Breast Disease - Volume 40, issue 2

Authors: Khojasteh Poor, Fatemeh | Keivan, Mona | Ramazii, Mohammad | Ghaedrahmati, Farhoodeh | Anbiyaiee, Amir | Panahandeh, Samira | Khoshnam, Seyed Esmaeil | Farzaneh, Maryam

Article Type: Review Article

Abstract: Breast cancer (BC) is the most common cancer and the prevalent type of malignancy among women. Multiple risk factors, including genetic changes, biological age, dense breast tissue, and obesity are associated with BC. The mitogen-activated protein kinases (MAPK) signaling pathway has a pivotal role in regulating biological functions such as cell proliferation, differentiation, apoptosis, and survival. It has become evident that the MAPK pathway is associated with tumorigenesis and may promote breast cancer development. The MAPK/RAS/RAF cascade is closely associated with breast cancer. RAS signaling can enhance BC cell growth and progression. B-Raf is an important kinase and a potent …RAF isoform involved in breast tumor initiation and differentiation. Depending on the reasons for cancer, there are different strategies for treatment of women with BC. Till now, several FDA-approved treatments have been investigated that inhibit the MAPK pathway and reduce metastatic progression in breast cancer. The most common breast cancer drugs that regulate or inhibit the MAPK pathway may include Farnesyltransferase inhibitors (FTIs), Sorafenib, Vemurafenib, PLX8394, Dabrafenib, Ulixertinib, Simvastatin, Alisertib, and Teriflunomide. In this review, we will discuss the roles of the MAPK/RAS/RAF/MEK/ERK pathway in BC and summarize the FDA-approved prescription drugs that target the MAPK signaling pathway in women with BC. Show more

Keywords: Breast cancer, MAPK pathway, RAS/RAF, MEK/ERK, FDA-approved drugs

DOI: 10.3233/BD-201063

Citation: Breast Disease, vol. 40, no. 2, pp. 51-62, 2021

Authors: Tarighi, Mahsa | Khalaj-Kondori, Mohammad | Hosseinzadeh, Asghar | Abtin, Maryam

Article Type: Research Article

Abstract: BACKGROUND: Accumulating evidence highlights that long noncoding RNA (lncRNA) DSCAM-AS1 play a key regulatory role in different stages of cancer development and progression. This study aimed to investigate whether the expression of DSCAM-AS1 is deregulated in breast cancer. MATERIALS AND METHODS: The relative expression of DSCAM-AS1 was measured in fifty breast cancerous and matched adjacent non-neoplastic tissue samples using quantitative real-time polymerase chain reaction (qPCR) technique. The association between DSCAM-AS1 expression and patients’ clinicopathological features was evaluated. Sensitivity and specificity of the DSCAM-AS1 expression for diagnosing breast cancer was obtained by the receiver operating characteristic (ROC) curve analysis. …RESULTS: Our results showed that the expression of DSCAM-AS1 was significantly up-regulated in breast cancerous tissues compared with the matched adjacent non-neoplastic tissues (P < 0.05). Furthermore, we observed a significant association between the DSCAM-AS1 expression and lymph node metastasis (P = 0.011) but no other clinicopathological characteristics (P > 0.05). ROC curve analysis resulted in an area under the curve (AUC) of 0.67 and showed that the DSCAM-AS1 expression level may discriminate cancerous and non-cancerous tissues with 68% sensitivity and 76% specificity. CONCLUSION: This study provides further evidence that the expression of DSCAM-AS1 is deregulated in breast cancer and highlights its potential in breast cancer development. Show more

Keywords: LncRNA, DSCAM-AS1, breast cancer, biomarker, gene expression

DOI: 10.3233/BD-201010

Citation: Breast Disease, vol. 40, no. 2, pp. 63-68, 2021

Authors: Russell, Thomas

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate what proportion of breast cancer patients were offered reconstruction following mastectomy (to assess compliance with national guidelines) and to consider the reasoning if patients were not given this option. METHODS: Records of all mastectomies were obtained from a prospectively maintained database (September 2018–October 2019). The following were collected: demographics, indication for surgery, tumour properties, and indication for mastectomy over breast-conserving surgery. Clinic letters were used to determine whether patients were offered reconstruction and whether they accepted. If a patient was not offered reconstruction, the rationale for this …was recorded. RESULTS: 201 mastectomies were carried out on 179 patients. 77.3% of women were offered reconstruction following mastectomy for cancer and 92.9% of women were offered reconstruction following mastectomy for non-invasive disease. Patients were not offered reconstruction only if they had significant co-morbidities (ASA grade III or higher); no patients who expressed an interest in reconstruction were declined. The most common reasons reconstruction was not offered included: deemed too frail following surgeon assessment (29.7%), advanced cancer (16.2%), and deemed high-risk following anaesthetist assessment (16.2%). 59.1% of patients who were offered reconstruction declined. Mean age in those who declined was significantly higher (P > 0.001). CONCLUSIONS: Our unit now complies with national guidelines when offering reconstruction to mastectomy patients; this service was not previously offered. Further research into the reasons behind why women are declining reconstruction is necessary to ensure we are providing adequate information in an appropriate format. Show more

Keywords: Breast cancer, mastectomy, reconstruction

DOI: 10.3233/BD-201047

Citation: Breast Disease, vol. 40, no. 2, pp. 69-73, 2021

Authors: Refaat, Sherif | Shamaa, Sameh | Elkhodary, Tawfik | Atwan, Nadia | Ghazy, Hayam | Akl, Tamer | Abdelwahab, Khaled | Foda, Abd AlRahman Mohammad | El-Badrawy, Adel | Emarah, Ziad

Article Type: Research Article

Abstract: BACKGROUND: Transforming growth factor–β (TGFβ) has a dual function in breast cancer, having a tumor suppressor activity in early carcinomas while enhancing tumor metastasis in advanced breast carcinoma. Consequently, the prognostic role of TGFβ and its signaling cascade in breast cancer remain unclear. OBJECTIVE: To investigate the relationship between TβRII expression, clinic-pathological characteristics, and prognostic significance of TβRII expression in clinical stage III breast cancer. METHODS: Biopsy from the primary tumor was obtained from 30 newly diagnosed clinical stage III breast cancer patients before receiving any therapy. Expression of TβRII, ER, PR, Her2 and Ki-67 was …assessed by immunohistochemistry. RESULTS: TβRII expression was positive in 66.7% of cases and was significantly associated with advanced nodal stage and distant metastases. After a median follow up of 42.3 months, TβRII was associated with poor disease-free survival and it was an independent factor for predicting the poor outcome for breast cancer patients, especially in node positive tumors, ER/PR positive and Her2-negative tumors. CONCLUSIONS: These findings suggest the usage of therapeutic drugs that target TGFβ in advanced breast cancer patients may be effective. Nevertheless, blockage of the tumor promoting and sparing of the tumor suppressor effect of TGFβ pathway should be taken into consideration. We suggest that these therapies might have more benefit in ER and PR positive tumors. Show more

Keywords: TβRII, transforming growth factor–β, breast cancer

DOI: 10.3233/BD-201009

Citation: Breast Disease, vol. 40, no. 2, pp. 75-83, 2021

Authors: Forte, Antonio J. | Huayllani, Maria T. | Boczar, Daniel | Avila, Francisco R. | Kassis, Salam | Ciudad, Pedro | Lu, Xiaona | Moore, Pamela A. | McLaughlin, Sarah A.

Article Type: Systematic Review

Abstract: BACKGROUND: Bioimpedance spectroscopy has been suggested as a useful tool for early diagnosis of breast cancer–related lymphedema (BCRL). We aimed to describe the outcomes of published studies that evaluated bioimpedance analysis as a method for prospective surveillance and early diagnosis of BCRL. METHODS: We queried the PubMed, Ovid Medline, and EMBASE databases to identify studies that evaluated use of bioimpedance spectroscopy as a diagnostic tool. We used the keywords “bioimpedance” AND (“lymphedema” OR “lymphoedema”) in the search. Only English-language studies that reported quantitative outcomes for patients with BCRL were included. RESULTS: Of 152, 235 and 116 …identified articles in PubMed, Ovid Medline and EMBASE databases, only 22 were included. Use of bioimpedance analysis for prospective surveillance has been shown to prevent chronic BCRL. All the cross-sectional and retrospective studies that evaluated bioimpedance for diagnosis of BCRL reported significantly different L-Dex scores between lymphedema patients and healthy participants; in addition, bioimpedance scores were positively correlated with volume of lymphedema. CONCLUSION: Bioimpedance analysis is a potential tool with demonstrated benefits for prevention of chronic BCRL and may be an economic and great alternative for early diagnosis of BCRL. Show more

Keywords: Bioimpedance, surveillance, diagnosis, breast cancer, lymphedema

DOI: 10.3233/BD-201008

Citation: Breast Disease, vol. 40, no. 2, pp. 85-93, 2021

Authors: Pecorella, Irene | Okello, Tom Richard | Okwang, Martin David

Article Type: Research Article

Abstract: BACKGROUND: Little information is available on male breast cancer (MBC) incidence from sub-Saharan Africa. OBJECTIVE: This is a retrospective study on MBC in rural North Uganda, based on the pathology records of a private, non-profit, missionary hospital. METHODS: All male patients that had histological diagnosis of breast carcinoma from January 2009 to December 2016 were included in this study. RESULTS: In time span of 8 years, there were 337 consecutive breast cancer presentations, including 21 MBC (6.2%). The latter patients showed advanced disease (mean symptom duration: 20.3 months; mean tumour size: 5 cm) skin …ulceration and ipsilateral lymph node metastasis: 60%). The mean age was 60.52 years (from 30 to 85 yrs). Ductal infiltrating carcinoma was the prevalent histological type in our series (65%), followed by an unusually high rate of papillary carcinomas (15%). There appeared to be a prevalence for left breasts (11 LT versus 6 RT; 64.7%), a finding also observed in the majority of MBC. CONCLUSIONS: This study is representative of the scenario in Northern Uganda, where MBC accounts for 6.2% of breast cancers, More information on the occurrence and risk factors of this unusual neoplasm in African countries may prompt prevention of chronic liver disease and early recognition and treatment of MBC. Show more

Keywords: Male breast cancer, Uganda, pathology, epidemiology

DOI: 10.3233/BD-201068

Citation: Breast Disease, vol. 40, no. 2, pp. 95-100, 2021

Authors: Odikpo, Linda C. | Chiejina, E.N.

Article Type: Research Article

Abstract: BACKGROUND: Knowledge of exercise is of paramount importance in improving and reclaiming the health of women with breast cancer and also enables them to reap the enormous benefits associated with healthy physical activity. AIM: To assess the knowledge and perceived benefits of exercise among women with breast cancer in Delta State. METHOD: Sample of 94 eligible consenting women who are still maintaining follow up with the two tertiary hospitals in Delta state, Federal Medical Center (FMC) Asaba and Delta State University Teaching Hospital (DELSUTH) Oghara were enlisted for the study. RESULT: Findings from the study …revealed knowledge of the recommended exercise was poor among the women with breast cancer, as only 21(22.3%) had good knowledge. For those knowledgeable, their knowledge source was mainly through the mass media 5(23.8%) and the internet 4(19.0%). On the benefits of exercise as perceived by the women with breast cancer, the result shows that 88 (93.6%) of the women with breast cancer perceived exercise as beneficial. The principal exercise perceived to be beneficial was walking 43(45.7) and treatment of discomfort 25(26.6%) was the main benefit they hoped to gain from exercise. Also demographic profiles of the women were not significantly related to their knowledge about the recommended exercise asp > 0.05. CONCLUSION: Knowledge of the recommended exercise was low among women with breast cancer despite their awareness of the benefits. It is therefore essential for health care providers, especially those involved in the care of these patients, to use every avenue to health-educate, counsel and help them in implementing the recommended exercise to enhance their survival. Show more

Keywords: Perceived benefits, exercise, breast cancer, Delta State

DOI: 10.3233/BD-201062

Citation: Breast Disease, vol. 40, no. 2, pp. 101-108, 2021

Authors: Salemis, Nikolaos S.

Article Type: Case Report

Abstract: Ectopic breast tissue (EBT) develops as the result of the incomplete embryologic regression of the mammary ridge, which extends bilaterally from the anterior axilla folds to the inguinal folds in the fifth and sixth weeks of gestation. EBT is encountered in 0.3%–6% of women and 1%–3% of men and can be found anywhere along the milk line. It is subject to the same pathologic changes that affect the orthotopic breast. Primary carcinoma arising on the ectopic breast (PEBC) is a very rare occurrence accounting for 0.3%–0.6% of all breast cancers and is most frequently found in the axilla. Due to …the rarity and atypical presentation of the disease, the diagnosis is often delayed. We herein present a very rare case of PEBC in the axilla along with a review of the literature. Any subcutaneous hypoechoic nodule located along the milk line without evidence of inflammation should raise concern for ectopic breast carcinoma. Accurate staging and differential diagnosis with detailed immunohistochemical analysis are required. No specific guidelines on diagnosis and treatment are available and the tumor is treated similarly to the orthotopic breast cancer of a similar stage. Physicians should be aware of this rare entity to avoid treatment delays. Show more

Keywords: Ectopic, carcinoma, breast

DOI: 10.3233/BD-201027

Citation: Breast Disease, vol. 40, no. 2, pp. 109-114, 2021

Authors: Edalatpour, Armin | Lucarelli, Katherine M. | Afifi, Ahmed M.

Article Type: Case Report

Abstract: Intraoperative vascular imaging using indocyanine green (ICG) angiography may better predict flap viability than clinical judgement alone. Intraoperative ICG angiography was used in a chronic corticosteroid user undergoing bilateral nipple sparing mastectomy with expander placement. Large blood vessels were visualized, however, the skin surrounding these vessels remained dark. The flap demarcated to full-thickness necrosis that matched the intraoperative SPY findings. Visualization of intact blood vessels may not be sufficient to rule out flap necrosis in some patients. In these circumstances, interpretation of perfusion with consideration of patient factors will be required to accurately predict flap viability.

Keywords: ICG, microangiopathy, mastectomy skin flap, breast reconstruction

DOI: 10.3233/BD-201050

Citation: Breast Disease, vol. 40, no. 2, pp. 115-116, 2021