of life of breast cancer patients and to optimize the system for managing this condition.

Investigation on the Changes of Perioperative Psychological State of Young Patients With Early Breast Cancer

OBJECTIVE

This study aims to explore the variations and dynamics in the mental states of young patients with early breast cancer across different perioperative periods and to analyse how different surgical methods impact these patients' psychological well-being.

METHODS

A prospective observational study was conducted on young patients with early breast cancer who underwent surgery from March 2021 to March 2022. Mental status questionnaires were administered at four key time points: preoperatively, 1 month, 6 months and 1 year postoperatively. The collected data were statistically analysed to discern the psychological shifts in these patients throughout the perioperative timeline. The patients were categorized into either the breast-conserving or mastectomy group based on their surgical procedure, and their mental state scores during each phase were analysed to investigate the effects of different surgical methods on their psychological health.

RESULTS

During the study period, 149 young patients with early breast cancer completed the four-phase questionnaire. Statistically significant differences were observed in self-evaluation, self-esteem, physiological state, fear of death, economic stress, negative emotion, and anxiety and depression among these patients across different periods. The baseline data revealed differences in marital status, place of residence and prior tumour history between the two surgical groups. Significant differences in self-evaluation, depression, self-esteem and positive emotions were found between the breast-conserving group and mastectomy groups.

CONCLUSION

Breast cancer presents significant physical and psychological challenges from diagnosis through treatment. Our findings indicate that young patients with early breast cancer experience varying degrees of psychological distress during the entire perioperative period, influencing their surgical choices and postoperative recovery. This study found that the psychological state of patients undergoing breast-conserving surgery is more favourable compared with that of patients who received mastectomies, particularly in terms of self-assessment, self-esteem, positive affect and depression levels.

Transcriptomic era of cancers in females: new epigenetic perspectives and therapeutic prospects

In the era of transcriptomics, the role of epigenetics in the study of cancers in females has gained increasing recognition. This article explores the impact of epigenetic modifications, such as DNA methylation, histone modification, and non-coding RNA, on cancers in females, including breast, cervical, and ovarian cancers (1). Our findings suggest that these epigenetic markers not only influence tumor onset, progression, and metastasis but also present novel targets for therapeutic intervention. Detailed analyses of DNA methylation patterns have revealed aberrant events in cancer cells, particularly promoter region hypermethylation, which may lead to silencing of tumor suppressor genes. Furthermore, we examined the complex roles of histone modifications and long non-coding RNAs in regulating the expression of cancer-related genes, thereby providing a scientific basis for developing targeted epigenetic therapies. Our research emphasizes the importance of understanding the functions and mechanisms of epigenetics in cancers in females to develop effective treatment strategies. Future therapeutic approaches may include drugs targeting specific epigenetic markers, which could not only improve therapeutic outcomes but also enhance patient survival and quality of life. Through these efforts, we aim to offer new perspectives and hope for the prevention, diagnosis, and treatment of cancers in females.

PD-1 inhibitor sintilimab treated patients with metastatic triple-negative breast cancer

Purpose

Triple-negative breast cancer (TNBC) is a highly challenging subtype due to a unique tumor microenvironment. Several evidence (IMpassion130 trial and KEYNOTE-355 trial) supported the therapeutic effect of the immune checkpoint inhibitor in TNBC. However, the efficacy and safety of the PD-1 inhibitor sintilimab in breast cancer (BC) has not been well-investigated. So the real-world data on sintilimab-treated patients with metastatic BC were collected and analyzed in this study.

Methods

The patients were eligible according to the requirements included: ages between 18 years and 75 years; recurrent or metastatic TNBC; measurable disease based on RECIST v1.1; no limitation on the prior systemic treatments; and ECOG performance status of 0-1. Patients received sintilimab 200 mg intravenously every 3 weeks until unacceptable toxicity or disease progression.

Results

From 1 June 2019 to 1 October 2022, 40 female patients (median age, 55.5 years) with metastatic TNBC (mTNBC) were enrolled into the study. The median prior lines of systemic therapy for mTNBC was three (range, 1-8), with 60% of cases receiving at least three lines of therapy for metastatic disease. The visceral or brain metastasis was detected in 40.4% or 9.6% of patients, respectively. The median duration of response was 2.8 months (range, 0.7-21.0), and the median number of sintilimab doses administered was 4 (range, 1-30). The ORR and DCR were 22.5% and 72.5%, separately. The median PFS was 3.5 months (range, 1.4-21.0), with a 6-month PFS rate of 15.0% (6/40). The median OS was 52.5 months (range, 9.0-247.0) as of data cut-off. Common adverse effects were acceptable, and fatigue, skin rash, and pruritus were the frequent toxicity observed. Two cases of grade 3 curable adverse events were considered to be treatment-related. PD-L1-positive tumor was found in 40% cases (4/10) of mTNBC. Although statistical difference was not reached, the trend was obvious. Patients with PD-L1-positive tumor gained better treatment response, while the TMB-high carrier received more benefits of PFS and OS.

Conclusion

In our study, preliminary evidence provided the anticancer activity and acceptable adverse effects of sintilimab administered every 3 weeks to pretreated patients with mTNBC. Sintilimab showed its efficacy and safety of immunotherapy for patients with advanced TNBC.

Relationships Between Chemotherapy-Related Cognitive Impairment, Self-Care Ability, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Study

OBJECTIVES

It is not clear how chemotherapy-related cognitive impairment and self-care ability affect the quality of life of women with breast cancer. The purpose of this study was to explore the relationships between chemotherapy-related cognitive impairment, self-care ability, and quality of life in breast cancer patients, and test whether self-care ability plays a mediating role in the association between cognitive impairment and quality of life.

METHODS

This study was a cross-sectional study, conducted in China in 2022. Self-reported scales were used to assess cognitive function, self-care ability, and quality of life. Data were analyzed using descriptive statistics, spearman correlation analysis and hierarchical multiple regression analyses, the SPSS Process program was used to explore the mediating effect of self-care ability.

RESULTS

A total of 218 participants were investigated, and approximately 79.3% of patients experienced mild chemotherapy-related cognitive impairment, the mean quality of life score was 59.96 ± 14.15, and the mean self-care ability score was 107.4 ± 24.09. Significant correlations among cognitive impairment, self-care ability, and quality of life were observed (P < .05). Additionally, self-care ability played a partial mediating role between cognitive impairment and quality of life (P < .05), accounting for 24.3% and 22.3%, respectively.

CONCLUSIONS

Chemotherapy-related cognitive impairment and self-care ability are factors affecting the quality of life of breast cancer survivors. Self-care ability mediates the relationship between cognitive impairment and quality of life. Enhancing patients' self-care ability can improve the quality of life of patients with cognitive impairment.

IMPLICATIONS FOR NURSING PRACTICE

In the future, oncology nurses should not only pay attention to the severity of cognitive impairment, but also assess the level of patients' self-care ability, provide relevant medical and healthcare guidance, train self-management behavior and strengthen self-care ability by integrating multidisciplinary forces to improve the quality of life of breast cancer patients effectively.

Evaluation of urban-rural difference in breast cancer mortality among Chinese women during 1987-2021: A hierarchical age-period-cohort analysis

BACKGROUND

Breast cancer mortality varies in urban and rural areas in China. Studies have reported urban-rural difference across time period, however, the evaluation on urban-rural differences in age and birth cohort effects is limited. Our aim was to quantitatively assess urban-rural disparities in age, period and cohort effects in breast cancer mortality in China.

METHODS

We collected age-specific breast cancer mortality rates for urban and rural females aged 20-84 years from 1987 to 2021. Hierarchical age-period-cohort (HAPC) models were used to evaluate the effect of area (urban, rural) on breast cancer mortality and investigate urban-rural differences in age, time period and birth cohort effects.

RESULTS

We found a significant area (urban, rural) effect on breast cancer mortality in that rural females had a lower mortality risk than urban females [-0.25 (95 % confidence interval (CI): -0.32, -0.17)]. Age trajectories of mortality based on the HAPC model showed nonlinear trends with adjustment for area variable. The urban-rural difference in age effect appeared to be divergent with age, and urban women had higher mortality risk in the senior age group. The urban-rural difference in birth cohort effect indicated a reversal around the birth cohort group of 1962-1966, after which rural females had a higher mortality risk than urban females.

CONCLUSION

The area (urban, rural) could affect breast cancer mortality among women, and the effect of urban-rural difference varies with age and birth cohort. To promote the health of urban and rural females, the gap between urban and rural areas should be shorten.

Associations Between Brain Structural Connectivity and 1-Year Demoralization in Breast Cancer: A Longitudinal Diffusion Tensor Imaging Study

Purposes: This study aims to explore the association between brain structural connectivity and 1-year demoralization in patients with newly diagnosed breast cancer. Methods: Patients were enrolled from a multicenter longitudinal program named as Be Resilient to Breast Cancer (BRBC) between 2017 and 2019. Brain structural connectivity was assessed with diffusion tensor imaging (DTI) at baseline and the demoralization scale II collected self-report data at baseline and 1 year later. A data-driven correlational tractography was performed to recognize significant neural pathways associated with the group membership (increased vs. nonincreased demoralization). The incremental prediction values of Quantitative Anisotropy (QA) extracted from the significant white matter tracts against the group membership were evaluated. Results: 21.2% (N = 31) reported increased 1-year demoralization. Inferior fronto-occipital fasciculus (IFOF) was associated with 1-year demoralization in breast cancer. The incremental prediction values of QAs in net reclassification improvement (NRI) and integrated discrimination improvement (IDI) ranged from 8.11% to 46.89% and 9.12% to 23.95%, respectively, over the conventional tumor-nodal metatasis (TNM) staging model. Conclusion: Anisotropy in IFOF is a potential prediction neuromarker to 1-year demoralization in patients with newly diagnosed breast cancer. Trial Registration: ClinicalTrials.gov identifier: NCT03026374.

CircRNA hsa_circ_0003528/miR-215 is considered a potential target for predictive prognosis and therapy for triple-negative breast cancer

BACKGROUND

Within the subtypes of breast cancer pathologies, triple-negative breast cancer (TNBC) exhibits the highest degree of malignancy and unfavorable outcome, which has great significance in exploring the molecular mechanisms underlying TNBC. This study especially investigated the expression and function of hsa_circ_0003528 in TNBC.

METHODS

The expression changes of hsa_circ_0003528 were identified from the GEO database (GSE101123) and validated by RT-qPCR. The clinical significance of hsa_circ_0003528 was evaluated using χ2 tests and Kaplan-Meier curve analysis. Bioinformatic analysis and dual-luciferase reporter assay were used to identify the potential downstream miRNA of hsa_circ_0003528. The cellular experiments were conducted to evaluate the impact of hsa_circ_0003528 or/and miR-215 on TNBC cells.

RESULTS

The hsa_circ_0003528 was selected from the circRNA profile in breast cancer obtained from the GSE101123 dataset. hsa_circ_0003528 expression levels were increased in breast cancer tissues, especially in TNBC tissues. The elevated expression of hsa_circ_0003528 was negatively associated with TNBC patients' overall survival. Silencing of hsa_circ_0003528 hindered the proliferative potential, migration abilities, and invasive capacities of TNBC cells, while downregulation of miR-215 partially diminished the effects of si-hsa_circ_0003528 on TNBC cells.

CONCLUSION

hsa_circ_0003528 is upregulated in TNBC and can facilitate aggressive cellular behaviors by regulating miR-215 expression, hinting at its potential as a biomarker and therapeutic target in the treatment of TNBC.

Initial ribociclib plus endocrine therapy for HR+/HER2- advanced breast cancer in pre- and postmenopausal Chinese women: Primary results from a phase 2 randomized study

Background

The MONALEESA‐7 and ‐2 phase 3 randomized trials demonstrated a statistically significant progression‐free survival (PFS) and overall survival (OS) benefit with initial ribociclib + endocrine therapy (ET) versus placebo + ET in pre‐ and postmenopausal patients with hormone receptor–positive (HR+)/human epidermal growth factor receptor 2–negative (HER2−) advanced breast cancer (ABC), respectively. Similar trends were observed in Asian subgroup analyses. This phase 2 bridging study of initial ET + ribociclib enrolled pre‐ and postmenopausal patients with HR+/HER2– ABC from China and was conducted to demonstrate consistency of PFS results in a Chinese population relative to the global MONALEESA‐7 and ‐2 studies.

Methods

Patients were randomized (1:1) to ET (nonsteroidal aromatase inhibitor + goserelin for premenopausal patients; letrozole for postmenopausal patients) + either ribociclib or placebo. The primary endpoint was investigator‐assessed PFS.

Results

As of April 25, 2022, the median follow‐up was 34.7 months in both cohorts. In the premenopausal cohort, median PFS was 27.6 months in the ribociclib arm (n = 79) versus 14.7 months in the placebo arm (n = 77) (hazard ratio 0.67 [95% CI: 0.45, 1.01]). In the postmenopausal cohort, median PFS was not reached in the ribociclib arm versus 18.5 months in the placebo arm (n = 77 in each arm) (hazard ratio 0.40 [95% CI: 0.26, 0.62]). Data also suggested improvements in secondary efficacy endpoints, although OS data were not mature. The safety profile in this population was consistent with that in global studies.

Conclusions

These data demonstrate a favorable benefit–risk profile for ribociclib + ET in Chinese patients.

Use of ultrasound imaging Omics in predicting molecular typing and assessing the risk of postoperative recurrence in breast cancer

BACKGROUND

The aim of this study is to assess the efficacy of a multiparametric ultrasound imaging omics model in predicting the risk of postoperative recurrence and molecular typing of breast cancer.

METHODS

A retrospective analysis was conducted on 534 female patients diagnosed with breast cancer through preoperative ultrasonography and pathology, from January 2018 to June 2023 at the Affiliated Cancer Hospital of Xinjiang Medical University. Univariate analysis and multifactorial logistic regression modeling were used to identify independent risk factors associated with clinical characteristics. The PyRadiomics package was used to delineate the region of interest in selected ultrasound images and extract radiomic features. Subsequently, radiomic scores were established through Least Absolute Shrinkage and Selection Operator (LASSO) regression and Support Vector Machine (SVM) methods. The predictive performance of the model was assessed using the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) was calculated. Evaluation of diagnostic efficacy and clinical practicability was conducted through calibration curves and decision curves.

RESULTS

In the training set, the AUC values for the postoperative recurrence risk prediction model were 0.9489, and for the validation set, they were 0.8491. Regarding the molecular typing prediction model, the AUC values in the training set and validation set were 0.93 and 0.92 for the HER-2 overexpression phenotype, 0.94 and 0.74 for the TNBC phenotype, 1.00 and 0.97 for the luminal A phenotype, and 1.00 and 0.89 for the luminal B phenotype, respectively. Based on a comprehensive analysis of calibration and decision curves, it was established that the model exhibits strong predictive performance and clinical practicability.

CONCLUSION

The use of multiparametric ultrasound imaging omics proves to be of significant value in predicting both the risk of postoperative recurrence and molecular typing in breast cancer. This non-invasive approach offers crucial guidance for the diagnosis and treatment of the condition.

A nomogram for predicting the risk of cancer-related cognitive impairment in breast cancer patients based on a scientific symptom model

Cancer-related cognitive impairment is a significant clinical challenge observed in patients with breast cancer, manifesting during or after treatment. This impairment leads to deteriorations in memory, processing speed, attention, and executive functioning, which profoundly impact patients' occupational performance, daily living activities, and overall quality of life. Grounded in the Symptom Science Model 2.0, this study investigates the contributing factors to Cancer-related cognitive impairment in breast cancer patients and develops a predictive nomogram for this demographic. Employing both univariate and multivariate logistic regression analyses, this investigation delineates the predictive factors influencing outcomes in breast cancer patients. A nomogram was constructed leveraging these identified predictive factors, accompanied by internal validation through bootstrap resampling methodology (1000 bootstrap samples). The efficacy of the predictive model was assessed by employing the Hosmer-Lemeshow goodness-of-fit test and calibration curves. The prevalence of cognitive impairment in breast cancer patients was identified to be 45.83%.Multivariate logistic regression analysis identified the independent predictors of Cancer-related cognitive impairment in breast cancer patients as place of residence, educational level, chemotherapy, benefit finding, post-traumatic growth, anxiety, fear of cancer progression, and fasting blood glucose levels. these factors were integrated into the nomogram. The Hosmer-Lemeshow goodness-of-fit test demonstrated that the prediction model was appropriately calibrated (χ2 = 11.520, P = 0.174). Furthermore, the model exhibited an area under the curve of 0.955 (95% CI 0.939 to 0.971) and a sensitivity of 0.906, evidencing its robust discriminative capacity and accuracy. Utilizing the Symptom Science Model 2.0 as a framework, this study comprehensively examines the multifaceted factors influencing Cancer-related cognitive impairment in breast cancer patients, spanning five critical domains: complex symptoms, phenotypic characterization, biobehavioral factors, social determinants of health, and patient-centered experiences. A predictive nomogram model was established, demonstrating satisfactory predictive accuracy and capability. This model is capable of identifying breast cancer patients with cognitive impairments with high precision. The findings furnish empirical evidence in support of the early detection, diagnosis, and intervention strategies for high-risk breast cancer patients afflicted with Cancer-related cognitive impairment.

Rujifang inhibits triple-negative breast cancer growth via the PI3K/AKT pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Rujifang (RJF) constitutes a traditional Chinese medicinal compound extensively employed in the management of triple-negative breast cancer (TNBC). However, information regarding its potential active ingredients, antitumor effects, safety, and mechanism of action remains unreported.

AIM OF THE STUDY

To investigate the efficacy and safety of RJF in the context of TNBC.

MATERIALS AND METHODS

We employed the ultra high-performance liquid chromatography-electrospray four-pole time-of-flight mass spectrometry technique (UPLC/Q-TOF-MS/MS) to scrutinize the chemical constituents of RJF. Subcutaneously transplanted tumor models were utilized to assess the impact of RJF on TNBC in vivo. Thirty female BLAB/c mice were randomly divided into five groups: the model group, cyclophosphamide group, and RJF high-dose, medium-dose, and low-dose groups. A total of 1 × 106 4T1 cells were subcutaneously injected into the right shoulder of mice, and they were administered treatments for a span of 28 days. We conducted evaluations on blood parameters, encompassing white blood cell count (WBC), red blood cell count (RBC), hemoglobin (HGB), platelet count (PLT), neutrophils, lymphocytes, and monocytes, as well as hepatorenal indicators including alkaline phosphatase (ALP), glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), albumin, and creatinine (CRE) to gauge the safety of RJF. Ki67 and TUNEL were detected via immunohistochemistry and immunofluorescence, respectively. We prepared RJF drug-containing serum for TNBC cell lines and assessed the in vitro inhibitory effect of RJF on tumor cell growth through the CCK8 assay and cell cycle analysis. RT-PCR was employed to detect the mRNA expression of cyclin-dependent kinase and cyclin-dependent kinase inhibitors in tumor tissues, and Western blot was carried out to ascertain the expression of cyclin and pathway-related proteins.

RESULTS

100 compounds were identified in RJF, which consisted of 3 flavonoids, 24 glycosides, 18 alkaloids, 3 amino acids, 8 phenylpropanoids, 6 terpenes, 20 organic acids, and 18 other compounds. In animal experiments, both CTX and RJF exhibited substantial antitumor effects. RJF led to an increase in the number of neutrophils in peripheral blood, with no significant impact on other hematological indices. In contrast, CTX reduced red blood cell count, hemoglobin levels, and white blood cell count, while increasing platelet count. RJF exhibited no discernible influence on hepatorenal function, whereas Cyclophosphamide (CTX) decreased ALP, GOT, and GPT levels. Both CTX and RJF reduced the expression of Ki67 and heightened the occurrence of apoptosis in tumor tissue. RJF drug-containing serum hindered the viability of 4T1 and MD-MBA-231 cells in a time and concentration-dependent manner. In cell cycle experiments, RJF diminished the proportion of G2 phase cells and arrested the cell cycle at the S phase. RT-PCR analysis indicated that RJF down-regulated the mRNA expression of CDK2 and CDK4, while up-regulating that of P21 and P27 in tumor tissue. The trends in CDKs and CDKIs protein expression mirrored those of mRNA expression. Moreover, the PI3K/AKT pathway displayed downregulation in the tumor tissue of mice treated with RJF.

CONCLUSION

RJF demonstrates effectiveness and safety in the context of TNBC. It exerts anti-tumor effects by arresting the cell cycle at the S phase through the PI3K-AKT pathway.

Historical trends of breast cancer burden attributable to metabolic factors among Chinese women, 1990-2019: A population-based epidemiological study

BACKGROUND

 This study aims to analyze breast cancer burden attributable to high body mass index (BMI) and high fasting plasma glucose (FPG) in China from 1990 to 2019.

METHODS

Data were obtained from the Global Burden of Disease (GBD) study 2019. Deaths and disability-adjusted life years (DALYs) were used for attributable burden, and age-period-cohort (APC) model was used to evaluate the independent effects of age, period and birth cohort.

RESULTS

In 2019, the age-standardized mortality and DALY rates of breast cancer attributable to high BMI were 1.107 (95% UI: 0.311, 2.327) and 29.990 (8.384, 60.713) per 100 000, and mortality and DALY rates attributable to high FPG were 0.519 (0.095, 1.226) and 13.662 (2.482, 32.425) per 100 000. From 1990 to 2019, the age-standardized mortality and DALY rates of breast cancer attributable to high BMI increased by 1.192% and 1.180%, and the trends of high FPG were not statistically significant. The APC results showed that the age effects of high BMI and high FPG-mortality and DALY rates increased, with the highest rates in the age group over 80 years. The birth cohort effects of high BMI showed "inverted V" shapes, while high FPG showed downward trends.

CONCLUSIONS

Age was the main reason for the increase of attributable burden, and postmenopausal women were the high-risk groups. Therefore, targeted prevention measures should be developed to improve postmenopausal women's awareness and effectively reduce the prevalence of obesity and diabetes, thereby reducing the breast cancer burden caused by metabolic factors in China.

Brain Connectomics Improve the Prediction of High-Risk Depression Profiles in the First Year following Breast Cancer Diagnosis

Background

Prediction of high-risk depression trajectories in the first year following breast cancer diagnosis with fMRI-related brain connectomics is unclear.

Methods

The Be Resilient to Breast Cancer (BRBC) study is a multicenter trial in which 189/232 participants (81.5%) completed baseline resting-state functional magnetic resonance imaging (rs-fMRI) and four sequential assessments of depression (T0-T3). The latent growth mixture model (LGMM) was utilized to differentiate depression profiles (high vs. low risk) and was followed by multivoxel pattern analysis (MVPA) to recognize distinct brain connectivity patterns. The incremental value of brain connectomics in the prediction model was also estimated.

Results

Four depression profiles were recognized and classified into high-risk (delayed and chronic, 14.8% and 12.7%) and low-risk (resilient and recovery, 50.3% and 22.2%). Frontal medial cortex and frontal pole were identified as two important brain areas against the high-risk profile outcome. The prediction model achieved 16.82-76.21% in NRI and 12.63-50.74% in IDI when brain connectomics were included.

Conclusion

Brain connectomics can optimize the prediction against high-risk depression profiles in the first year since breast cancer diagnoses.

Case report: From negative to positive: a remarkable journey of ER, PR and HER2 status in a patient with metastatic breast cancer

Breast cancer is the most common malignant tumor in women, posing a serious threat to women's health. HER2 has been identified as a key oncogene and prognostic factor in breast cancer. Recent studies have reported inconsistencies in ER, PR, and/or HER2 expression between primary breast tumors and metastatic lesions. Rarely is it reported that all three biomarkers experience conversion. In this report, we present the case of a female patient with relapsed and metastatic breast cancer, whose histology transformed from initially triple-negative to Luminal-B type (HER2 positive) (i.e., ER, PR, and HER2 positive). She underwent systematic chemotherapy, targeted therapy, and cranial radiotherapy, which was followed by maintenance treatment with targeted and endocrine therapy. Currently, she has been in nearly complete remission (nCR) for more than 12 months. For recurrent and metastatic breast cancer, it is necessary to perform the second biopsy for metastases, which would contribute to precision treatment and prognosis improvement.

The association between mammographic density and breast cancer risk in Chinese women: a systematic review and meta-analysis

PURPOSE

Breast density has consistently been shown to be an independent risk factor for breast cancer in Western populations; however, few studies have evaluated this topic in Chinese women and there is not yet a unified view. This study investigated the association between mammographic density (MD) and breast cancer risk in Chinese women.

METHODS

The PubMed, Cochrane Library, Embase, and Wanfang databases were systematically searched in June 2023 to include all studies on the association between MD and breast cancer risk in Chinese women. A total of 13,977 breast cancer cases from 14 studies were chosen, including 10 case-control/cross-sectional studies, and 4 case-only studies. For case-control/cross-sectional studies, the odds ratios (ORs) of MD were combined using random effects models, and for case-only studies, relative odds ratios (RORs) were combinations of premenopausal versus postmenopausal breast cancer cases.

RESULTS

Women with BI-RADS density category II-IV in case-control/cross-sectional studies had a 0.93-fold (95% confidence interval [CI] 0.55, 1.57), 1.08-fold (95% CI 0.40, 2.94), and 1.24-fold (95% CI 0.42, 3.69) higher risk compared to women with the lowest density category. Combined RORs for premenopausal versus postmenopausal women in case-only studies were 3.84 (95% CI 2.92, 5.05), 22.65 (95% CI 7.21, 71.13), and 42.06 (95% CI 4.22, 419.52), respectively, for BI-RADS density category II-IV versus I.

CONCLUSIONS

For Chinese women, breast cancer risk is weakly associated with MD; however, breast cancer risk is more strongly correlated with mammographic density in premenopausal women than postmenopausal women. Further research on the factors influencing MD in premenopausal women may provide meaningful insights into breast cancer prevention in China.

Influence of postdiagnostic aspirin use on clinical outcomes of women with breast cancer: a meta-analysis

We examined the association between postdiagnostic aspirin use and recurrence and disease-specific mortality among women with breast cancer in a meta-analysis. The PubMed, Embase, and Web of Science databases were searched to identify observational studies with longitudinal follow-ups according to the aim of the meta-analysis. Combining the results was achieved using a random-effects model that included inter-study heterogeneity. Fifteen cohort studies with 131,636 women with breast cancer were included. Based on a meta-analysis, women who took aspirin after being diagnosed with breast cancer had a lower risk of breast cancer recurrence (adjusted risk ratio [RR]: 0.77, 95 percent confidence interval [CI]: 0.63 to 0.95, P = .02; I2 = 72 percent) and breast cancer specific mortality (adjusted RR: 0.73, 95 percent CI: 0.60 to 0.90, P = .004; I2 = 80 percent) than those who did not use aspirin. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluations scoring system showed moderate certainty for both the outcomes because significant inconsistency was observed. In conclusion, aspirin use after diagnosis might be associated with reduced recurrence and disease-specific mortality in women with breast cancer.

Triglyceride-glucose index is a risk factor for breast cancer in China: a cross-sectional study

BACKGROUND

This research delved into the association between the risk of the Chinese population suffering from breast cancer (BC) and the triglyceride-glucose (TyG) index.

METHODS

A total of 2,111 sufferers with benign breast disease (BBD) and 477 sufferers with BC were enrolled, and their TyG index was measured. Participants with varying TyG index values were categorized into quartiles. Logistic regression analysis was employed to assess the relationship between the TyG index and BC risk. The diagnostic performance of the TyG index for different stages of BC was measured using the receiver operating characteristic (ROC) curve.

RESULTS

The TyG index of BC sufferers exceeded that of BBD (P < 0.001). A continuous increase in the risk of BC was found to be positively correlated with an ever-increasing TyG index. In the unadjusted model, the risk of getting BC mounted with quartiles of the TyG index growing (P < 0.001). In a logistic regression analysis that included all confounders, the highest quartile of the TyG index was strongly linked to BC risk [1.43 (1.01, 2.02), P < 0.05]. Moreover, with the adjustment of potential confounders, a high TyG index was found to result in a 2.53-fold higher risk of being diagnosed with advanced BC.

CONCLUSIONS

The risen TyG index was positively correlated to the heightening risk of BC and had the potential to serve as a promising biomarker for BC. Individuals with a high TyG index ought to be mindful of the heightened risk of BC onset and progression.

Cancer Burden and Attributable Risk Factors of Cancers in China: Epidemiological Insights and Comparisons With India

BACKGROUND

Cancer is a major health concern in China. Understanding the epidemiology of cancer can guide the development of effective prevention and control strategies. This study aimed to comprehensively analyze the cancer burden, time trends, and attributable risk factors of cancers in China and compare them with those in India.

METHODS

We utilized the GLOBOCAN database for 2022, Cancer Incidence in Five Continents (C15 plus) series, and Global Burden of Disease (GBD) 2021 to extract data on cancer incidence, mortality, disability-adjusted life years (DALYs), and risk factors. Time-trend analysis was performed using a join-point regression model. Correlations between cancer DALY rates and risk factors were analyzed using linear regression.

RESULTS

In 2022, China experienced 4,824,703 new cancer cases and 2,574,176 cancer-related deaths. Cancers also caused approximately 71.2 million DALYs in China in 2021. Compared with India, China has higher incidence, mortality, and DALY rates for various cancers. Breast and thyroid cancers in China have shown a rapid increase in the age-standardized incidence rate (ASIR), along with a substantial burden of lung, stomach, esophageal, and colorectal cancer. However, stomach and liver cancers in China showed a downward trend in ASIR. In 2021, diet low in milk was a major risk factor among females for colorectal cancer DALYs in China (23% of age-standardized DALYs) and India (22.9%). In China, smoking has been associated with increased DALYs due to lung cancer.

CONCLUSIONS

China has a heavier cancer burden than India. The heavy burden of lung, stomach, esophageal, and colorectal cancers, combined with the rising incidence of breast and thyroid cancers, pose a critical challenge to public health in China. Cancer burden may be reduced through public health initiatives that prioritize primary prevention, prompt identification, and therapeutic intervention.

Prediabetes and the risk of breast cancer: a meta-analysis

Background

Diabetes has been related to a higher risk of breast cancer (BC) in women. However, it remains unknown whether the incidence of BC is increased in women with prediabetes. A systematic review and meta-analysis was therefore performed to evaluate the relationship between prediabetes and risk of BC.

Methods

Observational studies with longitudinal follow-up relevant to the objective were found via searching Medline, Embase, Cochrane Library, and Web of Science. A fixed- or random-effects model was used to pool the results depending on heterogeneity.

Results

Eight prospective cohort studies and two nest case-control studies were included. A total of 1069079 community women were involved, and 72136 (6.7%) of them had prediabetes at baseline. During a mean duration follow-up of 9.6 years, 9960 (0.93%) patients were diagnosed as BC. Pooled results with a fixed-effects model showed that women with prediabetes were not associated with a higher incidence of BC as compared to those with normoglycemia (risk ratio: 0.99, 95% confidence interval: 0.93 to 1.05, p = 0.72) with mild heterogeneity (p for Cochrane Q test = 0.42, I2 = 3%). Subgroup analyses showed that study characteristics such as study design, menopausal status of the women, follow-up duration, diagnostic criteria for prediabetes, methods for validation of BC cases, and study quality scores did not significantly affect the results (p for subgroup analyses all > 0.05).

Conclusion

Women with prediabetes may not be associated with an increased risk of BC as compared to women with normoglycemia.

Potential of Dietary HDAC2i in Breast Cancer Patients Receiving PD-1/PD-L1 Inhibitors

Breast cancer (BC) is a lethal malignancy with high morbidity and mortality but lacks effective treatments thus far. Despite the introduction of immune checkpoint inhibitors (ICIs) (including PD-1/PD-L1 inhibitors), durable and optimal clinical benefits still remain elusive for a considerable number of BC patients. To break through such a dilemma, novel ICI-based combination therapy has been explored for enhancing the therapeutic effect. Recent evidence has just pointed out that the HDAC2 inhibitor (HDAC2i), which has been proven to exhibit an anti-cancer effect, can act as a sensitizer for ICIs therapy. Simultaneously, dietary intervention, as a crucial supportive therapy, has been reported to provide ingredients containing HDAC2 inhibitory activity. Thus, the novel integration of dietary intervention with ICIs therapy may offer promising possibilities for improving treatment outcomes. In this study, we first conducted the differential expression and prognostic analyses of HDAC2 and BC patients using the GENT2 and Kaplan-Meier plotter platform. Then, we summarized the potential diet candidates for such an integrated therapeutic strategy. This article not only provides a whole new therapeutic strategy for an HDAC2i-containing diet combined with PD-1/PD-L1 inhibitors for BC treatment, but also aims to ignite enthusiasm for exploring this field.