Breast Disease - Volume 41, issue 1

Authors: Masannat, Yazan A. | Lazaraviciute, Gabija | Garbett, Ian K. | Shivakumar, Natesh | Brownlee, Brittany V. | Gagliardi, Tanja | Bromiley, Andrew | Heys, Steven D. | Sharma, Ravi

Article Type: Research Article

Abstract: BACKGROUND: Radiotherapy after breast surgery decreases locoregional recurrence and improves survival. This is not without risks from radiation exposure and could have implications in clinical practice. Our study investigates the correlation between tumour location and radiation dose to the heart. METHODS: Left-sided breast cancer patients who had radiotherapy at Aberdeen Royal Infirmary in 2010 were identified. Tumour location was established from notes and imaging. Radiotherapy planning scans were reviewed, and cardiac doses calculated. The mean cardiac dose, maximum dose and volume of the heart in the field, along with V5-V40, were determined. RESULTS: 40 patients had …mastectomies and 118 breast conserving surgery. The median percentage of the heart in the field and the Interquartile Range was 0.59% (0.03–1.74) for all patients, with the highest for lower inner quadrant (LIQ) tumours 1.20% (0.29–2.40), followed by mastectomy 0.94% (0.02-1.82). The mean heart dose showed a higher median for mastectomies 1.59 Gy (1.00-1.94), followed by LIQ tumours 1.58 Gy (1.31–2.28), with an overall median of 1.42 Gy (1.13–1.95). The median percentage of the heart in the field, the mean cardiac dose and V5-V30 did not reach statistical significance, however, V40 and the maximum dose did. CONCLUSIONS: The benefits of radiotherapy after breast cancer surgery are established, but with potential harm from cardiac exposure. Our cohort showed higher radiation exposure to the heart in patients with LIQ tumours and mastectomies but reached significance only for V40 and maximum dose. This highlights tumour location as a potentially important risk factor for cardiac exposure with breast radiotherapy. Show more

Keywords: Breast cancer, radiotherapy, cardiac dose

DOI: 10.3233/BD-201025

Citation: Breast Disease, vol. 41, no. 1, pp. 67-74, 2022

Authors: Huayllani, Maria T. | Torres-Guzman, Ricardo A. | Avila, Francisco R. | Advani, Pooja P. | Spaulding, Aaron C. | Cochuyt, Jordan J. | Nguyen, Minh-Doan T. | Lu, Xiaona | Rinker, Brian D. | Forte, Antonio J.

Article Type: Research Article

Abstract: INTRODUCTION: Disparities in access to reconstructive surgery after breast cancer have been reported. We aim to evaluate demographic and socioeconomic factors influencing type of autologous breast reconstruction in Florida. METHODS: We queried the Florida Inpatient Discharge Dataset to evaluate disparities in type of autologous breast reconstructive surgery between January 1, 2013, and September 30, 2017. Patients 18 years of age or older were included. Women younger than 65 years old on Medicare were excluded. Patients were categorized into three groups according to type of autologous reconstruction: latissimus dorsi pedicled flap (pedicled flap), free flap, or pedicled flap with …implant (combined flap). Demographic and socioeconomic variables were evaluated. 𝜒2 and Mann–Whitney tests were used to estimate statistical significance. A multivariate logistic regression was performed to find independent associations. RESULTS: Our results showed higher odds of reconstruction with free flap in Hispanic patients (odds ratio (OR), 1.66; 95% CI, 1.32–2.09; P < 0.0001) and patients with comorbidities (OR, 1.45; 95% CI, 1.23–1.71; P < 0.0001). However, patients treated in Central and South Florida were less likely to undergo free flap than combined and pedicled flap reconstructions compared with those treated in North Florida (P < 0.05). Patients insured by Medicaid and Medicare were less likely to undergo free flap than combined or pedicled flap reconstruction compared to patients with private insurance (P < 0.05). CONCLUSIONS: Our study identified that race, region, insurance, and comorbidity are factors associated with type of autologous breast reconstruction in Florida. Show more

Keywords: Malignant breast disease, reconstructive surgery, breast reconstruction, disparities, race, insurance

DOI: 10.3233/BD-210004

Citation: Breast Disease, vol. 41, no. 1, pp. 75-80, 2022

Authors: Brar, Jasleen | Khalid, Ayisha | Ferdous, Mahzabin | Abedin, Tasnima | Turin, Tanvir C.

Article Type: Brief Report

Abstract: BACKGROUND: The YouTube platform has great potential of serving as a healthcare resource due to its easy accessibility, navigability and wide audience reach. Breast cancer screening is an important preventative measure that can reduce breast cancer mortality by 40%. Therefore, platforms being used as a healthcare resources, such as YouTube, can and should be used to advocate for essential preventative measures such as breast cancer screening. METHODS: In this study, the usefulness of videos related to breast cancer and breast cancer screening were analyzed. Videos were first screened for inclusion and then were categorized into very useful , …moderately useful , somewhat useful , and not useful categories according to a 10-point criteria scale developed by medical professionals based on existing breast cancer screening guidelines. Two reviewers independently assessed each video using the scale. RESULTS: 200 videos were identified in the preliminary analysis (100 for the search phrase ‘breast cancer’ and 100 for the search phrase ‘breast cancer screening’). After exclusion of duplicates and non-relevant videos, 162 videos were included in the final analysis. We found the following distribution of videos: 4.3% very useful , 17.9% moderately useful , 39.5% somewhat useful , and 38.3% not useful videos. There was a significant association between each of the following and the video’s level of usefulness: video length, the number of likes, and the uploading source. Longer videos were very useful , somewhat useful videos were the most liked, personally produced videos were the most not useful , and advertisements produced the highest ratio of very useful to not useful videos. CONCLUSION: It is necessary to create more reliable and useful healthcare resources for the general population as well as to monitor health information on easily accessible social platforms such as YouTube. Show more

Keywords: Cancer screening, health literacy, information, usefulness, video

DOI: 10.3233/BD-201028

Citation: Breast Disease, vol. 41, no. 1, pp. 81-87, 2022

Authors: Gerets, J.C.W.L. | Kool, M. | Simons, P.C.G. | Aarts, F. | Vogelaar, F.J.

Article Type: Research Article

Abstract: INTRODUCTION: The management of complex cysts of the breast is an ongoing topic of discussion. The aim of this study was to determine the prevalence of underlying malignancy in radiologically diagnosed complex cysts, and to assess whether watchful waiting could be the preferred method to safely manage complex cysts of the breast. SUBJECTS AND METHODS: A single-center retrospective study was performed between May 2003 and November 2019 in the VieCuri Medical Centre. Women with a radiologically diagnosed complex cyst of the breast were included. Prevalence of underlying malignancy was calculated, as were absolute risk reduction and number needed …to treat in order to diagnose malignancy. In addition, patient characteristics were compared to determine characteristics associated with malignancy. RESULTS: Of 78 radiologically diagnosed complex cysts of the breast, five (6,4%) were found to be malignant. The number needed to treat was calculated at 12,8 (absolute riks reduction 0,078). Age (P = 0,003) was associated with malignancy. CONCLUSION: Complex cysts of the breast could be managed more conservatively. Patient characteristics can be used to assess the eligibility for radiological follow-up. This, in turn, would lead to a lower NNT and possibly a decrease in disease burden and healthcare costs. Show more

Keywords: Complex cyst, breast, excision biopsy, follow up, number needed to treat

DOI: 10.3233/BD-201057

Citation: Breast Disease, vol. 41, no. 1, pp. 89-95, 2022

Authors: Salinas-Huertas, S. | Luzardo-González, A. | Vázquez-Gallego, S. | Pernas, S. | Falo, C. | Pla, M.J. | Gil-Gil, M. | Beranuy-Rodriguez, M. | Pérez-Montero, H. | Gomila-Sancho, M. | Manent-Molina, N. | Arencibia-Domínguez, A. | Gonzalez-Pineda, B. | Tormo-Collado, F. | Ortí-Asencio, M. | Terra, J. | Martinez-Perez, E. | Mestre-Jane, A. | Campos-Varela, I. | Jaraba-Armas, M. | Benítez-Segura, A. | Campos-Delgado, M. | Fernández-Montolí, M.E. | Valverde-Alcántara, Y. | Rodríguez, A. | Campos, G. | Guma, A. | Ponce-Sebastià, J. | Planas-Balagué, R. | Catasús-Clavé, M. | García-Tejedor, A.

Article Type: Research Article

Abstract: INTRODUCTION: The Objective was to investigate the incidence of lymphedema after breast cancer treatment and to analyze the risk factors involved in a tertiary level hospital. METHODS: Prospective longitudinal observational study over 3 years post-breast surgery. 232 patients undergoing surgery for breast cancer at our institution between September 2013 and February 2018. Sentinel lymph node biopsy (SLNB) or axillary lymphadenectomy (ALND) were mandatory in this cohort. In total, 201 patients met the inclusion criteria and had a median follow-up of 31 months (range, 1–54 months). Lymphedema was diagnosed by circumferential measurements and truncated cone calculations. Patients and tumor …characteristics, shoulder range of motion limitation and local and systemic therapies were analyzed as possible risk factors for lymphedema. RESULTS: Most cases of lymphedema appeared in the first 2 years. 13.9% of patients developed lymphedema: 31% after ALND and 4.6% after SLNB (p < 0.01), and 46.7% after mastectomy and 11.3% after breast-conserving surgery (p < 0.01). The lymphedema rate increased when axillary radiotherapy (RT) was added to radical surgery: 4.3% for SLNB alone, 6.7% for SLNB + RT, 17.6% for ALND alone, and 35.2% for ALND + RT (p < 0.01). In the multivariate analysis, the only risk factors associated with the development of lymphedema were ALND and mastectomy, which had hazard ratios (95% confidence intervals) of 7.28 (2.92–18.16) and 3.9 (1.60–9.49) respectively. CONCLUSIONS: The main risk factors for lymphedema were the more radical surgeries (ALND and mastectomy). The risk associated with these procedures appeared to be worsened by the addition of axillary radiotherapy. A follow-up protocol in patients with ALND lasting at least two years, in which special attention is paid to these risk factors, is necessary to guarantee a comprehensive control of lymphedema that provides early detection and treatment. Show more

Keywords: Breast cancer, lymphedema, sentinel lymph node biopsy, axillary lymphadenectomy, mastectomy

DOI: 10.3233/BD-210043

Citation: Breast Disease, vol. 41, no. 1, pp. 97-108, 2022

Authors: Yamamura, Jun | Miyamura, Yukiko | Kamigaki, Shunji | Fujita, Junya | Osato, Hiroki | Manabe, Hironobu | Tanaka, Yumiko | Shinzaki, Wataru | Hahimot, Yukihiko | Ito, Toshikazu | Komoike, Yoshifumi

Article Type: Research Article

Abstract: BACKGROUND: Current guidelines define primary and secondary endocrine resistance according to the periods of adjuvant endocrine therapy (adj-ET); however, the relationship between adj-ET period and endocrine resistance remains unclear. OBJECTIVE: We examined progression-free survival (PFS) after primary ET for recurrent hormone receptor-positive/HER2-negative breast cancer, and evaluated the relationship between endocrine resistance and the periods of adj-ET. METHODS: We assessed PFS among 183 patients who received ET as primary treatment for the first recurrence, according to the period of adj-ET (adj-ET < 1 year, 1–2 years, ≥2 years, and completion). RESULTS: Patients who relapsed during the …first year of adj-ET had the significantly shortest PFS. PFS did not significantly differ between patients who relapsed at 1–2 years of adj-ET and patients who relapsed while on adj-ET but after the first 2 years. CONCLUSIONS: Relapse at 1–2 years after adj-ET initiation might be better classified as secondary endocrine resistance rather than primary endocrine resistance. Show more

Keywords: Recurrent breast cancer, hormone receptor-positive, HER2-negative, adjuvant endocrine therapy, endocrine resistance

DOI: 10.3233/BD-210027

Citation: Breast Disease, vol. 41, no. 1, pp. 109-114, 2022

Authors: Goyal, Shina | Jacob, Linu Abraham | Lokanatha, D. | Suresh Babu, M.C. | Lokesh, K.N. | Rudresha, A.H. | Saldanha, Smitha | Amirtham, Usha | Thottian, Antony G.F. | Rajeev, L.K.

Article Type: Research Article

Abstract: BACKGROUND: The present era of individualized treatment for breast cancer is influenced by the initial disease status including the anatomical extent, grade, and receptor status. An accurate preoperative staging is the basis of treatment planning and prognostication. Our study aims to determine the discordance between the preoperative clinical and the postoperative pathological stages of breast cancer patients. METHODOLOGY: The medical records of all non-metastatic breast cancer patients from January 2017 to December 2018 who underwent upfront surgery were reviewed. They were staged as per the eighth AJCC and the concordance between the clinical (c) and pathological T (tumor), …N (nodal), and final AJCC stage was studied. A Chi-square test was used to determine factors that significantly correlate with disease discordance. RESULTS: A total of 307 breast cancer patients were analyzed. Among these, 43.3% were hormone receptor-positive, 30.6% were Her2 positive and 26% were triple-negative. Overall stage discordance was seen in 48.5% (n = 149) patients (upstaging in 22.1%, downstaging in 26.4%). The discordance rate was 48.9% for T stage (cT versus pT) and 57.4% for N stage (cN versus pN). Among patients with clinically node-negative disease, 53.4% were found to have positive nodes on histopathology, while 27.2% had vice versa. Overall, the factors associated with upstaging were ER-positive, Her2 positive and triple-negative status (all p < 0.05), while none of the factors showed significant association with downstaging. CONCLUSIONS: About half of breast cancer patients had discordance between clinical and pathological staging with higher discordance in the nodal stage. This changes the disease prognosis, and may also affect the offered surgical treatment and radiotherapy. Thus highlighting the need for a precise pre-operative staging. Also, this information will aid clinicians in discussions with patients, keeping in mind the likelihood of change in disease staging and management.  Show more

Keywords: Discordance, upstaging, breast cancer, preoperative staging, pathological staging

DOI: 10.3233/BD-201029

Citation: Breast Disease, vol. 41, no. 1, pp. 115-121, 2022

Authors: Gomes de Oliveira, Geilson | Gonçalves, Ana Katherine | Eleutério Jr, José | Pinheiro, Luiz Gonzaga Porto

Article Type: Systematic Review

Abstract: BACKGROUND: Although widely studied, the role of HPV in the genesis of breast carcinomas remains elusive due to the diversity of results across studies, possibly caused by the wide methodological heterogeneity, some of them with inadequate methods. OBJECTIVE: To verify the association between HPV and breast cancer through the meta-analysis of studies that used the best-recognized techniques for viral detection and tissue conservation. METHODS: A systematic review and meta-analysis restricted to studies that detected HPV by PCR in fresh and frozen tissue from breast cancer were conducted to obtain greater homogeneity. PubMed, Scopus, Science Direct, Cochrane …Library, and SciELO were searched until December 14, 2019. Search terms included “breast cancer” and “HPV” without language restrictions. Eleven studies were included in the meta-analysis. The pooled relative risks and 95% confidence interval (95% CI) were calculated, and heterogeneity was assessed using the I-squared (I2 ). RESULTS: The selected studies had very low heterogeneity (2%). There is a 2.15 times higher combined relative risk (95% CI = 1.60-2.89) of detecting HPV in breast cancer than in cancer-free breast controls with a statistically significant p -value (p < 0.0001). CONCLUSION: Our data support the association of DNA-HPV with breast carcinomas. Further studies are needed to find out which breast cancer subtypes this association is most frequent. Show more

Keywords: Human papillomavirus, breast cancer, meta-analysis, fresh tissue, PCR

DOI: 10.3233/BD-201032

Citation: Breast Disease, vol. 41, no. 1, pp. 123-132, 2022

Authors: Assunção Ribeiro da Costa, Rafael Everton | da Silva Fontinele, Danilo Rafael | Medeiros, Paula Catarina Dalia Rego | Vieira, Sabas Carlos

Article Type: Case Report

Abstract: BACKGROUND: Metaplastic breast carcinoma (MBC) is a rare type of breast cancer (0.20–1.00% of all cases). With a more aggressive clinical course, MBC frequently presents as a triple-negative subtype. OBJECTIVE: To describe a case series, analyzing patients survival in four MBC cases. METHODS: The cases were obtained from 532 medical records of breast cancer patients (0.7% of the total). RESULTS: All patients were female. Mean patient age was 49 years (range: 38–60 years). Mean tumor size was 8.9 cm (range: 3.0–15.5 cm). Mastectomy was performed in three cases. One patient had axillary nodal metastasis. All …underwent chemotherapy and three received radiation therapy after surgery. CONCLUSIONS: With a mean follow-up of 36 months (range: 10–60 months), one case had a tumor recurrence (25%). Three patients (75%) died from metastatic disease and one (25%) is still alive and free of disease. Show more

Keywords: Survival, breast neoplasms, recurrence, neoplasm metastasis, medical records

DOI: 10.3233/BD-210040

Citation: Breast Disease, vol. 41, no. 1, pp. 133-136, 2022

Authors: Ghafouri-Fard, Soudeh | Sohrabi, Behnoush | Hussen, Bashdar Mahmud | Mehravaran, Elham | Jamali, Elena | Arsang-Jang, Shahram | Fathi, Mohadeseh | Taheri, Mohammad | Samsami, Majid

Article Type: Research Article

Abstract: TP53 encodes a major tumor suppressor protein which blocks carcinogenesis process in a variety of tissues including breast tissue. Expression and function of this gene is regulated by a number of long non-coding RNAs (lncRNAs) among them are PANDA , MEG3 and CASC2 . We measured expression of TP53 and these transcripts in a cohort of Iranian breast cancer patients. Expression levels of TP53 , MEG3 , CASC2 and PANDA were significantly lower in tumoral samples compared with non-tumoral samples (Posterior mean differences =  −4.26, −1.66, −5.98 and −3.13, respectively; P values < …0.0001). Expression of CASC2 was higher in Her2 1+ cases compared with Her2 negative cases (Beta = 1.85, P value = 0.037). Expression levels of MEG3 and TP53 were lower in grade 2 samples compared with grade 1 (Beta = −1.86, P value = 0.006 and Beta = −2.24, P value = 0.003, respectively). There was no other significant association between expression of genes and clinical variables. CASC2 had the best performance among these genes with area under curve value of 0.78 and sensitivity and specificity values of 56.33% and 88.73%, respectively (P value < 0.0001). The current investigation supports the role of TP53 -related lncRNAs in the pathogenesis of breast cancer. Show more

Keywords: TP53, lncRNA, PANDA , MEG3 , CASC2

DOI: 10.3233/BD-210069

Citation: Breast Disease, vol. 41, no. 1, pp. 137-143, 2022