Risk factors for inflammatory and non-inflammatory breast cancer in North Africa.

PURPOSE: Studies of the etiology of inflammatory breast cancer (IBC), a rare but aggressive breast cancer, have been hampered by limited risk factor information. We extend previous studies by evaluating a broader range of risk factors. METHODS: Between 2009 and 2015, we conducted a case-control study of IBC at six centers in Egypt, Tunisia, and Morocco; enrolled were 267 IBC cases and for comparison 274 non-IBC cases and 275 controls, both matched on age and geographic area to the IBC cases. We administered questionnaires and collected anthropometric measurements for all study subjects. We used multiple imputation methods to account for missing values and calculated odds ratios (ORs) and 95% confidence intervals (CIs) using polytomous logistic regression comparing each of the two case groups to the controls, with statistical tests for the difference between the coefficients for the two case groups. RESULTS: After multivariable adjustment, a livebirth within the previous 2 years (OR 4.6; 95% CI 1.8 to 11.7) and diabetes (OR 1.8; 95% CI 1.1 to 3.0) were associated with increased risk of IBC, but not non-IBC (OR 0.9; 95% CI 0.3 to 2.5 and OR 0.9; 95% CI 0.5 to 1.6 for livebirth and diabetes, respectively). A family history of breast cancer, inflammatory-like breast problems, breast trauma, and low socioeconomic status were associated with increased risk of both tumor types. CONCLUSIONS: We identified novel risk factors for IBC and non-IBC, some of which preferentially increased risk of IBC compared to non-IBC. Upon confirmation, these findings could help illuminate the etiology and aid in prevention of this aggressive cancer.

Clinico-pathologic and mammographic characteristics of inflammatory and non-inflammatory breast cancer at six centers in North Africa.

PURPOSE: We describe the clinico-pathologic and mammographic characteristics of inflammatory breast cancer (IBC) and non-IBC cases enrolled in a case-control study. Because IBC is a clinico-pathologic entity with rapid appearance of erythema and other signs, its diagnosis is based on clinical observation and thus, by necessity, subjective. Therefore, we evaluate our cases by photographic review by outside expert clinicians and by degree of adherence to the two most recent definitions of IBC: the international expert panel consensus statement and American Joint Committee on Cancer (AJCC) 8th edition (we used the slightly less restrictive 7th edition definition for our study). METHODS: We enrolled 267 IBC and 274 age- and geographically matched non-IBC cases at 6 sites in Egypt, Tunisia, and Morocco in a case-control study of IBC conducted between 2009 and 2015. We collected clinico-pathologic and mammographic data and standardized medical photographs of the breast. RESULTS: We identified many differences between IBC and non-IBC cases: 54.5% versus 68.8% were estrogen receptor-positive, 39.9% versus 14.8% human epidermal growth factor receptor 2-positive, 91% versus 4% exhibited erythema, 63% versus 97% had a mass, and 57% versus 10% had mammographic evidence of skin thickening. Seventy-six percent of IBC cases adhered to the expert panel consensus statement and 36% to the AJCC definition; 86 percent were confirmed as IBC by either photographic review or adherence to the consensus statement. CONCLUSIONS: We successfully identified distinct groups of IBC and non-IBC cases. The reliability of IBC diagnosis would benefit from expert review of standardized medical photographs and associated clinical information.

Chronic Mastitis in Egypt and Morocco: Differentiating between Idiopathic Granulomatous Mastitis and IgG4-Related Disease.

Idiopathic granulomatous mastitis (IGM) is a benign, frequently severe chronic inflammatory lesion of the breast. Its etiology remains unknown and reported cases vary in their presentation and histologic findings with an optimal treatment algorithm yet to be described owing mainly to the disease's heterogeneity. IgG4-related disease (IgG4-RD) is a newly recognized systemic fibroinflammatory condition characterized by a dense lymphoplasmacytic infiltrate with many IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis. Immunosuppressive therapy is considered to be an effective first-line therapy for IgG4-RD. We sought to clarify and classify chronic mastitis according to the histologic findings of IgG4-RD mastitis with respect to IGM and to develop a robust diagnostic framework to help select patients for optimal treatment strategies. Using the largest collection to date (43 cases from Egypt and Morocco), we show that despite sharing many features, IGM and IgG4-RD mastitis are separate diseases. To diagnostically separate the diseases, we created a classification schema-termed the Michigan Classification-based upon our large series of cases, the consensus statement on IgG4-RD, and the histologic description of IGM in the literature. Using our classification, we discerned 17 cases of IgG4-RD and 8 cases of IGM among the 43 chronic mastitis cases, with 18 indeterminate cases. Thus, our Michigan Classification can form the basis of rational stratification of chronic mastitis patients between these two clinically and histopathologically heterogeneous diseases.

Incidence of Gastric Cancer in Marrakech and Casablanca, Morocco.

Gastric cancer is the fifth most common cancer globally with over 70% of new cases occurring in developing countries. In Morocco, oncologists in Marrakech suspected higher frequency of gastric cancer compared to Casablanca, a city 150 kilometers away. This study calculated age-specific, sex-specific, and total incidence rates of gastric cancer in Marrakech and was compared to the Casablanca population-based cancer registry. Using medical records from Center Hospital University Mohammad VI and reports from 4 main private pathology laboratories in Marrakech, we identified 774 patients for the period 2008-2012. Comparison of rates showed higher age-specific incidence in Marrakech in nearly all age groups for both genders. A higher total incidence in Marrakech than in Casablanca was found with rates of 5.50 and 3.23 per 100,000, respectively. Incidence was significantly higher among males in Marrakech than males in Casablanca (7.19 and 3.91 per 100,000, resp.) and females in Marrakech compared to females in Casablanca (3.87 and 2.58 per 100,000, resp.). Future studies should address possible underestimation of gastric cancer in Marrakech, estimate incidence in other regions of Morocco, and investigate possible risk factors to explain the difference in rates.

[Recent advances in targeted therapies in the treatment of HER2-positive metastatic breast cancer]. / Progrès récents dans les thérapies ciblées dans le traitement du cancer du sein métastatique HER2-positif.

Metastatic breast cancer (MBC) is an incurable disease. The goal of treatment is mainly palliative to improve quality of life by the control of disease (in terms of disease free survival [DFS]) as long as possible, and to treat symptoms with fewer side effects. The gene c-erb B2 or neu or HER2 is amplified in 20-25% of breast cancers. This amplification is associated with a more aggressive disease and a poor prognosis. Patients, carrying a HER2-positive MBC, benefit from new therapies targeting the HER2 receptor. These treatments have shown their efficacy as single agent, and have a synergistic effect with chemotherapy. There is a more toxicity profile in comparison with that of chemotherapy. In first line metastatic disease, treatment should include a combination based on trastuzumab and chemotherapy. After disease progression with trastuzumab-based therapy, rechallenging Trastuzumab in combination with chemotherapy is a reasonable option. After a second progression with trastuzumab, a combination based on lapatinib plus Capecitabine (or other chemotherapy if Capecitabine was previously used) should be proposed; the combination based on lapatinib and trastuzumab is reasonable. Inclusion in clinical trials must continue to improve outcomes for our patients.

[Trastuzumab in early breast cancer]. / Le trastuzumab dans le traitement adjuvant du cancer du sein.

BACKGROUND: The HER2 gene or c-erb B2 or neu is amplified in 15-25% of breast cancers. This amplification is associated with an aggressive course of disease. The trastuzumab is a monoclonal antibody targeting the extracellular domain of HER2. This is the first targeted molecule designed to treat breast cancer. In the firstline metastatic disease, trastuzumab in combination with chemotherapy significantly improved survival of patients with HER2-positive disease. In the adjuvant setting, trastuzumab has been evaluated in several randomized trials. OBJECTIVE: The purpose of this literature review is to evaluate the efficacy and safety of Trastuzumab in the adjuvant treatment of HER2-positive breast cancer. METHODS: A search of articles published in English literature, between 1987 (date of establishment of prognostic value of HER2) and November 2012, was conducted on Medline and in the database of the main international congress using the following terms: "breast cancer", "HER2-positive", "adjuvant therapy" and "Trastuzumab". RESULTS: We identified seven randomized phase 3 trial evaluating trastuzumab in the adjuvant treatment of HER2-positive. The trastuzumab was administered weekly or every 3weeks. Its administration with concomitant taxane chemotherapy and with concurrent radiotherapy was preferred. Four randomized trials have clearly confirmed the benefit of trastuzumab, two positive in overall survival (OS) and progression free survival (PFS), and two positive in PFS. The duration of trastuzumab for 1year was the most effective. The trastuzumab was well tolerated. The most significant toxicity, associated with trastuzumab, was cardiac toxicity. However, it is found in only 5% or less of cases, and it is severe in only 2% or less of cases, and most patients recovered their cardiac function by medical treatment alone. CONCLUSION: In the contemporary medical literature, several strong arguments confirm the benefit in survival of trastuzumab administered concomitantly with a taxane-based chemotherapy and with concurrent radiotherapy, and for a period of 1year. Trastuzumab was well tolerated. Only 2% or less of patients experienced a serious cardiac toxicity, but it was reversible in most of the time.

Risk factors for chronic mastitis in morocco and egypt.

Chronic mastitis is a prolonged inflammatory breast disease, and little is known about its etiology. We identified 85 cases and 112 controls from 5 hospitals in Morocco and Egypt. Cases were women with chronic mastitis (including periductal, lobular, granulomatous, lymphocytic, and duct ectasia with mastitis). Controls had benign breast disease, including fibroadenoma, benign phyllodes, and adenosis. Both groups were identified from histopathologically diagnosed patients from 2008 to 2011, frequency-matched on age. Patient interviews elicited demographic, reproductive, breastfeeding, and clinical histories. Cases had higher parity than controls (OR = 1.75, 1.62-1.90) and more reported history of contraception use (OR = 2.73, 2.07-3.61). Cases were less likely to report wearing a bra (OR = 0.56, 0.47-0.67) and less often used both breasts for breastfeeding (OR = 4.40, 3.39-5.72). Chronic mastitis cases were significantly less likely to be employed outside home (OR = 0.71, 0.60-0.84) and more likely to report mice in their households (OR = 1.63, 1.36-1.97). This is the largest case-control study reported to date on risk factors for chronic mastitis. Our study highlights distinct reproductive risk factors for the disease. Future studies should further explore these factors and the possible immunological and susceptibility predisposing conditions.

[Urological cancers: ECCO/ESMO congress 2011]. / Cancers urologiques : congrès de l'ECCO/ESMO 2011.

In the Congress of European Cancer Organisation (ECCO)/European Society for Medical Oncology (ESMO), which took place in Stockholm between 23 and 27 September 2011, urological cancers were the subject of various oral presentations and posters. A selection of the more innovative researches, likely to change the patients' management was performed. In prostate cancer, abiraterone acetate should be indicated in patients previously treated with docetaxel and sipuleucel-T in patients with asymptomatic or minimally symptomatic castrate-resistant prostate cancer. Alpharadine should be indicated in patients with symptomatic bone metastases and denosumab in non-metastatic prostate cancer patients with a high risk of developing bone metastases. In metastatic renal clear cell carcinoma, the genetic polymorphisms are predictive for efficacy of anti-angiogenic agents. Targeting both vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) pathways is a very promising strategy. In urothelial cancer, two molecules are promising, the belinostat and the bortezomib. Other news on penile cancer and testicular seminoma are discussed.