فهرست مطالب

  • Volume:6 Issue:2, 2019
  • تاریخ انتشار: 1398/04/09
  • تعداد عناوین: 7
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  • Zahra Abbasi, Mojgan Karbakhsh Pages 47-48
  • Mohammad Reza Sasani* Pages 49-50
  • Afsaneh Alikhassi* Pages 51-54
  • Sadaf Alipour*, Amirhossein Eskandaric Pages 55-68
    Background

    The association of exogenous steroid hormones with breast malignancy has long been, and still is, a subject of investigation. This manuscript, as part of a series of articles about effects of exogenous sex hormones on breast conditions, reviews the adverse and beneficial effects of oral contraceptives in various entities separately: benign and malignant breast diseases, women with risk factors of breast cancer, and the general population.

    Methods

    We first reviewed international clinical guidelines about the subject. Then, a comprehensive search of the literature was carried out using appropriate keywords. Clinical trials, population-based or cohort studies, nested case-control studies, and narrative/systematic reviews were reviewed and relevant data were extracted.

    Results

    Oral contraceptives are contraindicated in women with current or previous breast cancer. Among women at high risk for breast cancer, those with preceding chest wall irradiation should not use pills, while these are allowed in cases with BRCA mutations or with a positive family history of breast cancer. Oral contraceptives may be beneficial for benign breast diseases. For low-risk woman, pills either pose no risk or may induce a very mild risk for breast cancer.

    Conclusion

    Oral contraceptives are generally safe regarding breast diseases except in breast cancer patients or high-risk women, especially those with a history of chest wall irradiation.

    Keywords: Breast cancer, Contraception, Disease, Hormones, Steroid
  • Nahid Nafissia, Athena Farahzadia, Zahra Zeinalia, Hamidreza Mirzaeib, Hasan Moayerib, Azam Salatib, Mohammad esmail Akbari Pages 83-89
    Background

    Ductal Carcinoma In Situ (DCIS) which has recently been renamed into Ductal Intraepithelial Neoplasia (DIN), is a malignant cell proliferation without invasion to basement membrane of ducts or lobules of breast. DCIS consists 20-30% of newly diagnosed breast cancers in some Western countries due to higher diagnosis resulting from screening by mammography. Relative Risk (RR) of invasive ductal carcinoma is 8-10 times in DCIS, although high grading lesions and positive or close surgical margins are two important predictive factors in DCIS recurrences. The adjuvant radiotherapy has decreased the rate of ipsilateral local recurrence about 60%. In this article, we evaluated the recurrence rate as DCIS as well as invasive breast cancer in patients with DCIS undergoing breast conserving surgery (BCS) and intraoperative electron radiotherapy (IOERT).

    Methods

    Data were derived from Cancer Research Center database from 38 pure DCIS cases who had received intraoperative radiation therapy between 2012–2017. Intraoperative electron radiotherapy (IOERT) was performed according to Iran's intraoperative radiation therapy consensus.

    Results

    The median age of the patients was 55 years and median histological lesion size was 1.8 centimeters. Number of extracted lymph nodes had a median of 1 and all extracted nodes were negative. Hormonal therapy was performed in 42.1% of patients. IOERT was done as radical full exposure for 86.9% of cases and as boost dose for 13.1% of cases, who needed to complete radiotherapy by external beam. One case in the group received boost dose and 4 cases in the group received full dose had recurrence. The median follow-up of patients was 31 months. Pathology of recurrence was reported as DCIS in 3 cases and invasive breast cancer in 2 of them.

    Conclusion

    There is not a lot of data on the effectiveness of IOERT in DCIS management. Although there are not large number of cases in our study, the local recurrence (13.1%) was only event in our study with 31 months median follow up with no contralateral metastasis, distant metastasis, or death.

    Keywords: Breast Ductal Carcinoma in Situ, Intra-operative Radiotherapy, Partial Breast Radiation
  • Samane Jama, Alireza Abdollahib, Sanaz Zandc, Zahra Khazaeipourd, Ramesh Omranipouree Pages 90-94
    Background

    Triple-negative breast cancer (TNBC) accounts for 15 to 20% of all breast cancers. These patients do not benefit from hormone therapy and other targeted treatments of breast cancer. Recently, researchers proposed the use of androgen receptor (AR)-targeted therapies in this subset of patients. The rate of AR expression in TNBC patients varies from 0 to 53%. AR positivity is associated with a better outcome for breast cancer patients. The purpose of this study was to evaluate AR status in TNBC patients and its association with other demographic and pathologic features.

    Methods

    This cross-sectional study was conducted in the Cancer Institute of Iran, affiliated with Tehran University of Medical Sciences, in 2015. Archived formalin-fixed, paraffin-embedded breast tumor blocks were evaluated to determine the AR status of the tumors. Demographic and pathologic characteristics of the patients were retrieved from the department of pathology database. Data were analyzed with SPSS 18.0.

    Results

    Seventy-seven TNBC patients with the mean age of 45.3 ± 11.5 were assessed. Twenty-six patients (34%) showed AR expression, and 51 patients (56%) did not have AR expression. There was no significant correlation between AR status and age, tumor size, histopathologic type of tumor, or lymph node involvement. However, AR positivity had a statistically significant association with a lower tumor grade and lymphovascular invasion (P = 0.029 and P = 0.01, respectively).

    Conclusion

    TNBC patients with AR expression tend to have lower tumor grades and higher rates of lymphovascular invasion.

    Keywords: Triple Negative breast cancer (TNBC), Androgen receptor (AR), Histopathological features
  • Mahdis Mohamadianamiria, Majid Aklamlib, Seyedeh Fahimeh Shojaei Pages 100-103
    Background

    When breast cancer is diagnosed during pregnancy or within the first year after delivery, the condition is named as pregnancy-associated breast cancer (PABC). Breast cancer during pregnancy is a devastating situation for the patient, her family, and the medical team. Providing guidance for diagnosis and treatment of PABC, we report a case along with review of the literature.

    Case presentation

    Here we present a 31-year-old pregnant woman with low back pain who was referred to the gynecology ward. She was at 25 weeks and 6 days pregnancy. After workup, it was discovered that she had a lytic lesion in her spine. Further workup revealed that she had metastatic breast cancer with the pathology of invasive ductal carcinoma. After consultation with a multidisciplinary team (a gynecologist, an oncologist, a radiotherapist, a hematologist-oncologist, and a neurosurgeon), we terminated the pregnancy and put her on radiotherapy for the spine metastasis and systemic therapy. Also, we reviewed 36 pregnant patients with primary or recurrent breast cancer who were managed with outpatient chemotherapy, surgery, or surgery plus radiation therapy. Care was provided by medical oncologists, breast surgeons, and perinatal obstetricians.

    Conclusion

    Since there are no sufficient data in the literature to guide the development of standard protocols for management of PABC patients (specially in metastatic disease), pregnant women must be followed up by a multidisciplinary team, and each case should be managed considering the gestational age and the stage of cancer.

    Keywords: Metastatic breast cancer, Pregnancy, Diagnosis, Management