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1.
Medicine (Baltimore) ; 101(35): e30392, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107560

RESUMO

BACKGROUND: Breast cancer (BC) is a malignant tumor with the highest incidence rate worldwide, and its incidence of breast cancer brain metastases is increased in recent years. Although significant progress has been made in the systematic treatment of BC that of breast cancer brain metastases is still very difficult. Organically integrating local and systemic therapies remains an urgent problem to be solved. In this study, a network meta-analysis was performed to collect the treatment effects of different treatment measures on patients with BC brain metastasis in recent years, evaluate and screen the current best clinical treatment scheme, and assist doctors in formulating clinical treatment schemes. METHODS: Keywords were used to search databases, such as the Chinese Journal Full-text Database, VIP Chinese Science and Technology Journal Full-text Database (VP-CSJFD), Wanfang Data Journal Paper Resources (Wangfang), PubMed, the Cochrane Library, and EMBASE. The retrieval period was from the establishment of each database to February 2022. Qualified randomized controlled studies were screened according to the inclusion and exclusion criteria, and Stata 16 software was adopted for mesh meta-analysis of binary variable data. Using R4 0.2 software, and calling GeMTC and JAGS packages in R software, the Bayesian network model analysis of survival data was completed. CONCLUSION: Combined with overall response rate, disease control rate, and overall survival, whole-brain radiation therapy + 3-dimensional conformal radiation therapy + Che may be the intervention measure with the highest objective remission rate for patients with brain metastasis of BC, besides, it may also be the intervention measure of the highest disease control rate in patients after treatment. In contrast, WBRT + Che may be the intervention with the lowest overall survival risk ratio after treatment.


Assuntos
Neoplasias Encefálicas , Neoplasias da Mama , Teorema de Bayes , Neoplasias Encefálicas/secundário , Neoplasias da Mama/terapia , Irradiação Craniana/métodos , Feminino , Humanos , Metanálise em Rede
2.
Medicine (Baltimore) ; 101(35): e30320, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107602

RESUMO

INTRODUCTION: Breast cancer (BC) is the most diagnosed cancer worldwide. Multiple myeloma (MM) is a hematologic malignancy characterized by the overproduction of monoclonal antibodies in the bone marrow. Systemic lupus erythematosus (SLE) is distinguished by the aberrant activity of the immune system with heterogeneous clinical manifestations. The coexistence of more than one major illness in a patient can present a diagnostic challenge for clinical physicians, especially when the comorbid diseases share a similar clinical presentation. Herein, we report an unusual case of secondary synchronous diagnosis of MM and SLE after BC treatment. PATIENT CONCERNS: A 69-year-old female patient with breast cancer experienced severe skin itching and rashes on the face, anterior chest wall, back, and trunk for two days before admission. She had high levels of immunoglobulin and anti-nuclear antibodies; low levels of complements 3 and 4; positive anti-cardiolipin-IgM, anti-beta 2 glycoprotein-1 (anti-ß2GP1) antibodies, and lupus anticoagulant results at serological testing. DIAGNOSIS: The postoperative pathology report showed ductal carcinoma in situ in the right breast. SLE was confirmed based on the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) criteria. IgG-κ type multiple myeloma was confirmed by bone marrow biopsy, and the patient was synchronously diagnosed with SLE and MM after BC treatment. INTERVENTIONS: Glucocorticoids and immunosuppressive agents, including intravenous hydrocortisone (5 g every 8 hours) and oral hydroxychloroquine (Plaquenil) (200 mg twice daily) were administered to treat SLE. One capsule of thalidomide 50 mg was administered orally every night at bedtime for MM. OUTCOMES: The patient died two days later, shortly after the administration of drugs, due to multiple organ failures secondary to pneumonia and respiratory failure. CONCLUSION: This is a case of MM and SLE after BC treatment. The present challenge was the early detection and accurate diagnosis of the secondary major illnesses, as the clinical manifestations were similar and non-specific between these two diseases. Awareness and prompt recognition of the common clinical symptoms of SLE and MM should be considered by clinical physicians to avoid delayed diagnoses and facilitate early treatment for a better prognosis.


Assuntos
Neoplasias da Mama , Lúpus Eritematoso Sistêmico , Mieloma Múltiplo , Idoso , Anticorpos Monoclonais/uso terapêutico , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Feminino , Glicoproteínas/uso terapêutico , Humanos , Hidrocortisona/uso terapêutico , Hidroxicloroquina/uso terapêutico , Imunoglobulina G/uso terapêutico , Imunoglobulina M/uso terapêutico , Imunossupressores/uso terapêutico , Inibidor de Coagulação do Lúpus/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/terapia , Talidomida/uso terapêutico
3.
Clin J Oncol Nurs ; 26(5): 503-509, 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36108206

RESUMO

BACKGROUND: Cancer care is described as insufficiently patient-centered, requiring improved accessibility and coordination. Breast oncology nurse navigators may help provide timely patient care by improving care coordination. OBJECTIVES: This study evaluated a breast cancer navigation (BCN) program in a large ambulatory healthcare system. It examined measures related to quality and value, including timely service delivery, appropriate use of resources, and care coordination. METHODS: Using Lean methods, a BCN program focused on women receiving a breast biopsy was developed at a pilot site and later implemented throughout the healthcare system. Study data evaluated timely disclosure of biopsy results, prompt scheduling of initial consultations, outpatient use of cancer specialists, and coordination between primary care and oncology practices. FINDINGS: After implementing the BCN program, more timely biopsy results were delivered to patients. Patients were more likely to complete an initial consultation within two weeks of biopsy and made fewer outpatient visits. Referrals to cancer specialists within a month of biopsy increased, and primary care encounters with patients decreased.


Assuntos
Neoplasias da Mama , Biópsia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Feminino , Humanos , Pacientes Ambulatoriais , Encaminhamento e Consulta
4.
Breast J ; 2022: 8582894, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36111211

RESUMO

Objective: Given the challenges rural cancer patients face in accessing cancer care as well as the slower diffusion and adoption of new medical technologies among rural providers, the aim of our study was to examine trends in gene expression profiling (GEP) testing and evaluate the association between hospital rurality and receipt of GEP testing. Methods: Data from the Iowa Cancer Registry (ICR) were used to identify women with newly diagnosed, histologically confirmed breast cancer from 2010 through 2018 who met eligibility criteria for GEP testing. Patients were allocated to the hospitals where their most definitive surgical treatment was received, and Rural-Urban Commuting Area codes were used to categorize hospitals into urban (N = 43), large rural (N = 16), and small rural (N = 48). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression to evaluate the association between hospital rurality and GEP test use, adjusting for demographic and clinical characteristics. The association between test result and treatment received was assessed among patients who received Oncotype DX (ODX) testing. Results: Of 6,726 patients eligible for GEP test use, 46% (N = 3,069) underwent testing with 95% receiving ODX. While overall GEP testing rates increased over time from 42% between 2010 and 2012 to 51% between 2016 and 2018 (P trend < 0.0001), use continued to be the lowest among patients treated at hospitals in small rural areas. The odds of GEP testing remained significantly lower among patients treated at hospitals located in small rural areas (aOR 0.55; 95% CI 0.43-0.71), after adjusting for demographic and clinical characteristics. ODX recurrence scores were highly correlated with chemotherapy use across all strata of hospital rurality. Conclusions: GEP testing continues to be underutilized, especially among those treated at small rural hospitals. Targeted interventions aimed at increasing rates of GEP testing to ensure the appropriate use of adjuvant chemotherapy may improve health outcomes and lower treatment-related costs.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Feminino , Perfilação da Expressão Gênica , Hospitais , Humanos , Iowa
6.
Int J Mol Sci ; 23(17)2022 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-36077013

RESUMO

Breast cancer is the leading cause of cancer-related deaths in the female population [...].


Assuntos
Neoplasias da Mama , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Neoplasias da Mama/terapia , Feminino , Humanos
7.
Int J Mol Sci ; 23(17)2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36077348

RESUMO

Breast cancer (BC) is a highly heterogeneous disease. The treatment of BC is complicated owing to intratumoral complexity. Tissue biopsy and immunohistochemistry are the current gold standard techniques to guide breast cancer therapy; however, these techniques do not assess tumoral molecular heterogeneity. Personalized medicine aims to overcome these biological and clinical complexities. Advances in techniques and computational analyses have enabled increasingly sensitive, specific, and accurate application of liquid biopsy. Such progress has ushered in a new era in precision medicine, where the objective is personalized treatment of breast cancer, early screening, accurate diagnosis and prognosis, relapse detection, longitudinal monitoring, and drug selection. Liquid biopsy can be defined as the sampling of components of tumor cells that are released from a tumor and/or metastatic deposits into the blood, urine, feces, saliva, and other biological substances. Such components include circulating tumor cells (CTCs), circulating tumor DNA (ctDNA) or circulating tumor RNA (ctRNA), platelets, and exosomes. This review aims to highlight the role of liquid biopsy in breast cancer and precision medicine.


Assuntos
Neoplasias da Mama , DNA Tumoral Circulante , Células Neoplásicas Circulantes , Biomarcadores Tumorais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Feminino , Humanos , Biópsia Líquida/métodos , Recidiva Local de Neoplasia , Células Neoplásicas Circulantes/patologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-36078504

RESUMO

Breast cancer is the most common malignancy in Jordan. Rigorous needs assessment for breast cancer patients can prioritize both cancer care and palliative care to propose the appropriate services effectively. We conducted a cross-sectional study of breast cancer patients in a cancer center in Jordan. We assessed symptom burden, comorbidities, and performance using the Edmonton Symptom Assessment System (ESAS), the Charlson Comorbidity Index (CCI), and the Australia-modified Karnofsky performance scale (AKPS). Descriptive analysis and regression models to predict the highest symptom burden were used. A total of 233 participants were enrolled: curative vs. palliative intent groups (147 (63%) vs. 86 (37%) patients), respectively. Tiredness was the most reported symptom in 189 patients (81%), while nausea was the least in 61 patients (26.2%). A relationship between the AKPS score and total ESAS was seen (correlation coefficient of -0.487; p < 0.0001). The prevalence of anxiety (p = 0.014), lack of appetite (p = 0.002), poor well-being (p < 0.001), and sleep disorder (p = 0.035) was higher in the palliative care intent group than in the curative one. We identified unmet needs in breast cancer patients. Both groups showed a prevalence of distressing symptoms suggesting that even those with non-palliative intent have high needs and should receive integrated palliative care.


Assuntos
Neoplasias da Mama , Neoplasias , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Estudos Transversais , Fadiga , Feminino , Humanos , Jordânia/epidemiologia , Cuidados Paliativos , Qualidade de Vida
9.
BMC Musculoskelet Disord ; 23(1): 837, 2022 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-36057658

RESUMO

BACKGROUND: We evaluated the effects of combined complex decongestive therapy (CDT) with electrotherapy modalities (ultrasound and faradic currents) in patients with breast cancer-related lymphedema (BCRL), investigating upper extremity circumference, volume, pain, and functional disability. METHODS: Thirty-nine patients with unilateral BCRL were randomly allocated to three groups (n = 13) as the following: The control group received CDT, the ultrasound group received CDT and therapeutic ultrasound, and the faradic group received CDT and faradic current. All the participants underwent treatment for 10 sessions. The outcomes including volume, circumference (measured at five points), pain intensity, and functional disability of the affected upper extremity were evaluated at baseline and after the treatment. RESULTS: Following the treatment, an improvement was noted in lymphedema volume, pain, and functional disability in all the three groups and there was a significant difference between the groups (P < 0.05). However, changes in limb circumference at the end of the treatment were not significantly different among the three groups in any sites (P > 0.05). CONCLUSION: The combination of electrotherapy modalities, faradic current or ultrasound, with CDT can result in a greater reduction in lymphedema volume, pain, and functional disability in patients with BCRL. TRIAL REGISTRATION: IRCT, IRCT201310292391N14, registered 03/01/2016.


Assuntos
Linfedema Relacionado a Câncer de Mama , Neoplasias da Mama , Terapia por Estimulação Elétrica , Linfedema , Linfedema Relacionado a Câncer de Mama/terapia , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Feminino , Humanos , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Linfedema/terapia , Dor , Qualidade de Vida , Resultado do Tratamento
10.
Sci Rep ; 12(1): 15148, 2022 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-36071122

RESUMO

Ultrasound imaging texture analyses may provide information on tissue homogeneity changes in metastatic breast cancer (MBC) through second-order analyzes based on the gray-level co-occurrence matrix. This study aimed to analyze the responsiveness and correlations of biomarkers of muscular and fat echotexture after an exercise intervention in women with MBC. A 12-week exercise intervention was conducted in 2019, including aerobic and strength training. Echotexture variables were obtained at baseline and after intervention from the quadriceps (Q) and biceps brachii and brachialis. Mean differences were calculated using the T-Student parametric test for dependent samples of the differences in the means (P = 0.05; 95% CI). Data obtained from 13 MBC women showed significant differences in some echotexture variables after the intervention. QLQ-BR23 questionnaire correlated with several echotexture variables from muscle and subcutaneous fat. PFS-R scale correlated positively with the Q Subcutaneous Fat Non-Contraction Homogeneity (R = 0.43, P < 0.05). Q Muscle Non-Contraction Energy and Q Muscle Non-Contraction Textural Correlation explained 90% of the variance of QLQ-BR23. Some muscle and subcutaneous fat echotexture biomarkers showed good responsiveness after the exercise intervention. Additionally, some muscle and subcutaneous fat variables correlated with QLQ-BR23 and cancer-related fatigue measured by PFS-R scale in MBC patients.Trial registration: NCT03879096.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Exercício Físico , Terapia por Exercício/métodos , Fadiga , Feminino , Humanos , Inquéritos e Questionários
11.
Sensors (Basel) ; 22(17)2022 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-36080800

RESUMO

Microwave hyperthermia (MH) requires the effective calibration of antenna excitations for the selective focusing of the microwave energy on the target region, with a nominal effect on the surrounding tissue. To this end, many different antenna calibration methods, such as optimization techniques and look-up tables, have been proposed in the literature. These optimization procedures, however, do not consider the whole nature of the electric field, which is a complex vector field; instead, it is simplified to a real and scalar field component. Furthermore, most of the approaches in the literature are system-specific, limiting the applicability of the proposed methods to specific configurations. In this paper, we propose an antenna excitation optimization scheme applicable to a variety of configurations and present the results of a convolutional neural network (CNN)-based approach for two different configurations. The data set for CNN training is collected by superposing the information obtained from individual antenna elements. The results of the CNN models outperform the look-up table results. The proposed approach is promising, as the phase-only optimization and phase-power-combined optimization show a 27% and 4% lower hotspot-to-target energy ratio, respectively, than the look-up table results for the linear MH applicator. The proposed deep-learning-based optimization technique can be utilized as a protocol to be applied on any MH applicator for the optimization of the antenna excitations, as well as for a comparison of MH applicators.


Assuntos
Neoplasias da Mama , Aprendizado Profundo , Hipertermia Induzida , Neoplasias da Mama/terapia , Feminino , Humanos , Hipertermia , Hipertermia Induzida/métodos , Micro-Ondas
12.
Rev Med Inst Mex Seguro Soc ; 60(5): 487-494, 2022 Aug 31.
Artigo em Espanhol | MEDLINE | ID: mdl-36048571

RESUMO

Background: Returning to work and performing housework tasks (HWT) is the final step in overcoming breast cancer (BC). Objective: To assess whether clinical characteristics and type of treatment impact employment status and performance of HWT. Material and methods: A total of 119 patients diagnosed with early BC were enrolled. Occupational and HWT-related variables were measured. Results: At diagnosis, most of the patients were employed and performed HWT. Two years after the end of treatment, 50% of the patients who were working continued to work and 68.6% of these had issues returning to work. Patients who did not return to work were diagnosed at more advanced stages and had more postoperative complications (p < 0.005). Regarding the execution of HWT, 83.3% had some degree of difficulty to perform them. Patients who underwent axillary nodal removal, those who received more frequent psychological support, and those who had more postoperative complications performed HWT with greater difficulty (p < 0.005). Conclusions: Once treatment had finished, 50% of patients did not come back to their work. In this case, the stage negative effect and the postoperative complications materialized. These data reveal that returning to work after BC diagnosis and treatment is complicated.


Introducción: la reinserción laboral y la reanudación de las tareas del hogar suponen el último paso en la superación del cáncer de mama (CM). Objetivo: evaluar si las características clínicas y el tipo de tratamiento afectan de forma negativa el desempeño en el puesto de trabajo y en el hogar. Material y métodos: se incluyeron 119 pacientes diagnosticadas de CM precoz. Se midieron las variables laborales y las relacionadas con las tareas del hogar. Resultados: al ser diagnosticadas, la mayoría de las pacientes tenía trabajo y realizaba las tareas del hogar. A los dos años de finalizado el tratamiento, el 50% de las pacientes que trabajaban continuaba trabajando y el 68.6% de estas tuvieron dificultades para retomar su trabajo. Las pacientes que no retomaron su actividad laboral fueron diagnosticadas en estadios más avanzados y tuvieron más complicaciones postoperatorias (p < 0.005). En cuanto a la ejecución de las tareas del hogar, el 83.3% tuvieron algún grado de dificultad para llevarlas a cabo. Las pacientes que fueron sometidas a vaciamiento axilar ganglionar, las que recibieron más frecuentemente apoyo psicológico y las que tuvieron más complicaciones postoperatorias realizaron las tareas del hogar con mayor esfuerzo (p < 0.005). Conclusiones: una vez terminado el tratamiento, el 50% de las pacientes no se reincorporó a su actividad laboral. En este caso, se objetivó el efecto negativo del estadio y de las complicaciones postoperatorias (p < 0.005). Estos datos revelan que la reinserción laboral tras el diagnóstico y tratamiento del CM es complicada.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Emprego , Feminino , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Sobreviventes/psicologia
13.
Int J Hyperthermia ; 39(1): 1213-1221, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36104074

RESUMO

OBJECTIVE: The addition of hyperthermia in the treatment of intact breast cancer with the aim to improve local response is currently in a research phase. First, optimal hyperthermia devices need to be developed, for which a diverse, anatomically and pathologically accurate set of patient models is necessary. METHODS: To investigate the effects of inter-subject variations on hyperthermia treatment plans, we generated a repository of 22 anatomically and pathologically diverse patient models based on MR images of breast cancer patients. Hyperthermia treatment plans were generated for the 22 models using a generic theoretical phased array hyperthermia applicator. RESULTS: Good temperature coverage was achieved in the vast majority of the models, with median values for T10 = 43.5°C (41.9-43.8°C), T50 = 42.5°C (41.3-43.3°C), and T90 = 41.3°C (39.8-42.6°C) under the condition that the maximum temperature increase in the patient is limited to 44°C. CONCLUSIONS: For future development of hyperthermia devices and treatment methods, a repository with a sufficiently large number of representative patient models, such as the one provided in this study, should be used to ensure applicability to a wide variety of patients. This repository is therefore made publicly available.


Assuntos
Neoplasias da Mama , Hipertermia Induzida , Mama , Neoplasias da Mama/terapia , Feminino , Humanos , Hipertermia Induzida/métodos
14.
Lakartidningen ; 1192022 09 14.
Artigo em Sueco | MEDLINE | ID: mdl-36106740

RESUMO

Enhanced screening and efficient cancer treatments have led to a growing number of cancer survivors. In Sweden over 500 000 individuals have or have had cancer [1]. Cancer survivors can experience a wide range of disease and treatment related symptoms, that profoundly affect their health related quality of life. For example, women treated for breast cancer have on average 25 percent lower physical fitness compared to women without a cancer diagnosis. Recent evidence suggests that exercise has a positive effect on physical fitness, muscle strength, cancer related fatigue and quality of life among cancer survivors. An effective exercise prescription for health related outcomes in adult cancer survivors includes aerobic training at a moderate intensity for a total of 150 minutes per week. Adding resistance training two times per week has additional effects on muscle strength and physical functioning. Supervised exercise programs seem to be more effective than unsupervised or home based programs.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Adulto , Neoplasias da Mama/terapia , Exercício Físico/fisiologia , Feminino , Humanos , Força Muscular , Qualidade de Vida
15.
Front Immunol ; 13: 973935, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36119049

RESUMO

Pyroptosis is a brand-new category of programmed cell death (PCD) that is brought on by multitudinous inflammasomes, which can recognize several stimuli to pilot the cleavage of and activate inflammatory cytokines like IL-18 and IL-1ß is believed to have dual effects on the development of multiple cancers including breast cancer. However, pyroptosis has different effects on cancers depending on the type of tissues and their distinct heredity. Recently, the association between pyroptosis and breast cancer has received more and more attention, and it is thought that inducing pyroptosis could be used as a cancer treatment option. In addition, a great deal of evidence accumulating over the past decades has evinced the crosstalk between pyroptosis and tumor immunological therapy. Thus, a comprehensive summary combining the function of pyroptosis in breast cancer and antitumor immunity is imperative. We portray the prevalent knowledge of the multidimensional roles of pyroptosis in cancer and summarize the pyroptosis in breast cancer principally. Moreover, we elucidate the influence of inflammasomes and pyroptosis-produced cytokines on the tumor microenvironment (TME) of breast cancer. Taken together, we aim to provide a clue to harness pyroptosis rationally and apply it to augment immunotherapy efficiency for breast cancer.


Assuntos
Neoplasias da Mama , Piroptose , Apoptose/genética , Neoplasias da Mama/terapia , Feminino , Humanos , Inflamassomos/metabolismo , Interleucina-18/metabolismo , Piroptose/genética , Microambiente Tumoral
16.
Cell Commun Signal ; 20(1): 141, 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36096820

RESUMO

Breast cancer is the most common cancer in females, and to date, the mortality rate of breast cancer metastasis cannot be ignored. The metastasis of breast cancer is a complex, staged process, and the pattern of metastatic spread is not random. The pre-metastatic niche, as an organ-specific home for metastasis, is a favourable environment for tumour cell colonization. As detection techniques improve, the role of the pre-metastatic niche in breast cancer metastasis is being uncovered. sEVs (small extracellular vesicles) can deliver cargo, which is vital for the formation of pre-metastatic niches. sEVs participate in multiple aspects of creating a distant microenvironment to promote tumour invasion, including the secretion of inflammatory molecules, immunosuppression, angiogenesis and enhancement of vascular permeability, as well as regulation of the stromal environment. Here, we discuss the multifaceted mechanisms through which breast cancer-derived sEVs contribute to pre-metastatic niches. In addition, sEVs as biomarkers and antimetastatic therapies are also discussed, particularly their use in transporting exosomal microRNAs. The study of sEVs may provide insight into immunotherapy and targeted therapies for breast cancer, and we also provide an overview of their potential role in antitumour metastasis. Video Abstract.


Assuntos
Neoplasias da Mama , Vesículas Extracelulares , Melanoma , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Comunicação Celular , Vesículas Extracelulares/patologia , Feminino , Humanos , Melanoma/patologia , Neoplasias Cutâneas , Microambiente Tumoral
17.
Tokai J Exp Clin Med ; 47(3): 131-135, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36073284

RESUMO

OBJECTIVE: Herein, we report a case of a patient with recurrent breast cancer who was diagnosed antemortem with pulmonary tumor thrombotic microangiopathy (PTTM) using wedge aspiration cytology of the pulmonary artery after breast cancer surgery. CASE SUMMARY: The patient was a 50-year-old woman who underwent mastectomy and axillary lymph node dissection for stage IIIA (T3N2M0) triple-negative left breast cancer. Postoperative follow-up was performed with radiotherapy and anticancer chemotherapy. Seventeen months after the surgery, the patient was hospitalized for right heart failure and diagnosed with pulmonary arterial hypertension. The patient was diagnosed with PTTM following the detection of malignant cells in the pulmonary artery using wedge aspiration cytology. Anti-pulmonary hypertension therapy was administered; however, the patient did not respond and died 26 days after admission. Autopsy revealed multiple microscopic tumor emboli in the pulmonary artery. In portions of the pulmonary artery without embolization, fibro-cellular intimal hyperplasia and stenosis were observed. Tumor embolism was expressed for CK7+/CK20-, consistent with the primary breast cancer. DISCUSSION: Since the primary pathophysiology of PTTM entails narrowing due to fibro-cellular intimal hyperplasia rather than multiple tumor thrombi, the efficacy of chemotherapy combined with vasodilators is discussed.


Assuntos
Neoplasias da Mama , Neoplasias Pulmonares , Células Neoplásicas Circulantes , Microangiopatias Trombóticas , Autopsia , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Feminino , Humanos , Hiperplasia/complicações , Neoplasias Pulmonares/patologia , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Células Neoplásicas Circulantes/patologia , Microangiopatias Trombóticas/diagnóstico , Microangiopatias Trombóticas/etiologia , Microangiopatias Trombóticas/patologia
18.
J Natl Compr Canc Netw ; 20(9): 1005-1011, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36075384

RESUMO

BACKGROUND: The 49% decrease in breast cancer mortality since 1986 has increased the number of breast cancer survivors requiring survivorship care. The purpose of this analysis was to estimate the 2022 prevalence of breast cancer survivors diagnosed within the past 15 years among Canadian women. METHODS: We extracted the projected female breast cancer cases from 2007 to 2021 and rates of net survival (competing noncancer causes of death removed) from the Canadian Cancer Society's statistical reports. Overall survival was extracted from published Ontario data. Using known survival rates for 1, 5, 10, and 15 years, we interpolated remaining years and applied the corresponding net and overall survival rates to the projected cases for each year from 2007 to 2021 to determine survivors in 2022. Prevalence for predefined age groups was also calculated. As an example of excess healthcare costs attributable to breast cancer, we calculated the excess costs of heart failure hospitalizations. RESULTS: From 2007 to 2021, there were 370,756 breast cancer cases. Using net survival, 318,429 (85.9%) of these patients were projected to survive breast cancer by 2022, a prevalence of 2.1% of Canadian women. Using overall survival, prevalence was 1.8%. Prevalence increased with age group, from 0.01% of those aged 20 to 24 years to 12.7% of those aged ≥90 years, and from 1.0% among the working and/or child-raising (age 20-64 years) to 5.4% among elderly populations (age ≥65 years). Among these survivors, 24.9% of projected heart failure hospitalizations would be in excess of those among matched control subjects, with projected excess costs of $16.5 million CAD. Given the excess healthcare costs, potential for reduced contributions to the workforce, and reduced quality of life associated with long-term impairments and risk of excess non-breast cancer death, enhanced breast cancer survivorship care is warranted. CONCLUSIONS: With an overall prevalence of 2% among Canadian women, breast cancer survivors represent an increasing segment of the working-age and elderly populations.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Insuficiência Cardíaca , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Feminino , Humanos , Lactente , Ontário , Prevalência , Qualidade de Vida , Sobreviventes
19.
BMC Health Serv Res ; 22(1): 1136, 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36076226

RESUMO

BACKGROUND: In patient choice, patients are expected to select the provider that best fits their preferences. In this study, we assess to what extent the hospital choice of patients in practice corresponds with their preferred choice. METHODS: Dutch patients with breast cancer (n = 631) and cataract (n = 1109) were recruited. We employed a discrete choice experiment (DCE) per condition to measure stated preferences and predict the distribution of patients across four hospitals. Each DCE included five attributes: patient experiences, a clinical outcome indicator, waiting time, travel distance and whether the hospital had been recommended (e.g., by the General Practitioner (GP)). Revealed choices were derived from claims data. RESULTS: Hospital quality was valued as most important in the DCE; the largest marginal rates of substitution (willingness to wait) were observed for the clinical outcome indicator (breast cancer: 38.6 days (95% confidence interval (95%CI): 32.9-44.2); cataract: 210.5 days (95%CI: 140.8-280.2)). In practice, it was of lesser importance. In revealed choices, travel distance became the most important attribute; it accounted for 85.5% (breast cancer) and 95.5% (cataract) of the log-likelihood. The predicted distribution of patients differed from that observed in practice in terms of absolute value and, for breast cancer, also in relative order. Similar results were observed in population weighted analyses. DISCUSSION: Study findings show that patients highly valued quality information in the choice for a hospital. However, in practice these preferences did not prevail. Our findings suggest that GPs played a major role and that patients mostly ended up selecting the nearest hospital.


Assuntos
Neoplasias da Mama , Catarata , Neoplasias da Mama/terapia , Comportamento de Escolha , Feminino , Hospitais , Humanos , Preferência do Paciente
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