Trend of disease burden and risk factors of breast cancer in developing countries and territories, from 1990 to 2019: Results from the Global Burden of Disease Study 2019

Global, Regional, and National Burden of Breast Cancer, 1990-2021, and Projections to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study analyzes the global burden of breast cancer (BC) over the past 30 years, identifies key risk factors, and projects future incidence and mortality through 2050.

METHODS

Data were sourced from the 2021 Global Burden of Disease (GBD) database. The estimated annual percentage change (EAPC) was used to assess trends, and country development was measured using the Socio-Demographic Index (SDI). Projections were conducted using Bayesian age-period-cohort and autoregressive integrated moving average models.

RESULTS

In 2021, approximately 2.12 million new breast cancer cases and 674 199 deaths were recorded globally. From 1990 to 2021, incidence and prevalence increased, while mortality and disability-adjusted life years (DALYs) declined overall. Regional and national variations were observed, alongside age and gender differences in the disease burden. A diet high in red meat and a high body mass index were the leading global risk factors for breast cancer deaths. The BC burden was positively correlated with SDI across 21 GBD regions. Decomposition analysis highlighted demographic factors as the main drivers of increased disease burden over the past three decades. Projections indicate that BC incidence will continue to rise through 2050.

CONCLUSIONS

While global BC mortality has decreased over the past 30 years, incidence continues to rise. Low-SDI regions face increasing challenges, as incidence, mortality, and DALYs persistently climb. These findings underscore the need for targeted public health strategies and equitable resource distribution to mitigate the rising burden of breast cancer.

Associations Between Lipid Traits and Breast Cancer Risk: A Mendelian Randomization Study in African Women

BACKGROUND

Blood lipids are implicated in the development of breast cancer (BC), though the genetic connection remains unclear, particularly in African populations. Observational studies on this topic are limited by confounding factors and reverse causation, potentially affecting the reliability of findings.

METHODS

We applied univariate and multivariable two-sample Mendelian randomization to assess the causal association between blood lipids (total cholesterol [TC], high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides [TG]) and BC. Summary-level data for lipid traits were sourced from the Africa Wits-INDEPTH partnership for Genomic Research (AWI-Gen) (N = 10,603 women). BC data were obtained from the largest genome-wide association study of BC in African women, comprising 18,034 BC cases and 22,104 controls.

RESULTS

Our analysis revealed that genetically predicted TG was associated with a decreased BC risk (OR = 0.73, 95% CI = 0.56-0.95, p = 0.018. In contrast, no significant associations were found between TC, HDL, or LDL levels and BC risk: TC (OR = 1.04, 95% CI = 0.93-1.18, p = 0.467), HDL (OR = 1.29, 95% CI = 0.93-1.79, p = 0.121), and LDL (OR = 1.04, 95% CI = 0.90-1.20, p = 0.577). After adjusting for the effects of other lipid traits, the association between TG and BC was attenuated, and no associations were observed for TC, HDL, or LDL. No causal relationship was found between lipid traits and BC subtypes.

CONCLUSIONS

This study provides evidence that elevated triglycerides may be associated with a reduced risk of BC, whereas no significant associations were observed for TC, HDL, or LDL. Further research is needed to better understand the underlying mechanisms and potential clinical implications of these findings.

Global and regional burden of breast cancer attributable to high BMI, 1990-2036: A comprehensive analysis

OBJECTIVES

This study aimed to assess global, regional, and national trends in breast cancer burden attributable to high body mass index (BMI) from 1990 to 2021 and provide projections up to 2036 using data from the Global Burden of Disease (GBD) 2021 study.

STUDY DESIGN

Systematic analysis of the GBD 2021 dataset.

METHODS

We extracted high BMI-related breast cancer data from the GBD 2021 dataset, covering 204 countries and territories. Age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) were calculated to analyze temporal patterns and regional differences. Future trends were projected using the Bayesian age-period-cohort (BAPC) model.

RESULTS

In 2021, high BMI contributed to 44,707 breast cancer deaths and 1,041,309 DALYs globally, reflecting a 138.5 % and 142.7 % increase, respectively, compared to 1990. While global age-standardized mortality and DALY rates remained relatively stable, the absolute burden significantly increased, particularly in low- and middle-SDI regions. High-SDI regions exhibited the highest age-standardized rates, but low-SDI regions showed the fastest growth. Projections indicate that the global burden of breast cancer due to high BMI will continue to rise until 2036, driven by increasing obesity rates and insufficient healthcare resources.

CONCLUSIONS

High body mass index is a major driver of the global breast cancer burden, showing increasing trends not only in high-income regions but more prominently in low-SDI regions. Effective strategies, including public health interventions targeting obesity management, are needed to control the rising burden.

Psychometric Validation of the Bangla Version of the Breast Cancer Fear Scale Among Female University Students in Bangladesh

Background: Research suggests that fear of cancer could be a significant predictor influencing participation in cancer screening. However, no tools have been validated to measure breast cancer fear among women in Bangladesh, while the Breast Cancer Fear Scale (BCFS) has been extensively examined in Western contexts. Thus, this study intends to validate the Bangla version of the BCFS among female university students aged (> 18) years, given the urgent need for a culturally relevant tool to evaluate fear associated with breast cancer screening practices in this population. Methods: This cross-sectional study was conducted in 2023 among female university students in Bangladesh. Participants were aged > 18 years, able to read Bangla, and had no personal or familial history of cancer or chronic illnesses. Data were collected via an online survey using a random sampling method, resulting in 456 eligible participants after data cleaning. The BCFS was translated into Bangla following the standard forward-backward translation process. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted to evaluate the structure of the scale factor. Internal consistency, test-retest reliability, and convergent validity were also assessed. Results: The results showed that the mean age of the participants was 22.91 (SD: 1.12). The Bangla version of the BCFS showed a single-factor structure, high internal consistency (Cronbach's α = 0.939), and good test-retest reliability (r = 0.53, p < 0.001). The CFA results are consistent with the EFA findings, confirming that the scale is a good fit for the one-factor structure. The loadings range from 0.679 (Fear1) to 0.920 (Fear4) in the total sample, indicating that the items are significant indicators of the latent construct. The BCFS demonstrated an acceptable model fit, with RMSEA values below the 0.08 cutoff and SRMR values well below the 0.05 threshold across all samples. Additionally, the GFI, AGFI, NFI, TLI, and CFI values were all above the recommended thresholds, indicating a high fit for the model. Conclusions: The Bangla version of the BCFS has proven to be a powerful and reliable tool for gauging the multifaceted nature of breast cancer fear among Bangladeshi women, particularly female university students. This culturally tailored instrument holds the potential to shed light on the psychological barriers that hinder breast cancer screening.

Pharmacovigilance study of adverse reactions of anti-HER-2 drugs for the treatment of HER-2-positive breast cancer based on the FAERS database

OBJECTIVE

There are three categories of drugs that treat human epidermal growth factor receptor type 2 (HER-2) positive breast cancer: monoclonal antibodies (mAbs), antibody-drug conjugates (ADCs), and tyrosine kinase inhibitors (TKIs). The purpose of this study is to analyze and compare the adverse reactions of three classes of anti-HER-2 drugs to various body systems in patients based on the FDA Adverse Event Reporting System (FAERS).

METHODS

All data reports were extracted from the FAERS between 2004 and 2024. Data mining of adverse events associated with anti-HER-2 drugs was carried out using disproportionality analysis. A multivariate logistic regression analysis was conducted to explore the risk factors associated with AEs leading to hospitalization.

RESULTS

A total of 47,799 patients were screened for the three classes of drugs, among which ADC drugs caused the largest proportion of deaths. MAb has the strongest ADR signals associated with "cardiac disorders". Moreover, trastuzumab was associated with a greater risk of cardiotoxicity. Logistic regression analysis revealed that the treatment with mAbs should be wary of serious adverse reactions in "infections and infestations" and "metabolism and nutrition disorders". Moreover, "endocrine disorders" were the factor associated with the highest risk of prolonged hospitalization due to trastuzumab deruxtecan (T-DXd). The safety of tucatinib among TKI drugs is greater than that of other drugs.

CONCLUSION

In general, from the perspective of the effects of the three classes of drugs on the various body systems of patients, we should focus on mAb-associated "cardiac disorders", ADC-associated "hepatobiliary disorders", "respiratory, thoracic and mediastinal disorders", and TKI-associated "gastrointestinal disorders.

Patterns, Predictors, and Prognostic Implication of Treatment-Related Amenorrhea in Patients With Breast Cancer

Background

Treatment-related amenorrhea (TRA) is a common side effect of treatment in premenopausal patients with breast cancer, with important consequences for patient counseling and management. Its occurrence and potential influence on survival outcomes remain active areas of investigation. This study aimed to evaluate the incidence, risk factors, and prognostic significance of TRA in patients with breast cancer.

Methods

This is a retrospective cohort study. Patients were interviewed during and after chemotherapy to assess their menstrual status. Sociodemographic, clinical, and treatment data of patients were also collected. TRA was classified into early amenorrhea (EA) and late amenorrhea (LA) based on the duration of amenorrhea. Univariable and multivariable logistic regression were used to identify risk factors of EA and LA. Kaplan-Meier curves and Cox proportional hazards analyses were used to investigate the impact of EA and LA on 3-year overall survival (OS).

Results

There were 81 patients who were eligible for the final analysis. Of these subjects, 14 (17.3%) developed no amenorrhea, 67 (82.7%) developed EA, and 45 (55.6%) developed LA. We did not find any significant independent risk factor for EA. Age > 45 years (odds ratio (OR): 4.00; confidence interval (CI): 1.23 - 13.01; P = 0.021) and the usage of hormonal therapy (OR: 4.96; CI: 1.58 - 15.53; P = 0.006) independently significantly increase the risk of LA, whereas a metastatic disease status decreased the risk (OR: 0.20; CI: 0.04 - 0.90; P = 0.036). Both EA (hazard ratio (HR) = 0.262, CI: 0.105 - 0.653; P = 0.002) and LA (HR = 0.234, CI: 0.091 - 0.604; P = 0.001) were associated with an improved 3-year OS rate.

Conclusions

Age > 45 years and the usage of hormonal therapy are risk factors for LA, while metastatic disease was associated with a decreased risk. Both EA and LA had a significant association with favorable 3-year OS. These findings enable clinicians to provide personalized guidance, tailor treatment strategies, and improve the outcomes of premenopausal patients with breast cancer. Standardization of how TRA is defined and assessed in future studies is essential to improve comparability and enhance the understanding of its clinical implications.

Differences in Clinical, Epidemiological, and Pathological Features of Breast Cancer in the Saudi Population: An Analytical Cross-Sectional Single Institution Study

Background: In Saudi Arabia, breast cancer is the most common malignancy among women, significantly impacting cancer-related morbidity and mortality. The country's unique demographics and rapid socioeconomic development contribute to distinct breast cancer patterns. Objective: To analyze demographic and pathological characteristics of breast cancer with an emphasis on associations between the Ki67 proliferation index, tumor stages, and molecular subtypes. Materials and Methods: An analytical cross-sectional study was conducted on 294 breast cancer patients from 2013 to 2019, recruited from the Comprehensive Cancer Center at King Fahad Medical City, Riyadh, Saudi Arabia. A one-way ANOVA and logistic regression were used to identify risk factors associated with elevated Ki67 levels. Significance was set at a 95% confidence level. Results: The mean age of patients was 51.58. Among them, 67% were overweight/obese, 21.1% were diabetic, and 17% were hypertensive. Approximately 28.9% of all tumors were classified as T3, 46.9% as Grade III, and 40% as Stage IV. Invasive ductal carcinomas (83.9%) were the most common. ER, PR, and HER2 expression were positive in 63.4%, 54.3%, and 34.9% of patients, respectively, with a high Ki67 index in 50.7%. As compared to Grade I cancer, grade II cancer increased the likelihood of elevated Ki67 by 41 times (p = 0.001), Grade III cancer by 7.43 times (p = 0.001), and Stage IV cancer by 2.26 times (p = 0.03). Conversely, invasive lobular carcinomas and other cancer types were significantly less likely to have high Ki67 levels (p < 0.05). Conclusions: Elevated Ki67 appeared to predict higher tumor grades and certain molecular subtypes cancer.

Analysis the Burden of Breast Cancer Among Adolescents and Young Adults Using the Global Burden of Disease 2021

BACKGROUND

Unique features and worse outcomes have been reported for breast cancers among adolescents and young adults (AYAs; age 15-39 years). However, there are few up-to-date and comprehensive data to analyze the disease burden of AYA breast cancer.

PATIENTS AND METHODS

The data of incidence, deaths, and disability-adjusted life years (DALYs) owing to breast cancer was obtained from the Global Burden of Disease (GBD) 2021. We computed estimated annual percentage changes (EAPCs) of each indicator to capture the secular trend in breast cancer and conducted a decomposition analysis to examine factors behind DALYs changes. We also predicted the incident cases, deaths and DALYs to 2044.

RESULTS

From 1990 to 2021, the age-standardized incidence rate (ASIR) experienced an increasing trend globally [EAPC: 0.87, 95% confidence interval (CI) 0.77-0.97]. The age-standardized rates (ASRs) of male AYAs breast cancer were all on the rise. The most significant increase trends in ASRs among female AYAs occurred in North Africa and Middle East, while male AYAs showed the highest increases in East Asia. Population growth contributed the most to the growth of DALYs in East Asia. Frontier analysis showed that despite limited resources, some underdeveloped countries still exhibit superior performance, while other countries with higher sociodemographic index have great room for improvement.

CONCLUSIONS

The global burden of AYAs breast cancer is grim, especially in North Africa and Middle East. The significant increase in male AYAs breast cancer burden, targeted prevention strategies may need to be developed for AYAs breast cancer by sex and countries.

Modifiable Risk Factors for Breast Cancer: Insights From Systematic Reviews

OBJECTIVE

To conduct a comprehensive review of reversible factors associated with breast cancer, with the aim of offering insights for the creation of early intervention strategies for breast cancer prevention.

METHODS

The PubMed, EMBASE, and Scopus databases were systematically searched to collect systematic reviews and meta-analyses related to breast cancer risk. Searches were limited to literature published from the inception of each database up to May 1, 2024. Two investigators independently screened the literature, extracted data, and assessed the methodological quality and evidence synthesis of the studies included in our review.

RESULTS

We included 31 systematic reviews in our analysis, and breast cancer risk factors were divided into four categories: diet and lifestyle habits, reproductive and familial factors, body weight and physical activity, and environmental and miscellaneous factors.

CONCLUSION

Our findings suggest that a high-fat diet, low intake of dietary fiber, alcohol consumption, smoking, and obesity are linked to a higher risk of breast cancer. Conversely, physical activity and breastfeeding appear to lower breast cancer risk. However, the methodological and evidence quality of the reviewed studies was generally low, necessitating caution in the application of these findings. Additionally, there is a need for more research into lifestyle interventions to better develop and advocate for effective breast cancer prevention strategies.

Investigation of chemotherapy-induced cardiac dysfunction in breast cancer

Although recent advancements in cancer treatment have significantly improved survival rates, they have also raised concerns regarding severe adverse effects, including cardiotoxicity. We conducted a prospective study at Dayanand Medical College and Hospital, Ludhiana to assess chemotherapy-related cardiac dysfunction in newly diagnosed, histologically confirmed breast cancer cases. Among 97 breast cancer patients undergoing chemotherapy, 13 (13.4%) developed left ventricular dysfunction (LVD), predominantly in younger patients with left-sided breast involvement (64.9%). A significant association was found between estrogen receptor (ER) positivity and LVD risk (P = 0.03), with 15.4% of LVD patients also being hypertensive. The incidence of LVD was notably high at 38.5% among patients receiving trastuzumab, while cumulative doses of doxorubicin and cyclophosphamide did not show significant correlation with LVD. Recovery was promising, with 76.9% of affected patients demonstrating significant improvement post-treatment. These findings highlight the need for continuous cardiac monitoring and personalized treatment strategies to mitigate LVD risk.

Investigating the anticancer properties of urolithin B in triple negative breast cancer: In vivo and in vitro insights

Breast cancer (BC) is a leading cause of cancer-related mortality among women worldwide, with incidence rates rising globally. Urolithin B (UB), a bioactive metabolite of ellagic acid, has demonstrated promising anticancer effects in various cancer models. This study aimed to evaluate the effects of UB on the growth, angiogenesis, and metastasis of BC cells using both in vivo and in vitro approaches. Cytotoxic effects of UB were assessed on MDA-MB-231 cells and normal HFF cells using the MTT assay. Scratch assays and gelatin zymography demonstrated UB's suppression of cell migration and reduced enzymatic activities of MMP-2 and MMP-9. In a xenograft mouse model, UB significantly reduced tumor growth, enhanced necrosis, and decreased vascularity in tumor tissues. It downregulated mRNA expression levels of VEGF, VEGFR, MMP-2, and MMP-9, indicating potent anti-angiogenic and anti-metastatic properties. Additionally, UB exhibited antioxidant effects by increasing total thiol content and the activities of superoxide dismutase (SOD) and catalase (CAT) while reducing malondialdehyde (MDA) levels in tumor tissues. In conclusion, our results highlight the anticancer potential of UB, through its ability to suppress the proliferation, angiogenesis, and metastatic properties of BC both in vitro and in vivo. Coupled with its antioxidant properties, UB emerges as a promising and safe candidate for further pre-clinical and clinical research and therapeutic applications in BC management.

Burden and mortality of breast cancer attributed to diabetes and smoking in women: a secondary analysis based on Global Burden of Disease 2019 in North Africa and the Middle East

BACKGROUND

Breast cancer (BC) is the second most common cancer in the world. This study aimed to investigate the burden of BC due to some risk factors in the Middle East and North Africa (MENA) countries from 1990 to 2019.

METHODS

This study is a secondary analysis based on the Global Burden of Disease 2019 data. In this study, we used data for disability-adjusted life years (DALYs) and mortality of BC in MENA countries. Also, we presented data for DALYs and mortality attributed to diabetes, smoking and passive smoking among women with BC.

RESULTS

The age-standardised DALY due to BC in women increased slowly from 395 (95% CI: 357 to 458) per 100 000 in 1990 to 473 (95% CI: 409 to 544) per 100 000 in 2019. But Kuwait, Bahrain, Jordan and Turkey saw a decrease in age-standardised DALY trends between 1990 and 2019. In 1990, the age-standardised mortality rate was 12.3 (95% CI: 11.0 to 14.2) per 100 000 people, and by 2019, it had increased to 15.2 (95% CI: 13.3 to 17.3) per 100 000. The rate in 2019 varied between countries. Diabetes, smoking and passive smoking contribute significantly to the burden of disease and mortality from BC, with diabetes playing a more impactful role than the other risk factors. Across the MENA region, the burden and mortality attributed to diabetes vary among countries.

CONCLUSION

In the MENA region, the attributable fraction of risk factors such as diabetes, smoking and secondary smoking over BC deaths and DALY has increased in recent years.

Plant protein-derived anti-breast cancer peptides: sources, therapeutic approaches, mechanisms, and nanoparticle design

Breast cancer causes the deaths of approximately 685,000 women annually, posing a severe threat to women's health. Consequently, there is an urgent need for low-cost, low-toxicity and effective therapeutic methods to prevent or mitigate breast cancer progression. PDBP are natural, non-toxic, and affordable substances and have demonstrated excellent anti-breast cancer activities in inhibiting proliferation, migration, and invasion, and promoting apoptosis both in vitro and in vivo, thus effectively preventing or inhibiting breast cancer. However, there are no comprehensive reviews summarizing the effects and mechanisms of PDBP on the treatment of breast cancer. Therefore, this review described the inhibitory effects and mechanisms of active peptides from different plant protein sources on breast cancer. Additionally, we summarized the advantages and preparation methods of plant protein-derived anticancer peptide-encapsulated nanoparticles and their effects in inhibiting breast cancer. This review provides a scientific basis for understanding the anti-breast cancer mechanisms of PDBP and offers guidance for the development of therapeutic adjuvants enriched with these peptides.

Pathogenic variants in BRCA1 and BRCA2 genes associated with female breast and ovarian cancer in the Mexican population

Breast and ovarian cancers are significant global health challenges, with inherited variations in breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) substantially increasing the risk, aggressiveness, and early onset of these diseases. This work aimed to examine pathogenic variants (PVs) in BRCA1 and BRCA2 databases that include Mexican populations. A systematic review of literature and data mining spanning from 2002 to 2023 was conducted. Articles published in journals indexed in SCImago quartiles Q1 to Q4 were screened. Databases were paired, standardized, and enriched with data from reputable global platforms: Genome Data Viewer, dbSNP, ClinVar, gnomAD browser, Breast Cancer Information Core (BIC), ClinGen, Varsome, Human Genome Variation Society (HGVS), Bioproject, Ensembl, Gene NIH NCIB, UniProt, and BRCA Exchange. Outcomes included data from 9,026 Mexican genotypes, identifying 657 PVs. Genetic mapping revealed certain exons, notably exon 10 of BRCA1 and exon 11 of BRCA2, as highly mutagenic hot spots. The most frequent alteration was a large deletion in BRCA1 (ex9-12del), associated with a founder effect originating from a common Mexican ancestor. Finally, we constructed a genetic map containing all the single nucleotide variants (SNVs) and large rearrangements presented in the analyzed databases.

Hsa_Circ_002144 Promotes Glycolysis and Immune Escape of Breast Cancer Through miR-326/PKM Axis

Background: Breast cancer is a leading cause of cancer-related deaths in women worldwide, posing a significant threat to female health. Therefore, it is crucial to search for new therapeutic targets and prognostic biomarkers for breast cancer patients. Method: Bioinformatics analysis, quantitative real-time PCR (qRT-PCR), and fluorescence in situ hybridization (FISH) were employed to investigate the expression of hsa_circ_002144 in breast cancer. Transwell assay, Western blotting, and cell viability assay were utilized to assess the impact of hsa_circ_002144 on the proliferation, migration, and invasion of breast cancer cells. Additionally, a mouse model was established to validate its functionality. Flow cytometry, WB analysis, enzyme-linked immunosorbent assay (ELISA), qRT-PCR, exosomes isolation, and co-culture system were employed to elucidate the molecular mechanism underlying macrophage polarization. Result: we have discovered for the first time that hsa_circ_002144 is highly expressed in breast cancer. It affected tumor growth and metastasis and could influence macrophage polarization through the glycolytic pathway. Conclusion: This finding provides a new direction for breast cancer treatment and prognosis assessment.

Current status and hotspots in breast cancer patient self-management research: A bibliometric and visual analysis via CiteSpace

BACKGROUND

Breast cancer remains a leading cause of cancer-related mortality worldwide. Patient self-management plays a pivotal role in enhancing outcomes and quality of life for individuals affected by this disease. This study employed bibliometric and visual analysis techniques utilizing CiteSpace to elucidate the current status and research hotspots in breast cancer patient self-management from January 1, 2005, to August 31, 2023.

METHODS

A comprehensive search was conducted in the Web of Science Core Collection (WoSCC). The retrieved literature was subjected to visualization and analysis using CiteSpace, focusing on publication timeline, article count, geographical distribution, institutional affiliations, journal sources, reference co-citation networks, and keyword analysis.

RESULTS

The analysis encompassed 1413 English-language documents. The United States emerged as the most prolific contributor, while the University of Toronto demonstrated the highest institutional output. The two-map overlay revealed prominent citation paths, indicating strong interconnections between publications in "Medicine, Medicine, Clinical" and "Health, Nursing, Medicine," as well as "Psychology, Education, Health" and "Health, Nursing, Medicine." The most frequently co-cited reference was "Self-Management: Enabling and Empowering Patients Living with Cancer as a Chronic Illness." High-frequency keywords identified included quality of life, chronic disease, self-management, patient education, randomized controlled trials, education, and intervention. These keywords formed 11 distinct clusters related to intervention content, methodologies, outcome indicators, and emerging research trends. Keyword burst analysis predicted future research hotspots focusing on patient needs, psychological distress, Internet technology, and mobile applications.

CONCLUSIONS

Research in breast cancer self-management is experiencing significant growth. Enhanced collaboration between countries, regions, and institutions is imperative. Further investigation is warranted, particularly in the domains of "quality of life," "patient education," and "mobile health." These findings provide valuable insights to guide future research directions in this critical field.

A health belief model-based community health education on mammography screening among reproductive-aged women in Ethiopia: a randomized controlled trial

Background

Early intervention in mammography use prevents breast cancer-related deaths. Therefore, this study aimed to apply health education interventions to mammography use in reproductive-aged women.

Methods

This was a sequential exploratory design using qualitative and quantitative methods. The qualitative part used to gain insights into the design and development of interventions. For the randomized trial, a sample of 405 participants was recruited in each arm. The mean difference of interventions on the study variables was determined using a general linear model for repeated measures (ANOVA). For dichotomous variables, nonparametric tests (Cochran Q) were used. Path analysis was used to observe how the constructs of the Health Belief Model interacted. We registered PACTR database (https://pactr.samrc.ac.za/): "PACTR201802002902886."

Results

The study found that there was a strong interplay between perceptions of mammography screening and the intervention, showing that the likelihood of mammography use and comprehensive knowledge increased from baseline to endpoint (p < 0.005). Likewise, health motivation and all constructs of the health belief model had a statistically significant mean difference between the intervention and control groups (p < 0.005). However, the mean value of perceived barriers in the intervention group was statistically significantly reduced after three and six months (mean difference = -2.054 between Measure 1 and measure 2 and -1.942 between Measure 2 and Measure 3). The hypothesized causal paths effect of the model was explained by 64.3% that shows there is strong relationship of the variables significantly (p < 0.005).

Conclusion

The study found that model-based mammography screening interventions had a significant impact at various time periods. We recommend future researchers consider the intensity and range of information to advance the field and figure out the problem while investigating the dose and peak of the intervention.

Semi-supervised recognition for artificial intelligence assisted pathology image diagnosis

The analysis and interpretation of cytopathological images are crucial in modern medical diagnostics. However, manually locating and identifying relevant cells from the vast amount of image data can be a daunting task. This challenge is particularly pronounced in developing countries where there may be a shortage of medical expertise to handle such tasks. The challenge of acquiring large amounts of high-quality labelled data remains, many researchers have begun to use semi-supervised learning methods to learn from unlabeled data. Although current semi-supervised learning models partially solve the issue of limited labelled data, they are inefficient in exploiting unlabeled samples. To address this, we introduce a new AI-assisted semi-supervised scheme, the Reliable-Unlabeled Semi-Supervised Segmentation (RU3S) model. This model integrates the ResUNet-SE-ASPP-Attention (RSAA) model, which includes the Squeeze-and-Excitation (SE) network, Atrous Spatial Pyramid Pooling (ASPP) structure, Attention module, and ResUNet architecture. Our model leverages unlabeled data effectively, improving accuracy significantly. A novel confidence filtering strategy is introduced to make better use of unlabeled samples, addressing the scarcity of labelled data. Experimental results show a 2.0% improvement in mIoU accuracy over the current state-of-the-art semi-supervised segmentation model ST, demonstrating our approach's effectiveness in solving this medical problem.

Plant-based diets-impacts of consumption of little or no animal-source foods on human health

The world, in 2024, faces both climate and biodiversity crises, and the food system does contribute significantly to these crises. For some, the solution is simple - intakes of animal source foods (ASFs) should be considerably reduced, and consumption of plant-source foods (PSFs) should be greatly increased. Advocates for such a dietary transformation express confidence that plant-based diets will not only benefit planetary health, but will provide nutrient adequacy for all, and will also result in considerable protection from chronic non-communicable diseases (NCDs). However, as described in this perspective, the dramatic reductions in ASFs, entailed by many plant-based diets, will worsen already prevalent micronutrient and protein deficiencies. The protections provided by plant-based diets against NCDs appear to be more strongly associated with reduced intakes of calories and salt, and increased intakes of fruit, vegetables, nuts and whole grains, rather than with reduced intakes of ASFs. Any possible absolute adverse effects of red and processed meat consumption on NCDs are very small and uncertain. Other ASFs either appear to have no impact on NCDs (poultry meat and eggs), or are associated with protections against obesity, cardiovascular events, brain disorders and some cancers (seafood and dairy). Rigorous randomized controlled trials of all newly proposed environmentally-protective plant-based diets are required, so as to provide clear-cut evidence of micronutrient and protein adequacy, with or without, supplementation, fortification and/or biofortification. In the meantime, dietary guidelines should advise moderating excessive consumption, rather than substantially limiting or excluding ASFs from the human diet.

Morchella conica, Morchella esculenta and Morchella delicosa Induce Apoptosis in Breast and Colon Cancer Cell Lines via Pro-apoptotic and Anti-apoptotic Regulation

OBJECTIVE

To explore the potential apoptotic mechanisms of 3 Morchella extracts (Morchella conica, Morchella esculenta and Morchella delicosa) on breast and colon cancer cell lines using apoptotic biomarkers.

METHODS

Human breast cell line (MCF-7) and colon cancer cell line (SW-480) were treated with methanol and ethanol extracts of 3 Morchella species with concentration ranging from 0.0625 to 2 mg/mL. After that their effects on gene expression of apoptosis related markers (pro-apoptotic markers including Bax, caspase-3, caspase-7, and caspase-9, and the antiapoptotic marker including Bcl-2) were determined using reverse transcription polymerase chain reaction.

RESULTS

All Morchella extracts reduced breast and colon cancer cells proliferation at half inhibitory concentration (IC50) of 0.02 ±0.01 to 0.68 ±0.30 mg/mL. As expected, all Morchella extracts significantly increased gene expressions of Bax, caspase-3, caspase-7, and caspase-9 and downregulated the gene expression of Bcl-2 in MCF-7 and SW-480 cell lines (P<0.05).

CONCLUSIONS

Morchella extracts demonstrated significant anti-proliferative activity against breast and colon cancer cell lines via an apoptosis induction mechanism. Anticancer activity of Morchella extracts and activation of apoptosis in breast and colon cancer cells suggest that it may be used to develop chemotherapeutic agents against cancer in future.

Global burden and attributable risk factors of breast cancer in young women: historical trends from 1990 to 2019 and forecasts to 2030 by sociodemographic index regions and countries

Background

Breast cancer in young women (BCY) is much less common but has significant health sequelae and societal costs. We aimed to evaluate the global and regional burden of breast cancer in women aged 15-39 years from 1990 to 2019.

Methods

We collected detailed data on breast cancer from the Global Burden of Disease Study 2019 (GBD 2019) Data Resources. The age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR), age-standardised disability-adjusted life years rate (ASDR), and estimated annual percentage change (EAPC) were used to assess the disease burden of BCY. The Bayesian Age-Period-Cohort model was used to forecast disease burden from 2020 to 2030.

Results

From 1990 to 2019, significant increases in ASIR were found for BCY (EAPC = 0.59, 95% confidence interval (CI) = 0.5 to 0.68), whereas decreases in ASMR (EAPC = -0.41, 95% CI = -0.53 to -0.3) and ASDR (EAPC = -0.35, 95% CI = -0.46 to -0.24). Across countries with varying sociodemographic indexes (SDI), all regions showed an upward trend in BCY morbidity, except for countries with a high SDI. While mortality and DALYs rates have decreased in countries with high, high-middle, and middle SDI, they have increased in countries with low-middle and low SDI. Countries with lower SDIs are projected to bear the greatest burden of BCY over the next decade, including both low and low-middle categories. Alcohol use was the main risk factor attributed to BCY deaths in most countries, while exposure to second hand smoke was the predominant risk factor for BCY deaths in middle and low-middle SDI countries.

Conclusions

The burden of breast cancer in young women is on the rise worldwide, and there are significant regional differences. Countries with a low-middle or low SDI face even more challenges, as they experienced a more significant and increasing BCY burden than countries with higher SDIs.

Inhibition of ABI2 ubiquitination-dependent degradation suppresses TNBC cell growth via down-regulating PI3K/Akt signaling pathway

Triple negative breast cancer (TNBC) is a type of cancer that lacks receptor expression and has complex molecular mechanisms. Recent evidence shows that the ubiquitin-protease system is closely related to TNBC. In this study, we obtain a key ubiquitination regulatory substrate-ABI2 protein by bioinformatics methods, which is also closely related to the survival and prognosis of TNBC. Further, through a series of experiments, we demonstrated that ABI2 expressed at a low level in TNBC tumors, and it has the ability to control cell cycle and inhibit TNBC cell migration, invasion and proliferation. Molecular mechanism studies proved E3 ligase CBLC could increase the ubiquitination degradation of ABI2 protein. Meanwhile, RNA-seq and IP experiments indicated that ABI2, acting as a crucial factor of tumor suppression, can significantly inhibit PI3K/Akt signaling pathway via the interaction with Rho GTPase RAC1. Finally, based on TNBC drug target ABI2, we screened and found that FDA-approved drug Colistimethate sodium(CS) has significant potential in suppressing the proliferation of TNBC cells and inducing cell apoptosis, making it a promising candidate for impeding the progression of TNBC.

Breast cancer mortality in Chinese women and men from 1990 to 2019: Analysis of trends in risk factors

OBJECTIVE

This study aimed to examine the relative risk of risk factor in male and female breast cancer (BC) deaths in China and analyzed the changing trends in BC mortality rates from 1990 to 2019.

METHODS

Open data from the Global Burden of Disease database from 1990 to 2019 were analyzed to assess the number of BC deaths and age-standardized mortality rates (ASMR) in China. The age-period-cohort model was employed to study age effects, period effects, cohort effects, as well as local drift and net drift of the data, determining the impact of changing risk factors on crude mortality rates and ASMR of BC.

RESULTS

In 2019, the number of BC deaths across all age groups in China increased by 130.38% compared to 1990, with an increase of 125.68% in females and 648.80% in males. The ASMR for BC and male BC increased in 2019, while female BC ASMR declined. Overall, alcohol consumption and smoking as risk factors contributed to increased mortality rates of BC with advancing age. Over the entire study period, the net drift of alcohol consumption in females for BC was 0.06% (95% confidence interval [CI]: -0.24% to 0.36%), while for smoking it was -0.64% (95% CI: -0.83% to -0.45%). For males, the net drift of alcohol consumption for BC was 6.75% (95% CI: 5.55% to 7.96%), and for smoking, it was 6.09% (95% CI: 2.66% to 9.64%).

CONCLUSION

Hence, improving awareness of BC-related risk factors and implementing prevention strategies are necessary to alleviate future BC burdens.

A contemporary review of breast cancer risk factors and the role of artificial intelligence

Background

Breast cancer continues to be a significant global health issue, necessitating advancements in prevention and early detection strategies. This review aims to assess and synthesize research conducted from 2020 to the present, focusing on breast cancer risk factors, including genetic, lifestyle, and environmental aspects, as well as the innovative role of artificial intelligence (AI) in prediction and diagnostics.

Methods

A comprehensive literature search, covering studies from 2020 to the present, was conducted to evaluate the diversity of breast cancer risk factors and the latest advances in Artificial Intelligence (AI) in this field. The review prioritized high-quality peer-reviewed research articles and meta-analyses.

Results

Our analysis reveals a complex interplay of genetic, lifestyle, and environmental risk factors for breast cancer, with significant variability across different populations. Furthermore, AI has emerged as a promising tool in enhancing the accuracy of breast cancer risk prediction and the personalization of prevention strategies.

Conclusion

The review highlights the necessity for personalized breast cancer prevention and detection approaches that account for individual risk factor profiles. It underscores the potential of AI to revolutionize these strategies, offering clear recommendations for future research directions and clinical practice improvements.

Trends in breast cancer mortality attributable to metabolic risks in Chinese women from 1990 to 2019: an age-period-cohort analysis

Objective

Metabolic risks (MRs) are the primary determinants of breast cancer (BC) mortality among women. This study aimed to examine the changing trends in BC mortality associated with MRs and explore how they related to age, time period, and birth cohorts in Chinese women aged 25 and above.

Methods

Data were sourced from the Global Burden of Disease Study 2019 (GBD2019). The BC mortality trajectories and patterns attributable to MRs were assessed using Joinpoint regression. The age-period-cohort (APC) model was employed to evaluate cohort and time period effects.

Results

The age-standardized mortality rate (ASMR) of BC mortality linked to MRs displayed an escalating trend from 1990 to 2019, demonstrating an average annual percentage change (AAPC) of 1.79% (95% CI: 1.69~1.87). AAPCs attributable to high fasting plasma glucose (HFPG) and high body mass index (HBMI) were 0.41% (95% CI: 0.32~0.53) and 2.75% (95% CI: 2.68~2.82), respectively. APC analysis revealed that BC mortality due to HBMI in women aged 50 and above showed a rise with age and mortality associated with HFPG consistently demonstrated a positive correlation with age. The impact of HBMI on BC mortality significantly outweighed that of HFPG. The risk of BC mortality linked to HBMI has steadily increased since 2005, while HFPG demonstrated a trend of initial increase followed by a decrease in the period effect. Regarding the cohort effect, the relative risk of mortality was greater in the birth cohort of women after the 1960s of MRs on BC mortality, whereas those born after 1980 displayed a slight decline in the relative risk (RR) associated with BC mortality due to HBMI.

Conclusion

This study suggests that middle-aged and elderly women should be considered as a priority population, and control of HBMI and HFPG should be used as a primary tool to control metabolic risk factors and effectively reduce BC mortality.

Assessing the Impact of Organ Failure and Metastases on Quality of Life in Breast Cancer Patients: A Prospective Study Based on Utilizing EORTC QLQ-C30 and EORTC QLQ-BR45 Questionnaires in Romania

Breast cancer (BC) significantly impacts the quality of life (QoL) of affected individuals. This study, conducted at Colțea Clinical Hospital, Bucharest, aimed to assess the impact of organ failures and metastases on QoL in breast cancer patients using EORTC QLQ-C30 and EORTC QLQ-BR45 questionnaires and the survival rate to understand the clinical journey and the quality of life status in breast cancer patients. From January 2019 to October 2022, a prospective, observational study surveyed 874 patients, revealing 201 fatalities, 66 refusals, and 607 eligible participants. Results indicated statistically significant differences in various QoL aspects for patients experiencing heart failure, including physical functioning, pain, insomnia, global health status, and overall summary score. Kidney failure exhibited significance in physical functioning for QLQ-C30 and body image, sexual functioning, and endocrine sexual symptoms for QLQ-BR45. Respiratory failure demonstrated significant differences across multiple QoL domains. Patients with bone metastases reported lower physical functioning (p = 0.006) and increased pain (p = 0.002). This study has revealed an overall 5-year life expectancy of 68.8%, with survival rates of 93.8% for Stage I, 86.3% for Stage II, and 77.2% for Stage III breast cancer. Metastatic cancer patients have shown a 35.6% survival rate over 45 months, with a median survival duration of 36 months. A significant limitation of our study was the administration of the questionnaire only once, preventing us from quantifying the impact of specific treatment types on quality of life. This study emphasizes the necessity of using standardized QoL assessments in clinical practice from the initial presentation to ongoing follow-up.

Pharmaceutical characterization and exploration of Arkeshwara rasa in MDA-MB-231 cells

BACKGROUND

The diverse specificity mode of cancer treatment targets and chemo resistance demands the necessity of drug entities which can address the devastating dynamicity of the disease.

OBJECTIVES

To check the anti-tumour potential of traditional medicine rich in polyherbal components and metal nanoparticle namely Arkeshwara rasa (AR).

MATERIAL METHODS

The AR was prepared in a modified version with reference from Rasaratna Samuchaya and characterized using sophisticated instrumental analysis including XRD, SEM-EDAX, TEM, TGA-DSC, and LC-MS and tested against the MDA-MB-231 cell line to screen cell viability and the cytotoxicity with MTT, SRB and the AO assay.

RESULTS

XRD pattern shows cubic tetrahedrite structure with Sb, Cu, S peaks and trace elements like Fe, Mg, etc. The particle size of AR ranges between 20 and 30 nm. The TGA points thermal decomposition at 210 °C and the metal sulphide peaks in DSC. LC-MS analysis reveals the components of the formulation more on the flavonoid portion. The IC50 value of MTT and SRB are 25.28 μg/mL and 31.7 μg/mL respectively. The AO colorimeter substantiated the cell viability and the apoptosis figures of the same cell line. The AR exhibits cytotoxicity and reaffirms the apoptosis fraction with SRB assay.

CONCLUSIONS

The Hesperidine, Neohesperidin, Rutin components in the phytochemical pool can synergize the anti-tumour potential with either influencing cellular pathways or decreasing chemo resistance to conventional treatment. AR need to be further experimented with reverse transcription, flow cytometry, western blotting, etc.

Analyzing Cancer Incidence Trends in Oman From 1996 to 2019: A Comprehensive Study of the National Cancer Annual Reports

PURPOSE

Previous studies have reported that cancer incidence trends in Oman varied by tumor site and sex. No comprehensive analysis of all cancer sites had been reported. The objective of this study is to analyze cancer incidence trends in Oman and calculate the annual percent change (APC) in age-standardized rates (ASRs) for all-cancer and 61 individual cancer sites in Omani men and women from 1996 to 2019.

METHODS

We gathered incidence data from The Omani National Cancer Registry for all cancers combined and individual tumor sites. We estimated the APC using Poisson regression.

RESULTS

The cancer ASR in the Omani population increased by 23% (from 95/100,000 in 1996 to 117.2/100,000 in 2019), with the increase being more pronounced in females (48% v 7% in males). Among the male population, there was significant increase in the ASRs of colon, rectum, thyroid, and prostate cancers, with APCs of 6.92%, 4.24%, 4.19%, and 2.03%, respectively. Among females, all-cancer incidence showed significant increase (APC = 1.39%), and increasing trends were observed in uterine, colon, rectum, thyroid, and breast cancers (APCs = 7.57%, 7.08%, 5.19%, 5.16%, and 4.19%, respectively).

CONCLUSION

The ASR of all-cancer increased significantly in Omani women but not in men. Uterine cancer had the highest APC. Colorectal cancer and thyroid ASR increased in both males and females. Breast and prostate cancers showed increasing trends. Further research is needed to explore factors contributing to increasing cancer incidences.

Disparities in Breast Cancer Diagnostics: How Radiologists Can Level the Inequalities

Access to medical imaging is pivotal in healthcare, playing a crucial role in the prevention, diagnosis, and management of diseases. However, disparities persist in this scenario, disproportionately affecting marginalized communities, racial and ethnic minorities, and individuals facing linguistic or cultural barriers. This paper critically assesses methods to mitigate these disparities, with a focus on breast cancer screening. We underscore scientific mobility as a vital tool for radiologists to advocate for healthcare policy changes: it not only enhances diversity and cultural competence within the radiology community but also fosters international cooperation and knowledge exchange among healthcare institutions. Efforts to ensure cultural competency among radiologists are discussed, including ongoing cultural education, sensitivity training, and workforce diversification. These initiatives are key to improving patient communication and reducing healthcare disparities. This paper also highlights the crucial role of policy changes and legislation in promoting equal access to essential screening services like mammography. We explore the challenges and potential of teleradiology in improving access to medical imaging in remote and underserved areas. In the era of artificial intelligence, this paper emphasizes the necessity of validating its models across a spectrum of populations to prevent bias and achieve equitable healthcare outcomes. Finally, the importance of international collaboration is illustrated, showcasing its role in sharing insights and strategies to overcome global access barriers in medical imaging. Overall, this paper offers a comprehensive overview of the challenges related to disparities in medical imaging access and proposes actionable strategies to address these challenges, aiming for equitable healthcare delivery.

Estimating disparities in breast cancer screening programs towards mortality, case fatality, and DALYs across BRICS-plus

BACKGROUND

Numerous studies over the past four decades have revealed that breast cancer screening (BCS) significantly reduces breast cancer (BC) mortality. However, in BRICS-plus countries, the association between BCS and BC case fatality and disability are unknown. This study examines the association of different BCS approaches with age-standardized mortality, case-fatality, and disability-adjusted life years (DALYs) rates, as well as with other biological and sociodemographic risk variables, across BRICS-plus from a national and economic perspective.

METHODS

In this ecological study applying mixed-effect multilevel regression models, a country-specific dataset was analyzed by combining data from the Global Burden of Disease study 2019 on female age-standardized BC mortality, incidence, and DALYs rates with information on national/regional BCS availability (against no such program or only a pilot program) and BCS type (only self-breast examination (SBE) and/or clinical breast examination (CBE) [SBE/CBE] versus SBE/CBE with mammographic screening availability [MM and/or SBE/CBE] versus SBE/CBE/mammographic with digital mammography and/or ultrasound (US) [DMM/US and/or previous tests] in BRICS-plus countries.

RESULTS

Compared to self/clinical breast examinations (SBE/CBE) across BRICS-plus, more complex BCS program availability was the most significant predictor of decreased mortality [MM and/or SBE/CBE: - 2.64, p < 0.001; DMM/US and/or previous tests: - 1.40, p < 0.001]. In the BRICS-plus, CVD presence, high BMI, second-hand smoke, and active smoking all contributed to an increase in BC mortality and DALY rate. High-income and middle-income regions in BRICS-plus had significantly lower age-standardized BC mortality, case-fatality, and DALYs rates than low-income regions when nationwide BC screening programs were implemented.

CONCLUSIONS

The availability of mammography (digital or traditional) and BCS is associated with breast cancer burden in BRICS-plus countries, with regional variations. In light of high-quality evidence from previous causal studies, these findings further support the preventive role of mammography screening for BCS at the national level. Intervening on BCS related risk factors may further reduce the disease burden associated with BC.

Epidemiology and clinicopathologic features of breast cancer in China and the United States

Background

Breast cancer has kept increasing since the past decades and the incidence rate is the highest among all neoplasms nowadays. China, as well as other countries, faces severe burden from the increasing population with breast cancer. This study aimed to analyze the epidemiology and clinicopathologic features of breast cancer in China and the United States (US).

Methods

Data of hospitalized patients diagnosed with primary breast cancer between 1 January 1999 and 31 December 2014 in the Cancer Hospital, Chinese Academy of Medical Sciences (CHCAMS) were reviewed. Clinical and demographic data were extracted from medical history systems, and the sixteen-year trends were analyzed. Meanwhile, retrieved data from the Surveillance, Epidemiology, and End Results (SEER) database from 1999 to 2014 were used for comparisons.

Results

A total of 18,768 breast cancer patients were included from CHCAMS, China, with 18,685 female cases (99.57%) and 81 male cases (0.43%). A total of 762,954 breast cancer patients were included from the SEER database, US, with 757,357 female cases (99.27%) and 5,597 male cases (0.73%). The peak age of breast cancer was 45-49 years old from 1999 to 2014 in China, while the peak age was 55-59 years from 1999 to 2006 and 60-64 years from 2007 to 2014 in the US. There were more young (<35 years, 6.56% vs. 1.97%, P<0.001), less elderly (≥65 years, 9.99% vs. 40.88%, P<0.001), less stage I (24.93% vs. 48.84%, P<0.001) and more stage III (21.00% vs. 12.35%, P<0.001) breast cancer patients in China than in the US. Patients aged 30-49 years old had a decreased trend (P<0.001), while 55-64 years old patients had an increased trend (P<0.001) from 1999 to 2014 in China, the same trend was also observed in the US. Mucinous carcinoma and histological grade I breast cancer patients increased with age both in China and the US (P<0.001).

Conclusions

The unique epidemiology and clinicopathologic features of breast cancer (earlier peak age, more younger patients, more advanced stage, etc.), as well as the typical trend in China, should be seriously recognized, so as to guide future prevention and management strategies.

OBHS Drives Abnormal Glycometabolis Reprogramming via GLUT1 in Breast Cancer

Due to the poor metabolic conditions fomenting the emergence of the Warburg effect (WE) phenotype, abnormal glycometabolism has become a unique and fundamental research topic in the field of tumor biology. Moreover, hyperglycemia and hyperinsulinism are associated with poor outcomes in patients with breast cancer. However, there are a few studies on anticancer drugs targeting glycometabolism in breast cancer. We hypothesized that Oxabicycloheptene sulfonate (OBHS), a class of compounds that function as selective estrogen receptor modulators, may hold potential in a therapy for breast cancer glycometabolism. Here, we evaluated concentrations of glucose, glucose transporters, lactate, 40 metabolic intermediates, and glycolytic enzymes using an enzyme-linked immunosorbent assay, Western blotting, and targeted metabolomic analysis in, in vitro and in vivo breast cancer models. OBHS significantly inhibited the expression of glucose transporter 1 (GLUT1) via PI3K/Akt signaling pathway to suppress breast cancer progression and proliferation. Following an investigation of the modulatory effect of OBHS on breast cancer cells, we found that OBHS suppressed the glucose phosphorylation and oxidative phosphorylation of glycolytic enzymes, leading to the decreased biological synthesis of ATP. This study was novel in highlighting the role of OBHS in the remodeling of tumor glycometabolism in breast cancer, and this is worth further investigation of breast cancer in clinical trials.