Estimates of past and future time trends in age-specific breast cancer incidence among women in Karachi, Pakistan: 2004-2025

Fully Interpretable Deep Learning Model Using IR Thermal Images for Possible Breast Cancer Cases

Breast cancer remains a global health problem requiring effective diagnostic methods for early detection, in order to achieve the World Health Organization's ultimate goal of breast self-examination. A literature review indicates the urgency of improving diagnostic methods and identifies thermography as a promising, cost-effective, non-invasive, adjunctive, and complementary detection method. This research explores the potential of using machine learning techniques, specifically Bayesian networks combined with convolutional neural networks, to improve possible breast cancer diagnosis at early stages. Explainable artificial intelligence aims to clarify the reasoning behind any output of artificial neural network-based models. The proposed integration adds interpretability of the diagnosis, which is particularly significant for a medical diagnosis. We constructed two diagnostic expert models: Model A and Model B. In this research, Model A, combining thermal images after the explainable artificial intelligence process together with medical records, achieved an accuracy of 84.07%, while model B, which also includes a convolutional neural network prediction, achieved an accuracy of 90.93%. These results demonstrate the potential of explainable artificial intelligence to improve possible breast cancer diagnosis, with very high accuracy.

CK5/6 Expression in Molecular Subtypes of Invasive Ductal Carcinoma

Background Breast cancer (BC) is the leading cause of cancer-related deaths in women worldwide. There has been a significant increase in the incidence of BC in Pakistan. Family history, older age, obesity, tobacco use, oral contraceptive use, early menarche, and hormonal replacement therapy are among the major risk factors. The most common histological subtype of BC is invasive ductal carcinoma (IDC). Molecular subtypes of BC include mainly Luminal A, Luminal B, human epidermal growth factor receptor 2 (HER-2) enriched, and triple-negative BC subtypes, with the triple-negative subtype having the worst prognosis. CK5/6 serves as a basal keratin biomarker. This aimed to assess the expression of CK5/6 in IDC of the breast belonging to different molecular classes and to compare its expression with traditionally defined prognostic factors for different molecular subtypes. Methodology A cross-sectional, observational study was conducted at the Chughtai Institute of Pathology after approval from the Institutional Review Board (approval number: 1198/IRB/CIP). All cases during a period of six months (April 2023 to September 2023) were sampled using non-probability convenient sampling. All mastectomy samples diagnosed as IDC were included in the study. After standard tissue processing, paraffin tissue blocks and slides were prepared followed by hematoxylin & eosin staining. Hormonal receptors (estrogen receptor, progesterone receptor, HER-2) were assessed for cases to segregate them into molecular subtypes. CK5/6 antibody was then applied and the data were collected on a pre-designed proforma. SPSS version 25.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results Of a total of 85 cases, 19 (22.3%) were positive for CK5/6. Of these 19 cases, the majority (68%, p = 0.001) belonged to the triple-negative class of tumors, comprising 13 cases. No case from the Luminal A class showed expression for CK5/6 stain (p = 0.028). Overall, four cases of the Luminal B subtype showed CK5/6 positivity (10.8%, p = 0.022) while two cases of the HER-2-enriched subtype were positive for the stain (33.3%, p > 0.05). These results were analyzed in relation to different prognostic factors. The majority of CK5/6-positive cases showed lymphovascular invasion (42%) and belonged to grade 3 tumors (57.8%). Conclusions The expression of CK5/6 in IDC of the breast is associated with poor prognostic factors such as triple-negative molecular subtypes, high histological grade, lymphovascular invasion, positive nodal status, and high pathological stage.

Assessing Awareness, Attitude, and Practices of Breast Cancer Screening and Prevention Among General Public and Physicians in Pakistan: A Nation With the Highest Breast Cancer Incidence in Asia

Introduction: Breast cancer is a global health challenge with significant mortality, affecting millions worldwide. The current study is aimed at evaluating awareness and practices related to breast cancer screening, prevention, and treatment among the general public and physicians in Lahore, Pakistan, which has a significant incidence of breast cancer. Methodology: The current study adopted a cross-sectional study design conducted in Lahore, Pakistan, between March and August 2023, among 404 participants from the general public and 240 physicians. Data collection and evaluation involved the use of validated questionnaires, and both descriptive and inferential statistics were performed using SPSS Version 25. Result: In Lahore, Pakistan, breast cancer awareness among the public was low, with 80.2% unaware of its global prevalence, 65.3% believing not everyone is at risk, and only 42.1% recognizing symptoms. Females showed greater awareness (OR: 1.020, CI: 0.617-1.686, p = 0.002) and positive attitudes (OR: 2.711, CI: 1.478-6.478, p = 0.045), while the 18-29 age group had higher odds of positive practices (OR: 4.317, CI: 2.678-5.956, p = 0.004). Educational attainment significantly influences knowledge and attitudes. Only 13.9% practiced self-examination. Among physicians, 88.8% were confident in screenings, but patient fear (42.9%) and financial barriers (79.2%) hindered action. Physicians with FCPS qualifications had higher odds of awareness (OR: 1.550, CI: 1.130-2.117, p = 0.007), attitudes (OR: 1.500, CI: 1.050-2.150, p = 0.025), and practices (OR: 1.470, CI: 1.070-2.017, p = 0.020). Those with 11-20 years of experience also showed better awareness (OR: 1.400, CI: 1.050-1.868, p = 0.022) and attitudes (OR: 1.450, CI: 1.045-2.018, p = 0.029). Conclusion: In conclusion, breast cancer awareness among the general public is limited, highlighting the need for tailored education programs. Although most physicians show high awareness, challenges in patient communication and barriers, such as fear and financial constraints, must be addressed to improve screening uptake. These findings emphasize the importance of targeted interventions to enhance public awareness, screening practices, and physician-patient communication.

Early post-operative outcome of pre-pectoral implant-based immediate total breast reconstruction with Polyglactin 910 (Vicryl™) mesh - low cost solution for a low-middle income country

BACKGROUND

The incidence of breast cancer in Pakistan has been rising with approximately one third of these patients requiring mastectomy. Among breast reconstruction treatment options, the use of Acellular Dermal Matrix (ADM) for pre-pectoral breast implant surgery has proven effective with improved cosmetic outcome. However, due to high cost it cannot be regularly implemented in a developing country like Pakistan. An alternative to ADM, Polyglactin 910 (Vicryl™, Ethicon) mesh has been introduced in pre-pectoral breast reconstructive surgery which has shown to be almost 10 times lower in cost. We set out to determine the frequency of early postoperative complications when using Polyglactin 910 mesh for pre-pectoral implant-based breast reconstruction surgery.

METHODS

A single centre, retrospective, chart review was conducted, and a total 28 women were included in the study. Thirty-two pre-pectoral implant-based mastectomies with Polyglactin 910 mesh were performed. Early post-operative outcomes (within 12 months of procedure) including duration of antibiotic use, post-operative infection, implant displacement, flap necrosis, seroma formation, wound dehiscence, hematoma formation, capsular contracture and reconstruction failure, were recorded.

RESULTS

Only 4 (12.5%) women experienced early post-operative morbidity. One patient developed a wound dehiscence, which eventually led to reconstruction failure and removal of the implant. Another patient had seroma formation and flap necrosis. None of the patients developed postoperative implant displacement, hematoma formation or capsular contracture in the early post-operative period.

CONCLUSION

This study reveals that early post-operative outcomes with Polyglactin 910 mesh in breast reconstructive surgery are few, thus making it a cost effective, reliable, and safe treatment option, especially in developing countries like Pakistan.

Epidemiological breast cancer prediction by country: A novel machine learning approach

Breast cancer remains a significant contributor to cancer-related deaths among women globally. We seek for this study to examine the correlation between the incidence rates of breast cancer and newly identified risk factors. Additionally, we aim to utilize machine learning models to predict breast cancer incidence at a country level. Following an extensive review of the available literature, we have identified a range of recently studied risk factors associated with breast cancer. Subsequently, we gathered data on these factors and breast cancer incidence rates from numerous online sources encompassing 151 countries. To evaluate the relationship between these factors and breast cancer incidence, we assessed the normality of the data and conducted Spearman's correlation test. Furthermore, we refined six regression models to forecast future breast cancer incidence rates. Our findings indicate that the incidence of breast cancer is most positively correlated with the average age of women in a country, as well as factors such as meat consumption, CO2 emissions, depression, sugar consumption, tobacco use, milk intake, mobile cells, alcohol consumption, pesticides, and oral contraceptive use. As for prediction, the CatBoost Regressor successfully predicted future breast cancer incidence with an R squared value of 0.84 ± 0.03. An increased incidence of breast cancer is mainly associated with dietary habits and lifestyle. Our findings and recommendations can serve as a baseline for developing educational programs intended to heighten awareness amongst women in countries with heightened risk.

Leukemia in India: Insights Into Incidence, Prevalence, Mortality, and Disability-Adjusted Life Years

OBJECTIVE

This study aimed to examine the impact of leukemia and other cancers in India and to observe any changes over time.

METHODOLOGY

Detailed estimates of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for 30 types of cancers in India were analyzed for 29 years from 1990 to 2019 as part of the Global Burden of Diseases (GBD) study. Data from all available sources were used to gather information on the overall burden of disease in India.

RESULTS

Cancer is a leading cause of death worldwide, with varying rates of incidence in India, making prevention and treatment a challenge. Because cancer is not a reportable disease in India, the overall burden estimate is still a work in progress. This study analyzed the impact of leukemia and other cancers in India, including trends in incidence, DALYs, and mortality related to all cancers and various malignancies. The causes of leukemia in India were also explored.

CONCLUSIONS

The study found the trends of cancer types that account for the majority of leukemia-related and cancer-related DALYs, death, prevalence, and incidence in India. Among the four most frequent malignancies, such as leukemia, there was significant variation based on age. Over the last 29 years, mortality from chronic myelogenous leukemia (CML) and acute lymphocytic leukemia (ALL) has decreased, while deaths from acute myelogenous leukemia (AML) and chronic lymphocytic leukemia (CLL) have increased steadily.

Body mass index and altered lipid profile as major risk markers for breast cancer progression: a cross-sectional study of postmenopausal women in Pakistan

BACKGROUND

In Pakistan, the death rate for post-menopausal women with breast cancer is significant due to late detection and delayed referral to proper facilities. There are a few reports on Pakistan's epidemiology and breast cancer risk factors. There are modifiable and non-modifiable risk factors associated with the development of breast carcinoma; of which body mass index (BMI), central obesity, and lipid profile are considered as major risk markers.

METHODS

This was a cross-sectional analytical study. A total of 384 women constituted the present study sample. Purposive sampling was used to collect 192 confirmed new breast cancer cases throughout the study. By using basic random sampling, an equal number of controls were chosen. Studied parameters included age, fasting blood sugar, cholesterol, triglyceride, serum high-density lipoprotein, cholesterol, serum low-density lipoprotein cholesterol, weight, height, BMI, waist circumference, and waist-to-hip ratio. The inclusion criteria of this study were post-menopausal women (45-65 years) in Pakistan. The confirmation of breast carcinoma was done through histopathology. Breast cancer occurrence was taken as a dependent variable, whereas BMI, central obesity, and lipid profile were taken as independent variables.

RESULTS

Studied risk factors (cholesterol, BMI, and central obesity) significantly correlated with breast cancer. Cholesterol has a significantly high positive correlation (0.646) with breast cancer. BMI has a positive significant correlation (0.491) with breast cancer, and central obesity has a low but positive significant correlation (0.266) with breast cancer. Moreover, the binary logistic regression model also showed a significant association between biochemical factors and breast cancer occurrence. Regression analysis depicted a linear relationship between a dependent variable (breast cancer occurrence) and independent variables (central obesity, cholesterol, BMI).

CONCLUSION

Postmenopausal overweight (central obesity), increased BMI and high cholesterol levels are major risk factors for breast cancer. Moreover, high total cholesterol proved to be the most significant risk marker for the occurrence of breast cancer in post-menopausal women of Pakistan.

Cancer incidence in Iran in 2016: A study based on the Iranian National Cancer Registry

BACKGROUND

Cancer poses an escalating public health challenge, necessitating a comprehensive understanding of cancer incidence to formulate effective control strategies.

AIMS

This study aims to present a comprehensive overview of cancer incidence in Iran, utilizing data from the Iranian National Population-based Cancer Registry (INPCR) for the year 2016.

METHODS

The study employed INPCR data to compute crude and age-standardized incidence rates (ASR) per 100 000 for the most common cancers among men and women across Iran's 31 provinces. Data analysis utilized Excel (2019) and STATA 14.

RESULTS

In 2016, 124 833 new cancer cases were registered, with 65 495 (52.90%) occurring in men and 58 312 (47.10%) in women. ASRs for all cancers in the total population were 177.48, with specific rates for men and women at 192.96 and 162.33, respectively. The five most common cancers in men were prostate (23.25), stomach (21.56), colon (19.30), bladder (16.20), and lung (13.15). Among women, the leading cancers were breast (40.60), colon (14.64), thyroid (10.84), stomach (10.25), and lung (5.63). West Azarbaijan had the highest incidence among men, while Yazd topped the list for women. Age-specific incidence rates revealed peaks in the 67-74 age group for men and the 40-50 age group for women.

CONCLUSION

This study affirms that while Iran exhibits a lower cancer incidence compared to global averages, there has been a temporal increase. Disparities in ASR exist across sexes and provinces, with shifts in the ranking of common cancers by sex compared to previous reports.

Exploring Biomarkers in Breast Cancer: Hallmarks of Diagnosis, Treatment, and Follow-Up in Clinical Practice

Breast cancer is a prevalent malignancy in the present day, particularly affecting women as one of the most common forms of cancer. A significant portion of patients initially present with localized disease, for which curative treatments are pursued. Conversely, another substantial segment is diagnosed with metastatic disease, which has a worse prognosis. Recent years have witnessed a profound transformation in the prognosis for this latter group, primarily due to the discovery of various biomarkers and the emergence of targeted therapies. These biomarkers, encompassing serological, histological, and genetic indicators, have demonstrated their value across multiple aspects of breast cancer management. They play crucial roles in initial diagnosis, aiding in the detection of relapses during follow-up, guiding the application of targeted treatments, and offering valuable insights for prognostic stratification, especially for highly aggressive tumor types. Molecular markers have now become the keystone of metastatic breast cancer diagnosis, given the diverse array of chemotherapy options and treatment modalities available. These markers signify a transformative shift in the arsenal of therapeutic options against breast cancer. Their diagnostic precision enables the categorization of tumors with elevated risks of recurrence, increased aggressiveness, and heightened mortality. Furthermore, the existence of therapies tailored to target specific molecular anomalies triggers a cascade of changes in tumor behavior. Therefore, the primary objective of this article is to offer a comprehensive review of the clinical, diagnostic, prognostic, and therapeutic utility of the principal biomarkers currently in use, as well as of their clinical impact on metastatic breast cancer. In doing so, our goal is to contribute to a more profound comprehension of this complex disease and, ultimately, to enhance patient outcomes through more precise and effective treatment strategies.

Care for breast cancer survivors in Asian countries: A review of sexual dysfunction

Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.

Historical trends in breast cancer presentation among women in Pakistan from join-point regression analysis

Objective

Breast cancer prevalence in Pakistan is among the highest in Asian countries. Recent changes in the temporal trends of breast cancer are largely unknown and examination of these trends can provide a direction in national planning for future health programs. The aim of this study was to examine recent changes in breast cancer incidence in Pakistan.

Methods

A total of 9,771 diagnosed breast cancer women were registered from 2004 to 2015 in three hospitals of Karachi. Join-point regression analysis was applied to assessing the age-standardized breast cancer presentation trends for each five-year age group. Age-specific average annual percentage changes were also calculated to assess the proportion of women with increased or decreased incidence of breast cancer.

Results

Age-standardized rates of breast cancer steadily increased from 24.7 per 100,000 in 2004, to 45.4 per 100,000 in 2015. The analytical trend based on the join-point model showed an average percentage increase breast cancer prevalence of 5.4 (95% CI = 3.1, 7.8). Significantly higher prevalence rates were identified among women aged 40-44 years and 65-69 years with an average percentage change of 18.5 (95% CI = 2.3, 37.2) and 14.3 (95% CI = 2.2, 27.9) respectively in the four years from 2011 to 2015.

Conclusion

The findings indicate the trend in age-standardized prevalence increased significantly in all age groups with noticeably larger increases observed among older and post-menopausal women from 2011 to 2015. The results warrant the need for more targeted interventions to high-risk groups and a sound foundation for cancer control program planning and policy development in Pakistan to reduce the increasing incidence of breast cancer.

Roles of lncRNA in the diagnosis and prognosis of triple-negative breast cancer

Breast cancer is a malignant tumor that seriously endangers women's lives. The prognosis of breast cancer patients differs among molecular types. Compared with other subtypes, triple-negative breast cancer (TNBC) has been a research hotspot in recent years because of its high degree of malignancy, strong invasiveness, rapid progression, easy of recurrence, distant metastasis, poor prognosis, and high mortality. Many studies have found that long non-coding RNA (lncRNA) plays an important role in the occurrence, proliferation, migration, recurrence, chemotherapy resistance, and other characteristics of TNBC. Some lncRNAs are expected to become biomarkers in the diagnosis and prognosis of TNBC, and even new targets for its treatment. Based on a PubMed literature search, this review summarizes the progress in research on lncRNAs in TNBC and discusses their roles in TNBC diagnosis, prognosis, and chemotherapy with the hope of providing help for future research.

Advantages of contrast-enhanced ultrasound in the localization and diagnostics of sentinel lymph nodes in breast cancer

Sentinel lymph nodes (SLNs) are the first station of lymph nodes that extend from the breast tumor to the axillary lymphatic drainage. The pathological status of these LNs can predict that of the entire axillary lymph node. Therefore, the accurate identification of SLNs is necessary for sentinel lymph node biopsy (SLNB) to replace axillary lymph node dissection (ALND). The quality of life and prognosis of breast cancer patients are related to proper surgical treatment after the precise identification of SLNs. Some of the SLN tracers that have been identified include radioisotope, nano-carbon, indocyanine green (ICG), and methylene blue (MB). However, these tracers have certain limitations, such as pigmentation, radiation dangers, and the requirement for costly detection equipment. Ultrasound contrast agents (UCAs) have good specificity and sensitivity, and thus can compensate for some shortcomings of the mentioned tracers. This technique is also being applied to SLNB in patients with breast cancer, and can even provide an initial judgment on SLN status. Contrast-enhanced ultrasound (CEUS) has the advantages of high distinguishability, simple operation, no radiation harm, low cost, and accurate localization; therefore, it is expected to replace the traditional biopsy methods. In addition, it can significantly enhance the accuracy of SLN localization and shorten the operation time.

Mutational Landscape and In-Silico Analysis of TP53, PIK3CA, and PTEN in Patients with Breast Cancer from Khyber Pakhtunkhwa

Herein, we report the mutational spectrum of three breast cancer candidate genes (TP53, PIK3CA, and PTEN) using WES for identifying potential biomarkers. The WES data were thoroughly analyzed using SAMtools for variant calling and identification of the mutations. Various bioinformatic tools (SIFT, PolyPhen-2, Mutation Taster, ISPRED-SEQ, SAAFEQ-SEQ, ConSurf, PROCHECK etc.) were used to determine the pathogenicity and nature of the SNVs. Selected interaction site (IS) mutations were visualized in PyMOL after building 3D structures in Swiss-Model. Ramachandran plots were generated by using the PROCHECK server. The selected IS mutations were subjected to molecular dynamic simulation (MDS) studies using Gromacs 4.5. STRING and GeneMANIA were used for the prediction of gene-gene interactions and pathways. Our results revealed that the luminal A molecular subtype of the breast cancer was most common, whereas a high percentage of was Her2 negatives. Moreover, the somatic mutations were more common as compared to the germline mutations in TP53, PIK3CA, and PTEN. 20% of the identified mutations are reported for the first time from Khyber Pakhtunkhwa. In the enrolled cohort, 23 mutations were nonsynonymous SNVs. The frequency of mutations was the highest in PIK3CA, followed by TP53 and PTEN. A total of 13 mutations were found to be highly pathogenic. Four novel mutations were identified on PIK3CA and one each on PTEN and TP53. SAAFEQ-SEQ predicted the destabilizing effect for all mutations. ISPRED-SEQ predicted 9 IS mutations (6 on TP53 and 3 on PIK3CA), whereas no IS mutation was predicted on PTEN. The TP53 IS mutations were TP53R43H, TP53Y73X, TP53K93Q, TP53K93R, TP53D149E, and TP53Q199X; whereas for PIK3CA, the IS mutations were PIK3CAL156V, PIK3CAM610K, and PIK3CAH1047R. Analysis from the ConSurf Web server revealed five SNVs with a highly conserved status (conservation score 9) across TP53 and PTEN. TP53P33R was found predominant in the grade 3 tumors, whereas PTENp.C65S was distributed on ER+, ER-, PR+, PR-, Her2+, and Her2- patients. TP53p.P33R mutation was found to be recurring in the 14/19 (73.6%) patients and, therefore, can be considered as a potential biomarker. Finally, these mutations were studied in the context of their potential association with different hormonal and social factors.

Global epidemiology of breast cancer based on risk factors: a systematic review

BACKGROUND

Numerous reviews of the epidemiology and risk factors for breast cancer have been published previously which heighted different directions of breast cancer.

AIM

The present review examined the likelihood that incidence, prevalence, and particular risk factors might vary by geographic region and possibly by food and cultural practices as well.

METHODS

A systematic review (2017-2022) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, reporting on epidemiological and risk factor reports from different world regions. Medical Subject Heading (MeSH) terms: "Breast neoplasm" "AND" country terms such as "Pakistan/epidemiology", "India/epidemiology", "North America/epidemiology", "South Africa/epidemiology" were used to retrieve 2068 articles from PubMed. After applying inclusion and exclusion terms, 49 papers were selected for systematic review.

RESULTS

Results of selected articles were summarized based on risk factors, world regions and study type. Risk factors were classified into five categories: demographic, genetic and lifestyle risk factors varied among countries. This review article covers a variety of topics, including regions, main findings, and associated risk factors such as genetic factors, and lifestyle. Several studies revealed that lifestyle choices including diet and exercise could affect a person's chance of developing breast cancer. Breast cancer risk has also been linked to genetic variables, including DNA repair gene polymorphisms and mutations in the breast cancer gene (BRCA). It has been found that most of the genetic variability links to the population of Asia while the cause of breast cancer due to lifestyle modifications has been found in American and British people, indicating that demographic, genetic, and, lifestyle risk factors varied among countries.

CONCLUSION

There are many risk factors for breast cancer, which vary in their importance depending on the world region. However, further investigation is required to better comprehend the particular causes of breast cancer in these areas as well as to create efficient prevention and treatment plans that cater to the local population.

Frequency of axillary nodal complete pathological response of breast cancer patients in neoadjuvant chemotherapy setting: A cross-sectional study

Objectives

Pathological complete response (pCR) occurs in about 20-30% of patients undergoing systemic neoadjuvant therapy. This leads to the idea of sparing the patient the morbidity associated with axillary surgery. "Wait and watch" policy for cancers which achieve complete pathological response on neoadjuvant systemic therapy is a well-established practice in various cancers like the esophagus, rectum and larynx. This has led to organ preservation protocols being practiced worldwide for these cancers without affecting the overall survival of the patient. We believe patients undergoing a complete pathological response in the breast may be spared axillary surgery. Axillary surgery leads to morbidity and extra financial burden with no added advantage in survival.

Material and Methods

A total of 326 patients with breast cancer who had received neoadjuvant systemic chemotherapy from 2015 to 2020 were included in our retrospective study. Final histopathology of the breast and axillary surgery was noted to report the frequency of complete pathological response. The frequency of positive nodal disease with respect to stage, grade and type of cancer was measured.

Results

Among 326 patients, our study showed that 53% of patients with complete pathological response in breast also had complete response in the axilla compared to 43% with incomplete pathological response. No significant difference was found for age, menopausal status, initial tumor size when patients with complete pathological response were compared to non or partial responders. The rate of complete pathological response was higher in patients with clinically node negative patients after NACT, hormone negative, HER2 positive and triple negative population.

Conclusion

Our results indicated that 53% of the patients who developed complete pathological response in the breast underwent needless axillary procedure. Axillary surgery can be staged after the breast surgery if residual tumor is present on the histopathological specimen. In case of pCR, omission of axillary surgery can be considered. However, a larger population, multi-centric studies are needed for treatment guidelines.

Clinical and Translational Applications of Serological and Histopathological Biomarkers in Metastatic Breast Cancer: A Comprehensive Review

Breast cancer is one of the most common malignancies worldwide and the most common form of cancer in women. A large proportion of patients begin with localized disease and undergo treatment with curative intent, while another large proportion of patients debuts with disseminated metastatic disease. In the last subgroup of patients, the prognosis in recent years has changed radically, given the existence of different targeted therapies thanks to the discovery of different biomarkers. Serological, histological, and genetic biomarkers have demonstrated their usefulness in the initial diagnosis, in the follow-up to detect relapses, to guide targeted treatment, and to stratify the prognosis of the most aggressive tumors in those with breast cancer. Molecular markers are currently the basis for the diagnosis of metastatic disease, given the wide variety of chemotherapy regions and existing therapies. These markers have been a real revolution in the therapeutic arsenal for breast cancer, and their diagnostic validity allows the classification of tumors with higher rates of relapse, aggressiveness, and mortality. In this sense, the existence of therapies targeting different molecular alterations causes a series of changes in tumor biology that can be assessed throughout the course of the disease to provide information on the underlying pathophysiology of metastatic disease, which allows us to broaden our knowledge of the different mechanisms of tissue invasion. Therefore, the aim of the present article is to review the clinical, diagnostic, predictive, prognostic utility and limitations of the main biomarkers available and under development in metastatic breast cancer.

In Vitro Analysis of Cytotoxic Activities of Monotheca buxifolia Targeting WNT/β-Catenin Genes in Breast Cancer Cells

Breast cancer (BC) is known to be the most common malignancy among women throughout the world. Plant-derived natural products have been recognized as a great source of anticancer drugs. In this study, the efficacy and anticancer potential of the methanolic extract of Monotheca buxifolia leaves using human breast cancer cells targeting WNT/β-catenin signaling was evaluated. We used methanolic and other (chloroform, ethyl acetate, butanol, and aqueous) extracts to discover their potential cytotoxicity on breast cancer cells (MCF-7). Among these, the methanol showed significant activity in the inhibition of the proliferation of cancer cells because of the presence of bioactive compounds, including phenols and flavonoids, detected by a Fourier transform infrared spectrophotometer and by gas chromatography mass spectrometry. The cytotoxic effect of the plant extract on the MCF-7 cells was examined by MTT and acid phosphatase assays. Real-time PCR analysis was performed to measure the mRNA expression of WNT-3a and β-catenin, along with Caspase-1,-3,-7, and -9 in MCF-7 cells. The IC50 value of the extract was found to be 232 μg/mL and 173 μg/mL in the MTT and acid phosphatase assays, respectively. Dose selection (100 and 300 μg/mL) was performed for real-time PCR, Annexin V/PI analysis, and Western blotting using Doxorubicin as a positive control. The extract at 100 μg/mL significantly upregulated caspases and downregulated the WNT-3a and β-catenin gene in MCF-7 cells. Western blot analysis further confirmed the dysregulations of the WNT signaling component (*** p< 0.0001). The results showed an increase in the number of dead cells in methanolic extract-treated cells in the Annexin V/PI analysis. Our study concludes that M. buxifolia may serve as an effective anticancer mediator through gene modulation that targets WNT/β-catenin signaling, and it can be further characterized using more powerful experimental and computational tools.

Pakistani healthcare professionals' perceptions of communication with patients and their relatives about hereditary breast cancer: a qualitative study in a LMIC

Pakistan has the highest incidence and mortality rates of breast cancer in Asia, with high numbers of patients diagnosed at a young age suggesting the possibility of an inherited cancer syndrome. Communication of hereditary breast cancer (HBC) risk information with patients could enable earlier detection of the condition in relatives and reduce mortality rates. This study aimed to explore perceptions of healthcare professionals (HCPs) in Pakistan about communication with patients and their relatives about HBC. Semi-structured qualitative interviews were conducted with eighteen HCPs during March to May 2020 in Lahore. Thematic analysis shows the HCPs were generally supportive of informing patients themselves about HBC, but believed it was the patients' role to inform their relatives. HCPs also highlighted important barriers to communication with patients about HBC, including (i) patients' low socioeconomic status and educational attainment; (ii) high prevalence of the social stigma of breast cancer; and (iii) lack of health resources and facilities to provide genetic testing for HBC. In conclusion, HCPs would value the development of interventions to support communication between HCPs and patients. They also highlighted the need for interventions to support intrafamilial communication about HBC. Much research and political support are needed to address patient, social, and systemic-level barriers to facilitate communication about HBC.

Ethnic predisposition, risk factors and breast cancer presentation; a 10-year data. Single centered prospective cohort study from Karachi

Background

Breast cancer, a leading cause of mortality among females, has been the center of research for many decades. Work is in progress to advance the research worldwide and in our region. This study is conducted to look into regional ethical predilection/age, clinical presentation/stage, pathological subtypes and risk factors of BC among patients of Karachi, with the aim of proposing a ground in our policy making regarding protocol setting for screening and management of BC patients.

Methods

A prospective cohort study started at public Hospital, Karachi from 2010 to 2020.500 females with histo-pathologically proven BC selected. History, clinical examination, radiological and histo-pathological data retrieved; data regarding age, ethnicity, family history, parity, marriage/menopause, stage/lump size/symptoms were filled on pro-forma. Primary outcomes were age, ethnicity, family history, stage/histological type and menopausal status of our cohort while secondary outcomes were parity, marriage, symptoms and lump size/site. Data analyzed using SPSS in ranges and percentages.

Results

Among different ethnicities, Makrani were the most affected(34%). Majority were premenopausal females ≤50yrs (78%). Infiltrating ductal carcinoma (88.8%) was the commonest subtype. Family history was positive in few (5.8%). Parity and marital status had no effect on our population. Breast lump (88%) was the commonest presenting symptom and 51% of our patients had the right side involved. Upper outer quadrant (51%) was the most involved quadrant and the majority (46%) were stage II.

Conclusions

Age of presentation is around a decade earlier in our region, with women of Makrani descent more prone to develop BC. 2/3rd of patients were premenopausal, with lump breast as primary complaint. Majority of patients presented in stage-II. Results of age and racial predilection in our population suggest us to concentrate future research more on genetic profiling so we incorporate the results to devise population specific protocols with reference to age, presentation, BC type, ethnicity & risk factors.

Record submitted retrospectively at ClinicalTrials.govt on 09-07-2022 NCT05458570.

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Regional ethical predilection, diagnosis age, clinical presentation, pathological subtypes and risk factors of BC among patients of Karachi, Pakistan.

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Need of institutional/national level guidelines for breast cancer, specific to our population parameters.

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Age of presentation is around a decade earlier in our population as compare to the West.

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Screening age criteria specific to our population should be proposed and implemented.

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Women of Makrani decent are the most affected ethnic group from Karachi, followed by Memons.

Persistent post-surgical pain and its relationship to health-related quality of life in Pakistani women after breast cancer surgery

Background

Breast cancer is the most commonly diagnosed cancer in women; it is also the second-leading cause of death from cancer. Persistent pain after breast cancer surgery is a serious clinical problem that negatively impacts the health-related quality of life of breast cancer survivors. Although persistent post-surgical pain following breast cancer surgery has long been under-reported; however, it is less explored in Pakistan's geographical background.

Objective

The study aimed to examine the persistent post-surgical pain after breast cancer surgery and its relationship to health-related quality of life among Pakistani women.

Methods

A descriptive correlational research design was employed in this study. The Brief Pain Inventory Short Form (BPI-SF) was used to assess the persistent post-surgical pain. The Functional Assessment of Cancer Therapy-Breast (FACT-B) was used to measure the health-related quality of life. Data were collected between February and May 2019 from Pakistani women who have undergone breast cancer surgery for at least three months and attended follow-up visits at two tertiary care hospitals in Pakistan. A Spearman's correlation coefficient was used for data analysis.

Results

The study included 91 Pakistani women. The participants were all females, with an average age of 45.6 years (SD = 6.53). The majority received radical mastectomy (n = 84, 92.3%) with adjuvant therapy (n = 91, 100%). The prevalence of breast surgery-related persistent pain was 100%, with 63 (69.2%) rating the pain as moderate to severe and reported neuropathic pain. The data analysis revealed a statistically significant negative correlation between BPI-SF items and FACT-B dimensions (r = -.43, p < 0.01). The participants appeared to show the highest score of the FACT-B in the social/family well-being (M = 16.58, SD = 3.44). The lowest score of the FACT-B was physical well-being (M = 6.98, SD = 6.38).

Conclusion

Persistent post-surgical pain has a negative impact on the health-related quality of life of Pakistani women breast cancer survivors, particularly on their physical well-being. Therefore, follow-up care of breast cancer survivors after treatment completion requires proper persistent pain-relief treatments and interventions to control pain and maintain health-related quality of life in oncology and research in this sphere. This basic knowledge from this study will enlighten the nurses and health care professionals to pay more attention to pain management and regular evaluation of persistent post-surgical pain after breast cancer surgery in order to improve their health-related quality of life.

Sentinel Lymph Node Mapping in Breast Cancer: Initial Experience of a Multidisciplinary Team

Introduction: Breast cancer is one of the leading causes of cancer-related deaths in women; it is the most frequently diagnosed cancer in women in the United States with a lifetime risk of dying of about 3.4%. Regional lymph node involvement is quite early in breast carcinoma and axillary lymph node metastasis is an important predictor of recurrence and survival, particularly in invasive ductal histology of breast carcinoma. Localization of sentinel lymph node/nodes followed by frozen section and histopathological evaluation helps to prevent unnecessary axillary nodal dissection and, hence, reduces associated post-surgical morbidity. Sentinel nodes are the first ones to receive lymph-borne metastatic cells and, hence, lymphoscintigraphy followed by biopsy is quite reliable to detect nodal metastasis, particularly at an early stage (I, II) of breast cancer.

Methods: Here we will share our experience of introducing procedure, personnel training, and workflow of sentinel lymph node lymphoscintigraphy in breast cancer patients at our cancer institute to help other centers establish programs for this study.

Results: Initially, 10 procedures were performed, all of which were successful in the localization of sentinel nodes and played a substantial part in the surgical planning of breast cancer. Planar lymphoscintigraphy and single-photon emission computerized tomography (SPECT)-CT images of our first patient revealed radiotracer avidity in the lymph node in the ipsilateral axilla, which was later on diagnosed as metastatic resulting in axillary nodal clearance.

Conclusions: In multidisciplinary/closely-placed surgical, pathological, and hybrid imaging facility settings, lymphoscintigraphy provides a quick, accurate, and better way of nodal localization leading to correct surgical decision-making. In addition to planar imaging, SPECT-CT acquisition significantly improves the specificity of the lymphoscintigraphy procedure, which is beneficial for patients to avoid false-positive results, thus saving breast cancer patients from potential adverse effects of surgery.

Identification of Secondary Breast Cancer in Vital Organs through the Integration of Machine Learning and Microarrays

Breast cancer includes genetic and environmental factors and is the most prevalent malignancy in women contributing to the pathogenesis and progression of cancer. Breast cancer prognosis metastasizes towards bones, the liver, brain, and lungs, and is the main cause of death in patients. Furthermore, the selection of features and classification is significant in microarray data analysis, which suffers from huge time consumption. To address these issues, this research uniquely integrates machine learning and microarrays to identify secondary breast cancer in vital organs. This work firstly imputes the missing values using K-nearest neighbors and improves the recursive feature elimination with cross-validation (RFECV) using the random forest method. Secondly, the class imbalance is handled by employing K-means synthetic object oversampling technique (SMOTE) to balance minority class and prevent noise. We successfully identified the 16 most essential Entrez gene ids responsible for predicting metastatic locations in the bones, brain, liver, and lungs. Extensive experiments are conducted on NCBI Gene Expression Omnibus GSE14020 and GSE54323 datasets. The proposed methods have handled class imbalance, prevented noise, and appropriately reduced time consumption. Reliable results were obtained on four classification models: decision tree; K-nearest neighbors; random forest; and support vector machine. Results are presented having considered confusion matrices, accuracy, ROC-AUC and PR-AUC, and F1-score.

Strengthening Breast Cancer Screening Mammography Services in Pakistan Using Islamabad Capital Territory as a Pilot Public Health Intervention

Late diagnosis of treatable breast cancer is the reason for higher breast cancer mortality. Until now, no public breast cancer facility has been established in the Islamabad Capital Territory. First, a Federal Breast Screening Center (FBSC) was established. Afterward, awareness campaigns about breast cancer were organized among the public. Subsequently, women above 40 years of age were provided with mammography screenings. Data were analyzed in SPSS version 22.0. An intervention was performed using a six tier approach to strengthening the health system. Utilizing the offices of the FBSC and the national breast cancer screening campaign, breast cancer awareness has become a national cause and is being advocated by the highest offices of the country. The number of females undergoing mammography has increased each year, starting from 39 in 2015 to 1403 in 2019. Most of the cases were BI-RAD I (n = 2201, 50.74%) followed by BI-RAD II (n = 864, 19.92%), BI-RAD III (n = 516, 11.89%), BI-RAD IV (n = 384, 8.85%), BI-RAD V (n = 161, 3.71%), and BI-RVAD VI (n = 60, 1.38%). The current study has theoretical and practical implications for the contemplation of policymakers. The FBSC can serve as a model center for the establishment of centers in other parts of the country, thereby promoting nationwide screening coverage.

Breast cancer incidence and predictions (Monastir, Tunisia: 2002–2030): A registry-based study

Introduction

Breast cancer is a major public health problem worldwide. It is the leading cause of cancer deaths in females. In developing countries like Tunisia, the frequency of this cancer is still growing. The aim of this study was to determine the crude and standardized incidence rates, trends and predictions until 2030 of breast cancer incidence rates in a Tunisian governorate.

Methods

This is a descriptive study including all female patients diagnosed with breast cancer in Monastir between 2002 and 2013. The data were collected from the cancer register of the center. Tumors were coded according to the 10^th version of international classification of disease (ICD-10). Trends and predictions until 2030 were calculated using Poisson linear regression.

Results

A total of 1028 cases of female breast cancer were recorded. The median age of patients was 49 years (IQR: 41–59 years) with a minimum of 16 years and a maximum of 93 years. The age-standardized incidence rate (ASR) was of 39.12 per 100000 inhabitants. It increased significantly between 2002 and 2013 with APC of 8.4% (95% CI: 4.9; 11.9). Prediction until 2030 showed that ASR would reach 108.77 (95% CI: 57.13–209.10) per 100000 inhabitants.

Conclusion

The incidence and the chronological trends of breast cancer highlighted that this disease is of a serious concern in Tunisia. Strengthening preventive measures is a primary step to restrain its burden.

Top 100 Most-Cited Publications on Breast Cancer and Machine Learning Research: A Bibliometric Analysis

BACKGROUND

Rapid advancement in computing technology and digital information leads to the possible use of machine learning on breast cancer.

OBJECTIVE

This study aimed to evaluate the research output of the top 100 publications and further identify a research theme of breast cancer and machine-learning studies.

METHODS

Databases of Scopus and Web of Science were used to extract the top 100 publications. These publications were filtered based on the total citation of each paper. Additionally, a bibliometric analysis was applied to the top 100 publications.

RESULTS

The top 100 publications were published between 1993 and 2019. The most productive author was Giger ML, and the top two institutions were the University of Chicago and the National University of Singapore. The most active countries were the USA, Germany, and China. Ten clusters were identified as both basic and specialised themes of breast cancer and machine learning.

CONCLUSION

Various countries demonstrated comparable interest in breast cancer and machine-learning research. A few Asian countries, such as China, India and Singapore, were listed in the top 10 countries based on the total citation. Additionally, the use of deep learning and breast imaging data was trending in the past 10 years in the field of breast cancer and machine-learning research.

A national survey to assess breast cancer awareness among the female university students of Pakistan

The incidence of breast cancer is increasing in Pakistan as well as globally. Awareness of women about breast cancer plays a cornerstone role in its early detection, better management, and prevention. Keeping this in mind, a cross-sectional study was carried out to assess the awareness of female university students about breast cancer’s risk factors, signs and symptoms, and breast cancer examination. The data was collected from female university students studying in Pakistan. A total of 774 participants completed the survey and recorded their responses on an online pre-tested self-administered questionnaire. Only 29.8% of the participants have identified breast cancer history in their first-degree relatives as a risk factor. Moreover, 14.1% of the participant considered that the use of oral contraceptives for more than 5 years can increase the risk of developing breast cancer. In addition, inward pulled nipple, wounds around the nipple, and abrupt changes in the breast size were considered as the sign and symptoms of breast cancer by 25.2%, 25.7%, and 31.7% of the participants, respectively. Moreover, only 20.9% of the participants identified the correct year for starting breast cancer examination and 44.4% of the respondents marked that mammography should be initiated after 40 years. Overall, the university female students of Pakistan were poorly aware of breast cancer’s risk factors, signs and symptoms, and breast examination. This study has highlighted the need for initiation of aggressive strategies regarding breast cancer awareness in both the literate and illiterate female population of Pakistan.

Awareness levels of breast cancer among female university and medical college students in Sylhet city of Bangladesh

BACKGROUND

Breast cancer has become a concerning health problem worldwide due to its increasing incidence rate. Women from developing countries are dying off due to the lack of knowledge on breast cancer and its different early detection programs.

AIMS

This study explores the level of knowledge about breast cancer risk factors, early warning signs, screening, and therapeutic approaches and their influential determinants among university and medical college students.

METHODS

A cross-sectional study was conducted, including 567 female university-level students (343 female students from 1 university and 224 female students from 1 medical college). This study used a semi-structured questionnaire about four aspects (risk factors, early warning signs, screening, and therapeutic approaches) of breast cancer, latent class analysis (LCA), and latent class regression (LCR) for investigation.

RESULTS

The percent of knowing correct answers of risk factors, early warning signs, screening approaches, and therapeutic methods were 86.3%, 69.8%, 70.2%, and 51.2%, respectively for medical students who had a high level of awareness and those for university students were 73.0%, 66.8%, 35.9%, and 24.7%. On the other hand, only 37.95% of medical students had been practicing Breast self-examination (BSE), while it was 18.37% for university students. The most effective predictors of the high level of awareness were age, advertisements (ad) promoting awareness about breast cancer, programs/campaign related to breast cancer, and personal breast problem history.

CONCLUSIONS

Taken together, the awareness level about four aspects of breast cancer is low among university students and is moderately high among medical students. Therefore, relevant health education programs in every educational institute are urgently needed to improve the awareness levels among female students to improve women's health at home and abroad.

Correlation Between Site and Stage of Breast Cancer in Women

Introduction

Breast cancer is a worldwide public health issue and a primary cause of death among women. The present study aimed to assess the correlation between site and stage of breast cancer with respect to age among females.

Methods

A prospective observational study was conducted at the Medical Oncology Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan from May 2020 to June 2021. Female patients of 18 years or older with a confirmed diagnosis of breast cancer were included in the study. Histopathological reports were evaluated for tumor characteristics such as histological type, laterality, location, tumor size, grade, lymph node status, and stage of the tumor.

Results

The majority of the patients presented with advanced stages of tumor. Among all stages of breast tumor, the upper outer quadrant was the most frequent location of the tumor. The majority of the patients with cancer in the upper inner quadrant were diagnosed with stage I (28.57%) (p = 0.011). In contrast, the majority of the upper outer quadrant lesions were identified as stage III and stage IV (p < 0.0001). In patients of age <40 years, statistically significant differences in proportions of tumor location with respect to the stage of the tumor were observed (p = 0.018).

Conclusion

The upper outer quadrant and stage III of tumor are the most common site and stage of breast tumor in our population. There is a significant relationship between site and stage of breast tumor. Younger-aged patients had a significantly higher rate of cancers located in the upper outer quadrant in advance stages as compared to other quadrants.

Clinical and histopathological features of breast tumors in women: a cross-sectional study at three hospitals in the Kingdom of Saudi Arabia

Introduction

there is a dearth of data on the epidemiology of breast tumors in the Kingdom of Saudi Arabia (KSA). This study aimed to determine the demographics, clinical patterns, and their association with histopathological types of breast tumors among females presently residing in KSA.

Methods

a multi-centric, cross-sectional study including female patients with symptoms suggestive of breast tumor was conducted at three hospitals in KSA from February 2019 to February 2020. The patient´s electronic health records were used to collect information related to their demographics, clinical findings including comordbities and symptoms and investigations. Binary logistic regression models were used to determine factors associated with the breast tumors.

Results

a total of 270 female patients were included in the study. The most frequently encountered symptom was a breast lump (95.9%, n = 259), followed by pain (18.9%, n = 51). More than half the population (53%, n = 143) had a histopathological diagnosis of fibroadenoma. Multivariate analysis revealed that patients > 46 years of age were less likely to present with fibroadenoma (AOR: 0.049 95% CI 0.02 - 0.15; p < 0.005). Those in the 31 - 45 years age group were less likely to present with ductal/lobular/papillary carcinomacompared to the less than 30 years group (AOR: 0.42, 95% CI 0.18 - 0.97; p = 0.04).

Conclusion

in this population of Saudi women with symptoms suggestive of breast tumor, those aged less than 40 years were more likely to have a fibroadenoma whereas those above 40 years were more likely to have breast cancer.

Perception of breast cancer risk factors: Dysregulation of TGF-β/miRNA axis in Pakistani females

Breast cancer poses a serious health risk for women throughout the world. Among the Asian population, Pakistani women have the highest risk of developing breast cancer. One out of nine women is diagnosed with breast cancer in Pakistan. The etiology and the risk factor leading to breast cancer are largely unknown. In the current study the risk factors that are most pertinent to the Pakistani population, the etiology, molecular mechanisms of tumor progression, and therapeutic targets of breast cancer are studied. A correlative, cross-sectional, descriptive, and questionnaire-based study was designed to predict the risk factors in breast cancer patients. Invasive Ductal Carcinoma (90%) and grade-II tumor (73.2%) formation are more common in our patient’s data set. Clinical parameters such as mean age of 47.5 years (SD ± 11.17), disturbed menstrual cycle (> 2), cousin marriages (repeated), and lactation period (< 0.5 Y) along with stress, dietary and environmental factors have an essential role in the development of breast cancer. In addition to this in silico analysis was performed to screen the miRNA regulating the TGF-beta pathway using TargetScanHuman, and correlation was depicted through Mindjet Manager. The information thus obtained was observed in breast cancer clinical samples both in peripheral blood mononuclear cells, and biopsy through quantitative real-time PCR. There was a significant dysregulation (**P>0.001) of the TGF-β1 signaling pathway and the miRNAs (miR-29a, miR-140, and miR-148a) in patients’ biopsy in grade and stage specifically, correlated with expression in blood samples. miRNAs (miR-29a and miR-140, miR-148a) can be an effective diagnostic and prognostic marker as they regulate SMAD4 and SMAD2 expression respectively in breast cancer blood and biopsy samples. Therefore, proactive therapeutic strategies can be devised considering negatively regulated cascade genes and amalgamated miRNAs to control breast cancer better.

Fears and barriers: problems in breast cancer diagnosis and treatment in Pakistan

Background

Women in Pakistan lack appropriate awareness about diagnosis and treatment for breast cancer due to a range of multifaceted barriers. There is a dearth of literature examining the socio-cultural factors that inhibit women from breast cancer screening, diagnosis and treatment in Punjab, Pakistan. Addressing this gap, this qualitative study sought to identify and explore the barriers that hinder women from seeking timely screening and treatment.

Methods

In this process 45 women (age = 18–50 years) with breast cancer were purposively sampled and interviewed from the Punjab Institute of Nuclear Medicine (PINUM) hospital, Faisalabad, Pakistan.

Results

An inductive approach was used to analyze the data which resulted in the emergence of eight subthemes under the umbrella of three major themes that delineate individual, socio-cultural and structural barriers to seek screening and treatment of breast cancer in Punjab. Individual barriers included lack of awareness, hesitance in accepting social support, and spiritual healing. The identified socio-cultural factors included feminine sensitivity, stigmatization, and aversion to male doctors. Lack of financial resources and apathetic medical services were structural barriers that hinder screening and treatment.

Conclusions

These barriers can be addressed through raising awareness and community mobilization about breast-self exam and treatment. The healthcare system should also pay attention to socio-psychological and cultural factors impeding women's access to available health facilities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01293-6.

Modulating barriers of tumor microenvironment through nanocarrier systems for improved cancer immunotherapy: a review of current status and future perspective

Cancer immunotherapy suppresses and destroys tumors by re-activating and sustaining the tumor-immune process, and thus improving the immune response of the body to the tumor. Immunotherapeutic strategies are showing promising results in pre-clinical and clinical trials, however, tumor microenvironment (TME) is extremely immunosuppressive. Thus, their translation from labs to clinics still faces issues. Recently, nanomaterial-based strategies have been developed to modulate the TME for robust immunotherapeutic responses. The combination of nanotechnology with immunotherapy potentiates the effectiveness of immunotherapy by increasing delivery and retention, and by reducing immunomodulation toxicity. This review aims to highlight the barriers offered by TME for hindering the efficiency of immunotherapy for cancer treatment. Next, we highlight various nano-carriers based strategies for modulating those barriers for achieving better therapeutic efficacy of cancer immunotherapy with higher safety. This review will add to the body of scientific knowledge and will be a good reference material for academia and industries.

Anthocyanins Isolated from Vitis coignetiae Pulliat Enhances Cisplatin Sensitivity in MCF-7 Human Breast Cancer Cells through Inhibition of Akt and NF-κB Activation

Anthocyanins isolated from Vitis coignetiae Pulliat (Meoru in Korea) (AIMs) have various anti-cancer properties by inhibiting Akt and NF-κB which are involved in drug resistance. Cisplatin (CDDP) is one of the popular anti-cancer agents. Studies reported that MCF-7 human breast cancer cells have high resistance to CDDP compared to other breast cancer cell lines. In this study, we confirmed CDDP resistance of MCF-7 cells and tested whether AIMs can overcome CDDP resistance of MCF-7 cells. Cell viability assay revealed that MCF-7 cells were more resistant to CDDP treatment than MDA-MB-231 breast cancer cells exhibiting aggressive and high cancer stem cell phenotype. AIMs significantly augmented the efficacy of CDDP with synergistic effects on MCF-7 cells. Molecularly, Western blot analysis revealed that CDDP strongly increased Akt and moderately reduced p-NF-κB and p-IκB and that AIMs inhibited CDDP-induced Akt activation, and augmented CDDP-induced reduction of p-NF-κB and p-IκB in MCF-7 cells. In addition, AIMs significantly downregulated an anti-apoptotic protein, XIAP, and augmented PARP-1 cleavage in CDDP-treated MCF-7 cells. Moreover, under TNF-α treatment, AIMs augmented CDDP efficacy with inhibition of NF-κB activation on MCF-7 cells. In conclusion, AIMs enhanced CDDP sensitivity by inhibiting Akt and NF-κB activity of MCF-7 cells that show relative intrinsic CDDP resistance.

Lack of Androgen Receptor Expression Selects for Basal-Like Phenotype and Is a Predictor of Poor Clinical Outcome in Non-Metastatic Triple Negative Breast Cancer

Background: Androgen receptor (AR) has emerged as a significant favorable prognostic indicator in estrogen receptor expressing (ER⁺) breast cancer (BCa); however, its clinical and biological relevance in triple negative breast cancer (TNBC) and association with cancer stem cell (CSC) markers remain ambiguous. Methods: We examined the immunohistochemical expression of AR in a cohort of stage I-III TNBC cases (n = 197) with a long-term clinical follow-up data (mean follow-up = 53.6 months). Significance of AR expression was correlated with prognostic biomarkers including cancer stem cell markers (CD44, CD24, and ALDH1), basal markers (CK5, CK14, and nestin), proliferation marker (ki-67), apoptotic marker (Bcl-2), and COX-2. Expression of CK5 and nestin was used for the categorization of TNBC into basal (TN, CK5⁺, and/or nestin⁺) and non-basal (TN, CK5^-, and/or nestin^-) phenotypes, and Kaplan-Meier curves were used for estimation of overall survival and breast cancer-specific survival (BCSS). Results: AR expression was observed in 18.8% of non-metastatic TNBC tumors. Expression of AR correlated with lower grade (P < 0.001) and conferred a favorable prognostic significance in patients with axillary lymph node metastasis (P = 0.005). Lack of AR expression correlated with expression of CSC phenotype (CD44⁺/CD24^-) (P < 0.001), COX-2 (P = 0.02), basal markers (CK5: P = 0.03), and nestin (P = 0.01). Basal-like phenotype (TN, CK5⁺, and/or nestin⁺) correlated with quadruple-negative breast cancer (QNBC) and showed a significant association with adverse prognostic markers including high proliferation index (P < 0.001), expression of COX-2 (P = 0.009), and CSC phenotype (CD44⁺/CD24^-: P = 0.01). Expression of AR remained an independent prognostic indicator for improved overall survival (P = 0.003), whereas basal-like phenotype was associated with an adverse BCSS (P = 0.013). Conclusions: Assessment of AR and basal markers identified biologically and clinically distinct subgroups of TNBC. Expression of AR defined a low-risk TNBC subgroup associated with improved overall survival, whereas expression of basal markers (CK5 and nestin) identified a high-risk subgroup associated with adverse BCSS. Integration of immunohistochemical analysis of AR and basal biomarkers to the assessment of TNBC tumors is expected to improve the prognostication of an otherwise heterogeneous disease.