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1.
Ann R Coll Surg Engl ; 102(5): 369-374, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32233847

RESUMEN

INTRODUCTION: Between 16,000 and 48,000 women are estimated to present to UK breast clinics with nipple discharge each year. The incidence of malignancy in these women is 2.7-24.2%. Currently, there is no consensus on the best way to investigate and manage these women. The aim of this study was to assess the rate of malignancy in women presenting with unilateral nipple discharge, and to evaluate the role of examination, imaging and cytology in reliably predicting outcome. METHODS: Breast units were asked to prospectively collect data on all new patients with unilateral nipple discharge. Data collected included discharge colour, whether it was uniductal or multiductal, examination and imaging findings, cytology results and outcome. RESULTS: Complete datasets were submitted by 5 units on 228 patients. The incidence of malignancy was 4.4%. Clinical examination was valuable in detecting malignancy and multiductal discharge was not related to malignancy. The positive predictive value for detecting malignancy for an abnormality found on mammography was 53.5% and for ultrasonography, it was 65.2%. The role of cytology in detecting malignancy was inconclusive with positive predictive values of the presence of red blood cells and epithelial cells at 6.1% and 10.7% respectively. CONCLUSIONS: A large number of women are investigated for nipple discharge (with huge resource implications) but there is little reliable evidence on the best way to investigate and manage these patients. A larger study is needed to evaluate the role of investigations in nipple discharge to produce guidelines on optimal management.


Asunto(s)
Neoplasias de la Mama/epidemiología , Secreción del Pezón/citología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Conjuntos de Datos como Asunto , Inglaterra/epidemiología , Femenino , Humanos , Incidencia , Mamografía , Persona de Mediana Edad , Secreción del Pezón/diagnóstico por imagen , Pezones/diagnóstico por imagen , Pezones/patología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Ultrasonografía , Adulto Joven
2.
Medicine (Baltimore) ; 99(17): e19954, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332679

RESUMEN

The Hunan provincial government has implemented a free breast cancer screening program for rural women aged 35 to 64 years from 2016, under a 2015 policy aimed at of poverty eradication and improving women's health in China. However, there has been no population study of the breast cancer screening program in China to date, especially considering exploring differences related to the area's poverty status. We explored differences in risk factors, clinical examination results, and clinicopathological features among breast cancer patients in poor compared with non-poor counties in rural areas of Hunan province from 2016 to 2018 using χ and Fisher's exact test, and multivariate logistic regression analysis. A total of 3,151,679 women from rural areas participated in the screening program, and the breast cancer prevalence was 37.09/10. Breast cancer prevalence was lower in poor (29.68/10) than in non-poor counties (43.13/10). There were differences between breast cancers in poor and non-poor counties in terms of cysts, margins, internal echo, blood flow in solid masses in the right breast on ultrasound examination, lump structure in mammograms, and clinicopathological staging and grading in pathological examinations. Breast cancer in poor counties was more likely to be diagnosed at later stages as determined by ultrasound, mammography, and pathological examinations. Furthermore, indexes of the breast screening program including early detection, prevalence, pathological examination, and mammography examination were lower in poor compared with non-poor counties. Multivariate logistic regression analysis showed that education, ethnicity, reproductive history and the year 2017 were associated with an increased risk of breast cancer in poor counties (odds ratio >1, P < .05). In conclusion, women in poor areas were more likely to be diagnosed with breast cancer at a later stage compared with women in non-poor areas. Women in poor areas of Hunan province should therefore have better access to diagnostic and clinical services to help rectify this situation.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Gobierno Local , Tamizaje Masivo/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Adulto , Neoplasias de la Mama/epidemiología , China/epidemiología , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Modelos Logísticos , Mamografía/estadística & datos numéricos , Tamizaje Masivo/métodos , Persona de Mediana Edad , Áreas de Pobreza , Factores Socioeconómicos
3.
Anticancer Res ; 40(4): 1809-1815, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234869

RESUMEN

BACKGROUND/AIM: Wire-guided localisation (WGL) remains the most widely used technique for the localisation of non-palpable breast lesions; however, recent technological advances have resulted in non-wire, non-radioactive alternatives, such as magnetic seeds (Magseeds). The aim of this pooled analysis was to determine whether Magseeds are an effective tool for localising non-palpable breast lesions. MATERIALS AND METHODS: Various databases were searched for publications which reported data on the localisation and placement rates of Magseed. Data on re-excision rates under use of Magseed and WGL were also collected. RESULTS: Sixteen studies, spanning the insertion of 1,559 Magseeds, were analysed. The pooled analysis showed a successful placement rate of 94.42% and a successful localisation rate of 99.86%. Four studies were analysed in a separate pooled analysis and showed no statistically significant difference between re-excision rates using Magseeds and WGL. CONCLUSION: The use of Magseeds is an effective, non-inferior alternative to WGL that overcomes many of the limitations of the latter.


Asunto(s)
Neoplasias de la Mama/terapia , Mama/efectos de la radiación , Terapia de Campo Magnético , Campos Magnéticos , Mama/patología , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Femenino , Humanos , Magnetismo , Mastectomía Segmentaria
4.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(1): 25-29, ene.-mar. 2020.
Artículo en Español | IBECS | ID: ibc-187070

RESUMEN

El cáncer de mama es el que con más frecuecia afecta a las mujeres. Aunque no se ha podido todavía establecer una causa asociada a esta neoplasia, sí se conocen ciertos factores que podrían favorecer este proceso. Se ha investigado la presencia de algunos virus oncogénicos en el cáncer de mama (virus del papiloma humano, virus del tumor mamario del ratón y el virus de Epstein-Barr). Las técnicas moleculares actuales no permiten aplicar los postulados de Koch. Mediante las técnicas moleculares convencionales se ha podido detectar la presencia de estos virus en el 0-86% de los tejidos tumorales mamarios; sin embargo, no se ha mostrado evidencia de la transcripción activa de los genes virales en estos tejidos. Partiendo del criterio de que concentraciones de transcriptos inferiores a 2 ppm son inconsistentes con la participación de un determinado virus, puede concluirse que no existe actualmente ninguna evidencia científica de que un virus conocido esté implicado


Breast cancer is the most common cancer that affects women. Although it is known that certain factors favour this process, it has not yet been possible to establish a cause associated with this neoplasm. The presence of some oncogenic viruses in breast cancer, such as such as human papillomavirus), mouse mammary tumour virus, and Epstein-Barr virus, has been investigated. The Koch postulates cannot be applied with current molecular techniques. Although using conventional molecular techniques it has been possible to detect the presence of these viruses in between 0-86% of breast tumour tissues. However, no evidence of active transcription of the viral genes in these tissues has been demonstrated. Based on the criterion that transcript concentrations lower than 2ppm are inconsistent with the participation of a certain virus, it can be concluded that there is currently no scientific evidence that a known virus is involved


Asunto(s)
Humanos , Femenino , Neoplasias de la Mama/virología , Infecciones Tumorales por Virus/diagnóstico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/fisiopatología , Virus Oncogénicos
5.
East Mediterr Health J ; 26(2): 219-232, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32141601

RESUMEN

Background: Breast cancer is the fourth leading cause of death and disability in the Eastern Mediterranean Region (EMR); although the incidence is lower than in the developed regions, there has been an increasing trend in recent decades. Aims: Our aim was to calculate the pooled survival rate of patients with breast cancer in the EMR. Methods: We searched electronic databases from 1946 to 19 January 2018, without language restrictions. We used a random effect model to estimate pooled 1-, 3-, 5- and 10-year survival rates for patients with breast cancer. Chi-squared and I² index were used to assess between-study heterogeneity. Subgroup analysis and meta-regression were used to investigate the potential source of heterogeneity. Results: We found 80 articles eligible for inclusion in our review. The pooled 1-, 3-, 5- and 10-year survival rates in women with breast cancer in the EMR were 0.95, 0.80, 0.71, and 0.56, respectively. The I² index indicated considerable between-study heterogeneity (all I² > 50%). The 5-year survival rate in the male subgroup was 0.63. The 5-year survival rate of women with breast cancer in age groups ≤ 39, 40-64, and 65+ years were 0.74, 0.76 and 0.58, respectively. There was a statistically significant association between the Human Development Index (ß = 9, P = 0.01) and decade of study (ß = 8.2, P = 0.04) and 5-year survival rate. Conclusions: The survival rate of women with breast cancer in those countries in the EMR which have better health care systems improved in the past decade; women aged 40-64 years had the best survival rate.


Asunto(s)
Neoplasias de la Mama/mortalidad , Tasa de Supervivencia , Adulto , Neoplasias de la Mama/epidemiología , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Región Mediterránea/epidemiología , Persona de Mediana Edad
6.
Chem Biol Interact ; 322: 109060, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32171849

RESUMEN

BACKGROUND: Individual observational studies have suggested null, weak, linear, and J-shaped associations between alcohol consumption and breast cancer risk. However, observational studies are susceptible to confounders, which can obscure the true impact of an exposure on an outcome. Given the uncertainty regarding the association between alcohol consumption and breast cancer, and the challenges of identifying, measuring, and accounting for all potential confounders, we assessed whether and how authors of observational studies evaluating the impact of alcohol consumption on the risk of breast cancer considered bias when interpreting their main study findings. METHODS: We identified all observational studies included in a recent alcohol-breast cancer meta-analysis. The Abstract and/or Discussion sections were reviewed to determine whether authors considered confounding. RESULTS: Among 101 eligible studies, 73 (72.3%) mentioned confounding explicitly in the Abstract and Discussion sections. There were 33 (32.7%) studies that included statements regarding specific confounders that were not adjusted for in the analyses and 60 (59.4%) studies without any statements about the impact of residual confounding on their main findings. Although none of the studies outlined that their main findings were "likely" to be affected by residual confounding, 25 (24.8%) mentioned a "possible" impact and 16 (15.8%) claimed an "unlikely" impact. Only one (1.0%) article explicitly stated that caution was needed when interpreting their findings due to confounding. CONCLUSION: These results highlight the need for more adequate consideration of the potential impact of residual confounding in observational studies evaluating the impact of alcohol consumption on the risk of breast cancer.


Asunto(s)
Consumo de Bebidas Alcohólicas , Neoplasias de la Mama/etiología , Neoplasias de la Mama/epidemiología , Bases de Datos Factuales , Femenino , Carga Global de Enfermedades , Humanos , Factores de Riesgo
7.
J Cancer Res Clin Oncol ; 146(5): 1299-1306, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32107626

RESUMEN

BACKGROUND: The aim of this study was to verify the predictors of recurrence and survival in lung adenocarcinoma patients with experiences of breast cancer therapies. METHODS: We retrospectively reviewed consecutive patients who were treated at our hospital for lung adenocarcinoma from 2004/01 to 2014/03. The patients were divided into groups of those with lung adenocarcinoma alone and those with lung and breast cancer. Kaplan-Meier plots and log-rank tests were used to estimate outcomes. RESULTS: 54 patients with lung adenocarcinoma and breast cancer were compared with 457 patients with single primary lung adenocarcinomas. After propensity score matching with control of age, operation type, smoking status and pathologic stage, tumor differentiation, recurrence rate and tumor size were significantly different between two groups. The significant predictors for recurrence included undergone chemotherapy (HR = 25, p < 0.001), moderate/poor differentiation (HR = 8.125, p = 0.012), tumor size ≧ 2 cm (HR = 15, p < 0.001), LVSI (HR = 13.67, p = 0.031) and GGO ratio < 50% (HR = 14.667, p = 0.014). The significant prognostic factors for survival were accepted chemotherapy (HR = 6.182, p = 0.021), LVSI (HR = 22, p = 0.012) and GGO ratio < 50% (HR = 9.143, p = 0.045). Kaplan-Meier analysis revealed that patients with lung adenocarcinoma and breast cancer had a better 5-year disease-free survival (p = 0.009), while the Her2-negative patients obtained a better overall survival (p = 0.038). CONCLUSIONS: In patients with breast cancer and lung adenocarcinoma, independent risk factors of recurrence were undergone chemotherapy, moderate/poor differentiation, tumor size ≧ 2 cm, LVSI and GGO ratio < 50%. Only undergone chemotherapy, LVSI and GGO ratio < 50% were significant poor predictors for survival. However, patients with metachronous lung adenocarcinoma and breast cancer had better disease-free survival and less tumor recurrence than patients with lung adenocarcinoma alone.


Asunto(s)
Adenocarcinoma del Pulmón/diagnóstico , Neoplasias de la Mama/diagnóstico , Neoplasias Pulmonares/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias Primarias Secundarias/diagnóstico , Adenocarcinoma del Pulmón/epidemiología , Adenocarcinoma del Pulmón/metabolismo , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/metabolismo , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/metabolismo , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/metabolismo , Neoplasias Primarias Secundarias/epidemiología , Pronóstico , Puntaje de Propensión , Receptor ErbB-2/metabolismo , Sistema de Registros , Estudios Retrospectivos , Riesgo , Taiwán/epidemiología
8.
PLoS One ; 15(2): e0226950, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32015564

RESUMEN

BACKGROUND: An increased prevalence of allergies and an increased incidence of breast cancer have been observed. The hypothesis that atopy may have a protective effect against the risk of different types of breast cancer was evaluated. METHODS: In this study, 11,101 patients (11,101 women with a mean age of 55.2±14.7 years) with different types of breast cancer were tested for allergies. Allergies were confirmed based on the retrospective analysis of allergy diagnostic procedures in patients who had been previously diagnosed with breast cancer. The retrospective prevalence rates of active allergic diseases, including allergic rhinitis, bronchial asthma and atopic dermatitis, were assessed. All patients were also analyzed for bronchial asthma and allergic rhinitis according to the relevant guidelines. A group of healthy control patients was used for the comparisons. RESULTS: The women with breast cancer had a significantly lower incidence of IgE-mediated allergic diseases than the controls. The odds ratios (ORs) for allergic rhinitis, atopic dermatitis, and bronchial asthma were 0.61 (95% CI: 0.57-0.73), 0.17 (95% CI: 0.11-0.44), and 0.73 (95% CI: 0.65-0.83), respectively. The mean serum concentrations of total IgE were significantly lower in the study population of women with breast cancer than in the patients of the control group (39.2 ± 26.2 kU/L vs. 108.5 ± 38.5 kU/L; p = 0.002). CONCLUSION: Our results suggest that the overall incidence of allergies, especially allergic rhinitis, is lower in patients with certain types of cancer than in individuals who did not have cancer. Further studies are needed to confirm our findings.


Asunto(s)
Alérgenos/sangre , Neoplasias de la Mama/epidemiología , Hipersensibilidad/epidemiología , Inmunoglobulina E/sangre , Anciano , Asma/sangre , Asma/complicaciones , Asma/epidemiología , Neoplasias de la Mama/sangre , Dermatitis Atópica/sangre , Dermatitis Atópica/complicaciones , Dermatitis Atópica/epidemiología , Femenino , Humanos , Hipersensibilidad/sangre , Hipersensibilidad/complicaciones , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Rinitis Alérgica Estacional/sangre , Rinitis Alérgica Estacional/complicaciones , Rinitis Alérgica Estacional/epidemiología
9.
PLoS One ; 15(2): e0226157, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32106268

RESUMEN

The purpose of this study was to identify germline single nucleotide polymorphisms (SNPs) that optimally predict radiation-associated contralateral breast cancer (RCBC) and to provide new biological insights into the carcinogenic process. Fifty-two women with contralateral breast cancer and 153 women with unilateral breast cancer were identified within the Women's Environmental Cancer and Radiation Epidemiology (WECARE) Study who were at increased risk of RCBC because they were ≤ 40 years of age at first diagnosis of breast cancer and received a scatter radiation dose > 1 Gy to the contralateral breast. A previously reported algorithm, preconditioned random forest regression, was applied to predict the risk of developing RCBC. The resulting model produced an area under the curve (AUC) of 0.62 (p = 0.04) on hold-out validation data. The biological analysis identified the cyclic AMP-mediated signaling and Ephrin-A as significant biological correlates, which were previously shown to influence cell survival after radiation in an ATM-dependent manner. The key connected genes and proteins that are identified in this analysis were previously identified as relevant to breast cancer, radiation response, or both. In summary, machine learning/bioinformatics methods applied to genome-wide genotyping data have great potential to reveal plausible biological correlates associated with the risk of RCBC.


Asunto(s)
Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/genética , Estudio de Asociación del Genoma Completo/métodos , Aprendizaje Automático , Neoplasias Inducidas por Radiación/epidemiología , Neoplasias Inducidas por Radiación/genética , Adulto , Neoplasias de la Mama/radioterapia , Supervivientes de Cáncer , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Genotipo , Células Germinativas , Humanos , Polimorfismo de Nucleótido Simple , Factores de Riesgo , Adulto Joven
10.
Anticancer Res ; 40(2): 1041-1048, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32014951

RESUMEN

BACKGROUND/AIM: To quantify the association between a previous cancer diagnosis and healthcare use among breast cancer (BC) patients, and estimate five-year recurrence-free survival (RFS). PATIENTS AND METHODS: Women with BC were classified according to a previous cancer diagnosis (BC or other). Healthcare use during the first year and five-year RFS were obtained through clinical and administrative records. Adjusted odds ratios and hazard ratios (HR) were estimated. RESULTS: Among 681 BC patients, 21 had a previous BC and 32 a previous non-BC. The latter were less likely to receive anthracycline-based combination chemotherapy. The former had higher odds of mastectomy and genetic testing. Five-year RFS HRs (95% confidence interval) were 2.75 (0.79-9.52) and 0.52 (0.07-3.89) for previous BC and non-BC, respectively. CONCLUSION: Previous cancer was associated with less anthracycline-based combination chemotherapy, and patients were more likely to undergo mastectomy and genetic testing. These findings highlight the need for assessment of previous treatments, personal genetic risk and current BC characteristics.


Asunto(s)
Neoplasias de la Mama/epidemiología , Prestación de Atención de Salud , Aceptación de la Atención de Salud , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Manejo de la Enfermedad , Femenino , Humanos , Inmunohistoquímica , Estimación de Kaplan-Meier , Persona de Mediana Edad , Estadificación de Neoplasias , Oportunidad Relativa , Pronóstico
11.
Medicine (Baltimore) ; 99(8): e19083, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080081

RESUMEN

BACKGROUND: Breast cancer is the most prevalent cancer in females and disease recurrence remains a significant problem. To prevent recurrence, tamoxifen is prescribed for at least 5 years. However, among patients who receive tamoxifen, individual responses are highly variable. These responses are affected by the type, frequency, and severity of endocrine symptoms, as well as adherence rates. Polymorphisms in genes involved in the metabolism of tamoxifen (ie, CYP3A4, CYP2D6) may influence responses to tamoxifen. In this study, the inter-relationships among endocrine symptoms, drug adherence, and genetic polymorphisms in Chinese breast cancer patients receiving tamoxifen therapy will be examined. We hypothesize that patients with more severe endocrine symptoms will be less likely to adhere to tamoxifen treatment. In addition, we hypothesize that a relationship will exist between the severity of tamoxifen-induced symptoms and allelic variations in tamoxifen metabolism-related genes. Although many association studies have determined that select genotypes influence the efficacy of tamoxifen, very few studies have investigated for associations between tamoxifen-induced endocrine symptoms and these polymorphisms. OBJECTIVES: The aim of this study was to characterize genetic polymorphisms in tamoxifen metabolism-associated genes in Chinese women with breast cancer and to explore the inter-relationships between genetic polymorphisms, endocrine symptoms, and adherence to tamoxifen. METHOD: We will conduct a prospective cohort study that follows 200 Chinese women over 18 months and assess treatment-related symptoms and genetic variations. Endocrine symptoms and drug adherence will be determined through interview-administered standardized questionnaires. Polymorphisms in drug metabolism genes will be determined using real-time polymerase chain reaction based genotyping method. Data will be analyzed to determine associations between allelic variations, endocrine symptoms, and adherence. DISCUSSION: The proposed study will evaluate for polymorphisms in gene(s) that are associated with tamoxifen-related endocrine symptoms and adherence with tamoxifen. We will explore the relationships between genotypes, endocrine symptoms, and drug adherence in Chinese breast cancer patients. Findings from this study may assist clinicians to identify patients at higher risk for a worse symptom experience and lower adherence rates and enable them to initiate appropriate interventions. In the long term, the findings from this study may be used to develop and test tailored symptom management interventions for these patients.


Asunto(s)
Antineoplásicos Hormonales/administración & dosificación , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/genética , Enfermedades del Sistema Endocrino/inducido químicamente , Tamoxifeno/efectos adversos , Alelos , Antineoplásicos Hormonales/metabolismo , Antineoplásicos Hormonales/uso terapéutico , Grupo de Ascendencia Continental Asiática/genética , Neoplasias de la Mama/epidemiología , Citocromo P-450 CYP2D6/genética , Citocromo P-450 CYP3A/genética , Femenino , Genotipo , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Cooperación del Paciente , Polimorfismo de Nucleótido Simple , Prevalencia , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Tamoxifeno/metabolismo , Tamoxifeno/uso terapéutico
12.
Mymensingh Med J ; 29(1): 48-54, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915335

RESUMEN

One-fourth of all women suffer from breast disease in their lifetime. World Health Organization estimated that over 508,000 women died in 2011 due to breast cancer worldwide.For several years, fine needle aspiration cytology (FNAC) was the most practiced method for the pathological diagnosis of breast lump specially differentiation of benign from malignant. The advent of core needle or True-Cut biopsy (TCB) in the new millennium has resulted in many surgeons switching to TCB since it provides a sufficient amount of tissue for pathologists to make an accurate histological diagnosis.During the study period, patients present with clinically palpable breast lump admitted in different surgicalunits of MMCH, among them 100 patients selected purposively. Then a prospective comparative study was carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2017 to February 2018. Out of a total of 100 patients, who presented with suspicious breast lump, as clinically diagnosed 68 patients had benign breast lump and 32 patients had malignant breast lump. FNAC confirmed the diagnosis of breast carcinoma in 27 patients with sensitivity 89.65% and specificity 66.66%. True-cut biopsy confirmed the diagnosis of breast carcinoma in 29 patients with sensitivity 96.66% and specificity 100%. It also gave the definitive histological type and grade which correlated with the final histopathology report in 29 out of the 30 patientsTCB also provides adequate tissue for the evaluation of molecular markers which have extreme therapeutic value.


Asunto(s)
Biopsia con Aguja/métodos , Biopsia/métodos , Enfermedades de la Mama/patología , Neoplasias de la Mama/patología , Mama/patología , Carcinoma/patología , Adulto , Bangladesh/epidemiología , Biopsia con Aguja Fina , Neoplasias de la Mama/epidemiología , Carcinoma/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad
13.
Cancer Treat Rev ; 84: 101963, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31958739

RESUMEN

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized non-Hodgkin lymphoma of T-cell origin. Despite the low incidence of this new disease, the increasing use of breast implants for cosmetic or post-mastectomy reconstruction purposes places BIA-ALC as an emerging and compelling medical challenge. The real BIA-ALCL pathogenesis has not been fully uncovered so far, while different putative causal factors have been proposed. Breast implants with textured surfaces seem to be associated with nearly all cases of BIA-ALCL, while the real the risk of disease development has not been well estimated so far. Late onset, persistent seroma around breast implant represents the classical clinical presentation. Most of the BIA-ALCL patients presents with localized disease, which confers an excellent prognosis. Unlike other non-Hodgkin lymphomas, surgical excision of the mass has a key role in the treatment. For patients with advanced and disseminated diseases, the treatment did not differ from other types of T-cell lymphoma. For these reasons, BIA-ALCL represents an emerging disease which requires multidisciplinary team approach to well define diagnostic workup and treatment for each patient. This review article aims to summarize available data on BIA-ALCL. First, we will outline available data on BIA-ALCL epidemiology, pathogenesis, diagnostic work-up, and treatment. Second, we will point out the potential psychological implications as well as the risk of perception distortion for women with breast implants, especially for those with previous breast cancer. Lastly, we will summarize the current national recommendations regarding textured breast implants and discuss the diagnostic-therapeutic algorithm for BIA-ALCL management.


Asunto(s)
Implantación de Mama , Implantes de Mama , Neoplasias de la Mama/epidemiología , Linfoma Anaplásico de Células Grandes/epidemiología , Complicaciones Posoperatorias/epidemiología , Neoplasias de la Mama/inmunología , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Remoción de Dispositivos , Femenino , Humanos , Incidencia , Linfoma Anaplásico de Células Grandes/inmunología , Linfoma Anaplásico de Células Grandes/patología , Linfoma Anaplásico de Células Grandes/cirugía , Mamoplastia , Mastectomía , Estadificación de Neoplasias , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/cirugía , Pronóstico , Seroma , Tasa de Supervivencia
14.
Oncology ; 98(4): 248-251, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31962330

RESUMEN

BACKGROUND: The Oncotype DX Breast Cancer Assay is a 21-gene assay used to predict the likelihood of distant recurrence and the benefit of chemotherapy in patients with node-negative, tamoxifen-treated breast cancer. Prior studies demonstrated 7-19% discordance, or a difference between the recurrence score (RS) and tumor grade (TG) in breast cancer patients. BRCA mutated tumors (BRCA+) have been shown to be associated with higher RS as compared to BRCA-negative patients (BRCA-). OBJECTIVES: We developed a large Oncotype RS database to determine if the BRCA mutation status is associated with discordance. METHODS: We identified 723 patients (32 [4%] mutation-positive and 691 [96%] mutation-negative patients) with early-stage, hormone-positive breast cancer treated between 2006 and 2018, with tumor characteristics available for analysis. Discordance was defined as one- or two-step difference between RS (low, intermediate, high risk) and TG (well [WD], moderately [MD], and poorly [PD] differentiated). Mutation positive was defined as BRCA1 deleterious mutation, BRCA2 deleterious mutation, BRCA mutation of unknown type, BRCA variant of undetermined significance (VUS) or other mutation (classified as other VUS). Number (%) or median were used to describe patient characteristics between groups and were compared by the Kruskal-Wallis test at a significance level of 5%. RESULTS: Among these patients, there were 32 (4% of total) who were identified as mutation-positive. Of those patients, 16% had a documented deleterious mutation in BRCA1, 22% in BRCA2, 6% had a BRCA mutation of unknown type (either 1 or 2), 25% were BRCA VUS, and 31% other VUS (most commonly CHEK2 and ATM). The median RS was 23.5 in patients with deleterious BRCA mutations (1, 2 or unknown) versus 16 in patients in the BRCA-negative database, which was statistically significant (p < 0.01). One- and two-step discordance was present in 46 and 8%, respectively, of patients with deleterious BRCA mutations versus 53 and 11%, respectively, in the BRCA-negative database. CONCLUSIONS: Patients with deleterious BRCA mutations demonstrated no difference in rates of discordance as compared to BRCA-negative patients. We further demonstrated that patients with BRCA-positive tumors display higher RS than patients with BRCA-negative tumors.


Asunto(s)
Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/genética , Genes BRCA1 , Genes BRCA2 , Mutación , Recurrencia Local de Neoplasia/epidemiología , Neoplasias de la Mama/patología , Bases de Datos Factuales , Femenino , Humanos
15.
Cancer Causes Control ; 31(2): 127-138, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31916076

RESUMEN

PURPOSE: Breast density is an important risk factor for breast cancer and varies substantially across racial-ethnic groups. However, determinants of breast density in Vietnamese immigrants in the United States (US) have not been studied. We investigated whether reproductive factors, immigration history, and other demographic and lifestyle factors were associated with breast density in Vietnamese Americans. METHODS: We collected information on demographics, immigration history, and other lifestyle factors and mammogram reports from a convenience sample of 380 Vietnamese American women in California aged 40 to 70 years. Breast Imaging Reporting and Data System (BI-RADS) breast density was abstracted from mammogram reports. Multivariable logistic regression was used to investigate the association between lifestyle factors and having dense breasts (BI-RADS 3 or 4). RESULTS: All participants were born in Viet Nam and 82% had lived in the US for 10 years or longer. Younger age, lower body mass index, nulliparity/lower number of deliveries, and longer US residence (or younger age at migration) were associated with having dense breasts. Compared to women who migrated at age 40 or later, the odds ratios and 95% confidence intervals for having dense breasts among women who migrated between the ages of 30 and 39 and before age 30 were 1.72 (0.96-3.07) and 2.48 (1.43-4.32), respectively. CONCLUSIONS: Longer US residence and younger age at migration were associated with greater breast density in Vietnamese American women. Identifying modifiable mediating factors to reduce lifestyle changes that adversely impact breast density in this traditionally low-risk population for breast cancer is warranted.


Asunto(s)
Americanos Asiáticos , Densidad de la Mama/etnología , Emigrantes e Inmigrantes , Estilo de Vida , Adulto , Anciano , Índice de Masa Corporal , Neoplasias de la Mama/epidemiología , California , Estudios Transversales , Emigración e Inmigración , Femenino , Humanos , Persona de Mediana Edad , Oportunidad Relativa , Paridad , Factores de Riesgo , Estados Unidos , Salud de la Mujer
16.
Artículo en Inglés | MEDLINE | ID: mdl-31941024

RESUMEN

During puberty, a woman's breasts are vulnerable to environmental damage ("window of vulnerability"). Early exposure to environmental carcinogens, endocrine disruptors, and unhealthy foods (refined sugar, processed fats, food additives) are hypothesized to promote molecular damage that increases breast cancer risk. However, prospective human studies are difficult to perform and effective interventions to prevent these early exposures are lacking. It is difficult to prevent environmental exposures during puberty. Specifically, young women are repeatedly exposed to media messaging that promotes unhealthy foods. Young women living in disadvantaged neighborhoods experience additional challenges including a lack of access to healthy food and exposure to contaminated air, water, and soil. The purpose of this review is to gather information on potential exposures during puberty. In future directions, this information will be used to help elementary/middle-school girls to identify and quantitate environmental exposures and develop cost-effective strategies to reduce exposures.


Asunto(s)
Neoplasias de la Mama/epidemiología , Exposición a Riesgos Ambientales , Neoplasias de la Mama/genética , Susceptibilidad a Enfermedades , Epigénesis Genética , Femenino , Humanos , Estado Nutricional , Obesidad/epidemiología , Pubertad , Características de la Residencia , Factores de Riesgo , Estrés Fisiológico , Estrés Psicológico
17.
Int J Cancer ; 146(6): 1541-1552, 2020 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-31187481

RESUMEN

Adiposity increases estrogen receptor (ER)-positive postmenopausal breast cancer risk. While mechanisms underlying this relationship are uncertain, dysregulated sex-steroid hormone production and insulin signaling are likely pathways. Our aim was to quantify mediating effects of fasting insulin and free estradiol in the adiposity and ER-positive postmenopausal breast cancer association. We used data from a case-cohort study of sex hormones and insulin signaling nested within the Melbourne Collaborative Cohort Study. Eligible women, at baseline, were not diagnosed with cancer, were postmenopausal, did not use hormone therapy and had no history of diabetes or diabetes medication use. Women with ER-negative disease or breast cancer diagnosis within the first follow-up year were excluded. We analyzed the study as a cumulative sampling case-control study with 149 cases and 1,029 controls. Missing values for insulin and free estradiol were multiply imputed with chained equations. Interventional direct (IDE) and indirect (IIE) effects were estimated using regression-based multiple-mediator approach. For women with body mass index (BMI) >30 kg/m2 compared to women with BMI 18.5-25 kg/m2 , the risk ratio (RR) of breast cancer was 1.75 (95% confidence interval [CI] 1.05-2.91). The estimated IDE (RR) not through the mediators was 1.03 (95% CI 0.43-2.48). Percentage mediated effect through free estradiol was 72% (IIE-RR 1.56; 95% CI 1.11-2.19). There was no evidence for an indirect effect through insulin (IIE-RR 1.12; 95% CI 0.68-1.84; 28% mediated). Our results suggest that circulating free estradiol plays an important mediating role in the adiposity-breast cancer relationship but does not explain all of the association.


Asunto(s)
Adiposidad/fisiología , Neoplasias de la Mama/epidemiología , Estradiol/sangre , Insulina/metabolismo , Posmenopausia/metabolismo , Adulto , Anciano , Índice de Masa Corporal , Neoplasias de la Mama/sangre , Neoplasias de la Mama/metabolismo , Estudios de Casos y Controles , Ayuno/sangre , Ayuno/fisiología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Posmenopausia/sangre , Receptores Estrogénicos/metabolismo , Medición de Riesgo , Victoria/epidemiología , Circunferencia de la Cintura/fisiología
18.
Int J Cancer ; 146(5): 1219-1229, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31087647

RESUMEN

We previously identified a novel breast cancer susceptibility variant on chromosome 4q31.22 locus (rs1429142) conferring risk among women of European ancestry. Here, we report replication of findings, validation of the variant in diverse populations and fine-mapping of the associated locus in Caucasian population. The SNP rs1429142 (C/T, minor allele frequency 18%) showed association for the overall breast cancer risk in Stages 1-4 (n = 4,331 cases/4271 controls; p = 4.35 × 10-8 ; odds ratio, ORC-allele ,1.25), and an elevated risk among premenopausal women (n = 1,503 cases/4271 controls; p = 5.81 × 10-10 ; ORC-allele 1.40) in European populations. SNP rs1429142 was associated with premenopausal breast cancer risk in women of African (T/C; p-value 1.45 × 10-02 ; ORC-allele 1.2) but not from Chinese ancestry. Fine-mapping of the locus revealed several potential causal variants which are present within a single association signal, revealed from the conditional regression analysis. Functional annotation of the potential causal variants revealed three putative SNPs rs1366691, rs1429139 and rs7667633 with active enhancer functions inferred based on histone marks, DNase hypersensitive sites in breast cell line data. These putative variants were bound by transcription factors (C-FOS, STAT1/3 and POL2/3) with known roles in inflammatory pathways. Furthermore, Hi-C data revealed several short-range interactions in the fine-mapped locus harboring the putative variants. The fine mapped locus was predicted to be within a single topologically associated domain, potentially facilitating enhancer-promoter interactions possibly leading to the regulation of nearby genes.


Asunto(s)
Neoplasias de la Mama/genética , Cromosomas Humanos Par 4/genética , Sitios Genéticos/genética , Predisposición Genética a la Enfermedad , Premenopausia , Adulto , Grupo de Ascendencia Continental Africana/genética , Distribución por Edad , Anciano , Anciano de 80 o más Años , Alberta/epidemiología , Grupo de Ascendencia Continental Asiática/genética , Neoplasias de la Mama/epidemiología , Estudios de Casos y Controles , Mapeo Cromosómico , Conjuntos de Datos como Asunto , Elementos de Facilitación Genéticos/genética , Grupo de Ascendencia Continental Europea/genética , Femenino , Humanos , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Posmenopausia , Regiones Promotoras Genéticas/genética , Adulto Joven
19.
Int J Cancer ; 146(5): 1261-1267, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31125113

RESUMEN

Free thiol groups of intra and extracellular molecules are considered to be antioxidative and to protect cells from damage caused by free radicals. However, the associations of serum total thiol levels (TTL) with the incidences of the four most frequent cancer sites have not yet been investigated in a large population-based, prospective study. TTL was measured in case-cohort design in a sample from the population-based, Norwegian Tromsø 3 study (cancer cases: n = 941; random subcohort: n = 1,000) and was repeatedly measured at Tromsø 5. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated by weighted multivariable-adjusted Cox regression with time-dependent modeling of TTL for incident lung, colorectal, breast and prostate cancer. High serum TTL were associated with a reduced risk of all four major cancers. The associations with lung (top vs. bottom tertile: HR, 0.64; 95% CI, 0.41, 0.99) and breast cancer (top vs. bottom tertile: HR, 0.64; 95% CI, 0.42, 0.96) were statistically significant, whereas associations with colorectal (top vs. bottom tertile: HR, 0.79; 95% CI, 0.54, 1.16) and prostate cancer (top vs. bottom tertile: HR, 0.79; 95% CI, 0.53, 1.17) were not statistically significant but pointed in the same protective direction. These findings from a large, prospective Norwegian cohort study suggest a preventive role of thiols against the development of the four most frequent cancers. Whereas associations with breast and lung cancer could be shown with statistical significance, larger studies are needed to corroborate potential associations of TTL with colorectal and prostate cancer.


Asunto(s)
Neoplasias/sangre , Compuestos de Sulfhidrilo/sangre , Adulto , Anciano , Neoplasias de la Mama/sangre , Neoplasias de la Mama/epidemiología , Estudios de Cohortes , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/epidemiología , Femenino , Humanos , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Noruega/epidemiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/epidemiología , Riesgo , Adulto Joven
20.
Int J Cancer ; 146(7): 1827-1835, 2020 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-31228259

RESUMEN

Women with breast cancer are increasingly being cured of the disease but fatigue remains the most frequently reported symptom. The aims of our study were to identify distinct trajectories in four fatigue dimensions during 2 years after breast cancer surgery and to explore the demographic, clinical and personality characteristics associated with these profiles. We included women from the prospective longitudinal multicenter FATSEIN cohort in France. They completed the Multidimensional Fatigue Inventory for nine follow-ups over 24 months after surgery. A group-based trajectory model identified distinct trajectories in each fatigue dimension. Multinomial logistic regression determined the factors associated with each profile. From the 459 women followed, 3-5 fatigue trajectories were revealed in each fatigue dimension, from its absence to its severest degree. In our multivariate analysis, the risk of severe fatigue was decreased in all dimensions by a high quality of life before surgery (measured by the European Organization for Research and Treatment of Cancer 30-item QoL questionnaire; e.g., for general and physical fatigue: OR = 0.93, 95% CI 0.91, 0.96), especially a high physical and emotional functions for general and physical fatigue, and a high cognitive function for mental fatigue. Both severe mental fatigue and severely reduced motivation worsened with low optimism before surgery (e.g., for mental fatigue: OR = 0.93, 95% CI 0.89, 0.97). Severely reduced activities increased by having chemotherapy (OR = 9.41, 95% CI 2.28, 38.79). Targeting women at risk for severe fatigue can provide early preventive and curative treatment and appropriate psychological support.


Asunto(s)
Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/epidemiología , Fatiga/epidemiología , Fatiga/etiología , Anciano , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Oportunidad Relativa , Periodo Posoperatorio , Vigilancia en Salud Pública , Calidad de Vida , Factores de Riesgo , Factores Socioeconómicos
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