Current Challenges and Perspectives in Breast Cancer in Elderly Women: The Senologic International Society (SIS) Survey.

Objective: Mammographic screening and management of breast cancer (BC) in elderly women are controversial and continue to be an important health problem. To investigate, through members of the Senologic International Society (SIS), the current global practices in BC in elderly women, highlighting topics of debate and suggesting perspectives. Materials and Methods: The questionnaire was sent to the SIS network and included 55 questions on definitions of an elderly woman, BC epidemiology, screening, clinical and pathological characteristics, therapeutic management in elderly women, onco-geriatric assessment and perspectives. Results: Twenty-eight respondents from 21 countries and six continents, representing a population of 2.86 billion, completed and submitted the survey. Most respondents considered women 70 years and older to be elderly. In most countries, BC was often diagnosed at an advanced stage compared to younger women, and age-related mortality was high. For this reason, participants recommended that personalized screening be continued in elderly women with a long life expectancy.In addition, this survey highlighted that geriatric frailty assessment tools and comprehensive geriatric evaluations needed to be used more and should be developed to avoid undertreatment. Similarly, multidisciplinary meetings dedicated to elderly women with BC should be encouraged to avoid under- and over-treatment and to increase their participation in clinical trials. Conclusion: Due to increased life expectancy, BC in elderly women will become a more important field in public health. Therefore, screening, personalized treatment, and comprehensive geriatric assessment should be the cornerstones of future practice to avoid the current excess of age-related mortality. This survey described, through members of the SIS, a global picture of current international practices in BC in elderly women.

Breast Cancer Management During the COVID-19 Pandemic: The Senologic International Society Survey.

OBJECTIVE: In early 2020, the spread of coronavirus disease-2019 (COVID-19) led the World Health Organization to declare this disease a pandemic. Initial epidemiological data showed that patients with cancer were at high risk of developing severe forms of COVID-19. National scientific societies published recommendations modifying the patients' breast cancer (BC) management to preserve, in theory, quality oncologic care, avoiding the increased risk of contamination. The Senology International Society (SIS) decided to take an inventory of the actions taken worldwide. This study investigates COVID-19-related changes concerning BC management and analyzes the will to maintain them after the pandemic, evaluating their oncological safety consequences. MATERIALS AND METHODS: SIS network members participated in an online survey using a questionnaire (Microsoft® Forms) from June 15th to July 31st, 2020. RESULTS: Forty-five responses from 24 countries showed that screening programs had been suspended (68%); magnetic resonance imagines were postponed (73%); telemedicine was preferred when possible (71%). Surgeries were postponed: reconstructive (77%), for benign diseases (84%), and in patients with significant comorbidities (66%). Chemotherapy and radiotherapy protocols had been adapted in 28% of patients in both. Exception for telemedicine (34%), these changes in practice should not be continued. CONCLUSION: The SIS survey showed significant changes in BC's diagnosis and treatment during the first wave of the COVID-19 pandemic, but most of these changes should not be maintained. Indeed, women have fewer severe forms of COVID-19 and are less likely to die than men. The risk of dying from COVID-19 is more related to the presence of comorbidities and age than to BC. Stopping screening and delaying treatment leads to more advanced stages of BC. Only women aged over 65 with BC under treatment and comorbidities require adaptation of their cancer management.

Monitoring of intracellular enzyme kinetic characteristics of peripheral mononuclear cells in breast cancer patients.

A new methodology for the detection of functional response of peripheral blood mononuclear cells against breast cancer (BC) antigens was developed. The method is based on cellular enzymatic activity measurements, using a fluorogenic substrate. We used this method to estimate the kinetic activity of lymphocytes derived from cancer patients and healthy donors. The aim of the study was to determine a possible correlation between the basic characteristics (K(m) and V(max)) of biochemical enzymatic reactions in live peripheral white mononuclear cells and common clinical-pathological characteristics in BC patients. Our method shows that the enzymatic activity, upon interaction with mitogen or tumor antigens, of the peripheral blood cells in BC patients is different from the enzymatic reactions in healthy individuals. This holds true in the early stages, and the difference persists throughout all of the stages of the disease. This difference is manifested, primarily, by an increase in the K(m) values after cell incubation with tumor tissue. It was also demonstrated that higher K(m) values of tumor tissue-activated peripheral blood mononuclear cells are associated with a better prognostic status of the BC patients (lymph node-negative tumors, hormone receptor preservation, and the absence of Her-2/neu protein overexpression). Thus, the present methodology may serve as an additional criterion for prognosis and monitoring, both in BC patients, and in individuals associated with high cancer risk.

The Usefulness of MIBI Scanning to Detect Underlying Carcinoma in Women with Acute Mastitis.

The efficacy of Tc-99m sestamibi scintimammography in the detection of breast carcinoma has been proven in previous studies. In this study we evaluated the influence of active mammary inflammation on Tc-99m sestamibi scintimammography and its ability to detect breast malignancy in the presence of this condition. Twenty-one women with acute nonpuerperal mastitis underwent breast scintimammography using Tc-99m sestamibi. Their mean age was 49.6 years. In 15 women the scan was positive, 2 suffered from inflammatory carcinoma of the breast, and all the other women had acute mastitis. Six patients had a negative scan, and in all of them, acute mastitis was diagnosed. Total accuracy, sensitivity and specificity in the detection of breast mastitis were 62%, 68%, and 88%, respectively. Scintimammography in patients with acute inflammation of the breast is frequently positive in the absence of malignant condition, therefore it should not be used during acute mastitis for the detection of breast cancer.

The information-theory analysis of Michaelis-Menten constants for detection of breast cancer.

BACKGROUND: The Michaelis-Menten constants (K(m) and V(max)) operated by the Information Theory were employed for detection of breast cancer. METHODS: The rate of enzymatic hydrolysis of fluorescein diacetate (FDA) in live peripheral blood mononuclear cells (PBMC), derived from healthy subjects and breast cancer (BC) patients, was assessed by measuring the fluorescence intensity (FI) in individual cells under incubation with either the mitogen phytohemagglutinin (PHA) or with tumor tissue, as compared to control. The data were processed by the Information Theory to determine the parameters and test conditions, which can best discriminate between the different groups. The normalized mutual information (uncertainty coefficients) was used as the measure of correlation/discrimination. RESULTS: An estimated general correlation was established between the K(m)/V(max) parameters and the examined patterns in the different bioassays. The information-theoretical analysis revealed the relative diagnostic value of each parameter. CONCLUSION: It was found that K(m) and V(max) as individual parameters show relatively low correlations with the presence or absence of disease, yet in combination often provide a good diagnostic measure. Based on the relative diagnostic values of each parameter, a diagnostic decision making rule was constructed. The diagnostic rule provided correct diagnosis for 37 out of 40 subjects.