Trend of breast cancer mortality in Montenegro, 1990-2018 - Joinpoint regression.

OBJECTIVE: In this study, we analyzed breast cancer mortality data overall and by age groups in women in Montenegro, to determine if there were any changes in trend for period 1990-2018. MATERIALS AND METHODS: The study gathered data on breast cancer mortality in Montenegro obtained from Vital Registration System. Annual data on breast cancer mortality were extracted for period 1990-2018 and analyzed using World Standard Population age-standardized and age-specific rates and Joinpoint regression. RESULTS: In 2018 in Montenegro, breast cancer accounted for 4.64% of all deaths in women and for 19.78% of all cancer deaths in women. In terms of total cancer mortality, it ranked first among women. Age-standardized rates ranged from 11.41/100,000 in 1990 to 20.46/100,000 in 2016. Joinpoint regression showed no one joinpoint for the entire population of all women and age groups. In the observed period, breast cancer mortality rates significantly increased in the women in Montenegro [average annual percentage change (AAPC) = 1.44%; 95% confidence interval (CI): 0.9-2.0]. The most affected age group was 55-64 years. CONCLUSIONS: There is a growing breast cancer mortality trend in Montenegro. It is necessary to create specific programs for urgent action, in order to reduce this undesirable trend. At the same time, support from the competent institutions is needed for increasing screening coverage and better prevention of breast cancer in the target population.

Comparative study of immunohistochemical determination of breast cancer molecular subtypes on core biopsy and surgical specimens.

OBJECTIVE: We aimed to compare the distribution of different molecular subtypes of invasive breast cancer (BC) between patients whose samples were obtained by core needle biopsy (CB) and surgical specimens (SS) and to assess the reliability of CB as a diagnostic method in this context. PATIENTS AND METHODS: All patients (222) diagnosed with invasive BC were examined. Immunohistochemistry was performed on 40 samples obtained by CB and on 148 SS, while in 34 patients, the analysis was performed on both CB and SS. Molecular classification of BC was performed based on estrogen receptor (ER), progesterone receptor (PgR), Human epidermal growth factor receptor 2 (HER2), and Ki67 proliferative index status. RESULTS: The most common molecular subtypes were Luminal A (43.2%) and Luminal B HER2- (29.7%). When comparing the frequencies of determined molecular subtypes, no difference was observed between samples obtained by CB and SS (p>0.05). Concordance analysis of molecular subtypes determined by immunohistochemistry on CB and SS was performed in 34 patients whose samples were obtained using both methods. No significant difference was observed in the designation of molecular subtype in relation to the sampling method (p>0.05). Results of immunohistochemistry analysis on CB and SS demonstrated good statistical agreement (Concordance rate=85.29%, Kappa=0.771, p<0.001). CONCLUSIONS: CB might be a reliable method for the determination of the molecular subtype of invasive BC.

Immunohistochemical analysis of CD68, CD4, CD8 and CD20 expression in cervical dysplasia and its relationship with HR-HPV infection.

OBJECTIVE: The aim of the study was to examine the composition of the inflammatory infiltrates in cervical premalignant lesions and contribute to a better understanding of immune response to HR-HPV infection and dysplasia. PATIENTS AND METHODS: Semi-quantitative analysis of CD68, CD4, CD8 and CD20 immunohistochemical expression in a series of 41 cervical biopsies without dysplasia, 24 cases of LSIL and 35 HSIL cases was performed. In each subject, genotyping for 12 HR-HPV types was done prior to the biopsy. RESULTS: Observing the total sample, no correlation between CD68, CD4, CD8 and CD20 expression levels and HR-HPV infection was found, regardless of the presence of mono- or co-infection (p>0.05). A statistically significant correlation between dysplastic changes and CD68 expression, as well as between dysplastic changes and CD4 expression, was observed (p=0.003 and p=0.016, respectively). For CD68 expression, there was a positive correlation with both LSIL and HSIL, and concerning CD4 expression, there was a positive correlation primarily with LSIL. The finding of mild CD68 expression shows a 10.5 times greater chance of the sample being classified as LSIL, while the finding of a strong CD68 expression shows a 12 times greater chance of the sample being classified as HSIL, in comparison to cases with no expression. When the samples were stratified in relation to the lesion grade, a correlation between HR-HPV infection and CD68/CD4 expression again was not proved (p>0.05). No correlation between CD8 and CD20 expression with dysplasia was found (p>0.05). CONCLUSIONS: We consider a higher prevalence of macrophages and CD4 lymphocytes in dysplastic lesions to be a response to dysplasia rather than HR-HPV infection itself. The increase of the expression levels of macrophages with the degree of the lesion speaks in favour of their potential role in the progression of the neoplastic process.

Total leukocyte count, leukocyte subsets and their indexes in relation to cardiovascular risk in adolescent population.

OBJECTIVE: No studies investigated total leukocytes, their subpopulations and novel indexes based on different ratios of leukocyte subsets concerning cardiovascular risk (CV) risk in late adolescents. Therefore, the aim of the present study was to explore such potential relationships. PATIENTS AND METHODS: A total of 156 adolescents were included. CV risk score was calculated by summarizing each risk factor (i.e., female sex, low high density lipoprotein cholesterol (HDL-c), high non-HDL-c, smoking, blood pressure, and fasting glycemia). Adolescents were divided into a low CV risk score (i.e., -2≤ CV risk score ≤1) and moderate/higher CV risk score (i.e., CV risk score ≥ 2). White blood cell count (WBC) and its subsets were analyzed on an automatic device. The indexes were calculated. RESULTS: Total and differential WBC counts except basophil count were higher in moderate/higher CV risk participants. Multivariate binary regression analysis showed that total WBC count independently increased CV risk score by 1.623 times (p=0.001). Neutrophil and eosinophil counts (p=0.027 and p=0.010, respectively) were independently able to increase CV risk score by 1.486 and 1.556 times, respectively. On the contrary, indexes were not independently correlated with CV risk. CONCLUSIONS: WBC, neutrophil, and eosinophil count are the independent predictors of increased CV risk in adolescents. The associations may indicate the different pathways that lead to CV disease in adulthood.