Archives of Breast Cancer
Volume:8 Issue: 2, May 2021

The human breast undergoes processes of proliferation and involution, especially during puberty, pregnancy, and menopause. During these dynamic phases, some specific environmental factors play important roles, including pro-carcinogenic effects. In addition to the usual breast tumor, its pathologic characteristics, and genetic variants, different environmental and social factors create additional challenges to the accurate comprehension of breast cancer (BC) risk, diagnosis, prophylaxis, and treatment.

This mini-review is based on Medline database search for recent clinical studies on BC risk factors, development, and prevention, particularly at the time of puberty, pregnancy, and menopause.

Based on the medical literature review, some insights were provided into how external environmental factors influence BC risk, incidence, and mortality. Also, in an attempt to answer this key question, the selected chemical and physical components of the environment, as well as the large spectrum of social and behavioral elements, were analyzed.

It has been suggested that a broad spectrum of established and potential environmental elements have been related to BC etiology. Furthermore, a modern transdisciplinary approach to research studies, including epidemiological, biological, toxicological, pathological, genetic, social, and behavioral factors should help provide the “whole picture” of the environmental risk factors and causes for BC. This is particularly valid to medical personnel involved in women's health to facilitate preventive efforts, especially for those who are at the highest risk for this common and devastating malignancy.

Post-mastectomy radiation therapy (PMRT) is a key component in managing breast cancer with increased potential for locoregional recurrence. Breast reconstruction has evolved to include various techniques that can be categorized according to the type of reconstruction (implant-based versus autologous reconstruction), and the timing of reconstruction (one versus two-step techniques). Methods/

This review article aims to provide a digestible summary of PMRT in the context of breast reconstruction by summarizing salient existing literature with a focus on considerations of the plastic surgeon. The main findings summarized in this review include the technique and timing of breast reconstruction, how breast reconstruction can affect radiation delivery, and the type of reconstruction. Within implant-based reconstruction, existing data on the location of the implant in the context of PMRT and PMRT delivery to the tissue expander versus permanent implant are reviewed. Each consideration may alter the probability of successful reconstruction and patient satisfaction.

It is essential for the multidisciplinary breast cancer team to have knowledge of the various reconstructive options, and to understand the safety and comparative effectiveness of staged reconstruction in the setting of PMRT. Additionally, one must consider that reconstructive procedures may have implications on the timely administration of PMRT. This review serves as a reference for members of the oncologic care team when discussing reconstructive options with patients who will receive PMRTas part of their treatment plan.

The aim of the present study was to investigate the added value of F-18 fludeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) compared with conventional imaging modalities for the evaluation of locoregional and distant sites of recurrence in breast cancer patients.

From May 2013 to September 2016, 109 patients with suspected recurrent breast cancer who underwent conventional imaging and F-18 FDG PET/CT with an interval of 6 weeks were consecutively enrolled (mean age: 52.66 years; range: 29-79). Histopathologic results and clinical follow up based on the gold-standard imaging modality or serial imaging were considered as the reference for verification of F-18 FDG PET/CTfindings.

Of 109 patients, 81 were found to have at least one site of recurrence (74.31%). Local recurrence was correctly identified in 32/32 patients following PET/CT, which was higher than that on conventional imaging (20/32, 62.5%). PET/CT detected 27 additional nodal metastases compared with conventional imaging (59 vs. 32, 45.76%), most frequently in the hilar/mediastinal region (n=27), followed by the supraclavicular lymph nodes (n=20, 62.5%), internal mammary lymph nodes (n=6, 18.77%), and axillary basin (n=6, 18.77%). Additional sites of distant metastasis were identified in 41 patients (37.61%) following F-18 FDG PET/CT imaging, 48.78% of which were localized in the skeletal system (n=20), 21.95% in the liver (n=9), 12.19% in the lungs (n=5), 12.19% in the brain (n=5), and 4.87% in the adrenal glands (n=2).

F-18 FDG PET/CT serves as a useful supplement to conventional imaging techniques by identifying additional sites of disease recurrence in patients with breast cancer, which may change the preferred treatment strategy, particularly in regions that are not routinely evaluated by conventional imaging.

There is no generally accepted standard radiological approach to male breast diseases. Ultrasonography and mammography are the most preferred methods for imaging. The purpose of this study is to investigate the diagnostic performances of only single-view (mediolateral oblique) mammography and routine two-view mammography in the male breast diseases and also to evaluate the contribution of ultrasonography to the diagnosis and the management of the disease.

Three hundred-twenty male patients’ breast imaging findings were evaluated retrospectively. Only mediolateral oblique and routine two-view mammograms were re-evaluated four months apart by two breast radiologists. The kappa value was calculated to measure consistency between two groups. The sensitivity, specificity, positive and negative predictive value, and detection accuracy of malignancy were calculated for both mammographic examinations and ultrasonography.

The accuracy of detection of malignant breast masses according to mediolateral oblique and two-view mammograms, and ultrasonography were 96.3 %, 97.5 %, and 99.5 %, respectively. Consistency between single-view and twoview mammograms was excellent (κ = 0.967) and statistically significant (p=0.000). Two-view mammograms did not make any contribution to single-view mammograms.

Only mediolateral oblique mammogram is sufficient in terms of characterization, spread and localization of the lesion, as long as mastectomy is preferred and the findings are supported by ultrasonography. Since there is no diagnostic performance difference, only mediolateral oblique view would protect from the potential adverse effects of extra radiation exposure and this is an important advantage.

The aim of the study was to retrospectively evaluate possible imaging and histopathology criteria that can be used in a clinical basis to assess the success of excision of suspicious calcifications using the breast lesion excision system (BLES).

We investigated 400 BLES stereotactic biopsies of suspicious calcifications with the mean size of 15.38 mm (st. dev.= 13.579 mm, range 3-78 mm) using a 20 mm probe performed in our department between January 2014 and 2016. The mean age of our population was 58.5 years old (range 39-78 years). The pathology results of BLES specimens were compared with the final surgical results to assess excision success rates. Possible imaging and histopathology criteria for removal were statistically analyzed (mammographic size, disease free margins, grade, comedo phenotype, molecular type).

The results showed that 90/400 (22.5%) biopsies were cancers (80% DCIS) and 38/400 were lesions with cell atypia (9.5%) of which 29/38 had subsequent surgery and were included in the study. Excision was achieved in 31/90 cancers (34.4%) and in 23/29 lesions with cell atypia (76.3%). The imaging and histopathology criteria for BLES excision that could be potentially clinically assessed were the initial mammographic size (p<0.001), the distance of the lesion from the specimen margins (p<0.001), the presence of comedo necrosis (p=0.014) and the grade of the cancers (p=0.021). The underestimation rate was 15.5%.

the mammographic size, grade, comedo presence and disease-free margins, were the main criteria for BLES success rate of excision of suspicious calcifications.

Breast MRI has demonstrated excellent sensitivity in determining the extent of breast cancer and occult malignancy. This study aimed to evaluate the added value of breast MRI compared to mammography and ultrasonography in surgical decision.

A cross-sectional study was conducted on 84 female patients with newly diagnosed breast cancer by ultrasonography and mammography where conservative breast surgery was initially considered, and then bilateral breast MRI was performed and the multidisciplinary decision was revised. The data was analyzed to determine the additional value of breast MRI in treatment planning.

Eighty-four patients were included of whom 44 (52.4%) patients had additional findings on MRI. The treatment plan was changed after the second ultrasonography and histopathology in 44 patients (52.4%) with a remarkable increase in the rate of modified radical mastectomy after MRI.

Preoperative breast MRI has great value in defining the surgical decision in patients with early breast cancer.

The spasm and/or contracture of the pectoralis major contribute to the post-breast surgery pain. The purpose of our study was to evaluate changes in the post-breast surgical pain syndrome after the infiltration of botulinum-toxin type-A (BTX-A), according to the type of surgery and the reconstitution of the botulinumtoxin.

This retrospective study was conducted at the Rehabilitation Department with two cohorts: BTX-A reconstituted with saline solution (SS group) or with levobupivacaine (LV group). Data about pectoralis major contracture and pain (global, at night, at rest and during activity) before the infiltration and six weeks after that were collected from the medical records and compared between SS and LV groups, and between conservative breast surgery and mastectomy cases.

in the study, 48 women aged 53.3 (±11.10) years were included, with 26 (54.2%) in SS group and 22 (45.8%) in LV group. There were no differences between both groups except transitory paresis (3.8% vs 22.7%; P=0.022). In all patients, baseline circumstances vs after 6 weeks were compared, and we found significant differences in contracture (1,77 (±0.57) vs 0.97 (±0.79)), VAS global (5.45 (±1.92) vs 3.46 (±2.48)), VAS night (3.17 (±3.13) vs 1.61 (±2.29)), VAS rest (2.14 (±2.56) vs 1.21 (±1.98)) and VAS activity (4.31 (±2.55) vs 2.78 (±2.58)). We found higher improvements in the breast conservative surgery.

A significant lower pain and contracture after BTX-A injection in the pectoralis major was observed, but its reconstitution in levobupivacaine may not be an effective method to increase the analgesic effect. There were higher improvements in the breast conservative surgery than in the mastectomy.

The aim of this study was to examine the clinical characteristics and quality of life (QOL) of patients with BCRL (breast cancer-related lymphedema).

In this cross-sectional descriptive study, patients' characteristics such as age, body mass index (BMI: kg/m²), history of chemotherapy (CT), radiotherapy (RT), hormone replacement therapy (HRT), neoadjuvant therapy (NT), cancer stages, and types of surgery were recorded. Patients were evaluated using the ‘Disabilities of the Arm, Shoulder and Hand questionnaire’ (DASH), the ‘Lymphedema Quality of Life Questionnaire’ (LYMQOL-ARM), and a visual analogue scale (VAS).

Atotal of 68 women with the mean age of 52.50±9.33 and BMI 29.240 ± 5.05 kg/m² were recruited after breast cancer surgery in this study: thirty-three patients (48.5%) in Stage 0; 24 (35.3%) in Stage 1; 10 (14.7%) in Stage 2; and 1 (1.5%) in Stage 3. No statistically significant difference was found in the QOL according to treatments received after the diagnosis of breast cancer surgery, RT(except the appearance domain of QOL), CT, HRT, or NT. In patients who had received axillary dissection in combination with RT, a statistically significant association was observed between QOL related to body image and symptoms (p=0.009 and p=0.017, respectively). A statistically significant difference was found only in body image and clinical symptom domains according to the lymphedema stage (p=0.027 and p=0.002, respectively). It was observed that as shoulder pain (VAS) and disability (DASH) scores increased, scores of all domains of QOLincreased except the overall domain in QOL(p<0.05).

It was observed that clinical symptoms and body image parameters in QOLwere associated with the lymphedema stage and the number of lymph nodes dissected. It was concluded that axillary dissection with axillary RT and RT alone after breast cancer surgery is associated with body image. Our study revealed that body image perception is related to the quality of life in patients with BCRL. Optimal management of the negative effects of self-reported lymphedema evaluated in the latency phase on quality of life requires coordination between Physical Medicine and Rehabilitation and General Surgery Clinics.

While stage and grade of breast cancer determines prognosis and outcome, race also impacts survival. While Black and White women have been studied, data for Hispanic women is sparse.

Age-matched Hispanic, Black and White women diagnosed/treated with breast cancer at a single institution were retrospectively evaluated regarding prevalence, treatments and outcomes.

Overall, 120 women were included in the study (40 per race). No demographic/histologic variables were significantly different among races. ER+/PR+ tumors were less frequent in Hispanics than Whites, but higher than Blacks. Prevalence of triple negative breast cancers in Hispanic women was between the Black and White cohorts (p=0.025 and p=0.011, respectively). Stage II and III diagnoses (p=0.025) were more frequent in Hispanics and they opted for chemotherapy more often (p=0.034); however, there were no significant differences in outcomes and mortality among groups. When compared to the State tumor registry, our population had more LCIS diagnoses (p=0.01), earlier stages (I p=0.02; II p=0.006), received more treatment overall (radiation p=0.02, chemotherapy p=0.0001) and experienced better survival (p=0.004). In comparing the study population to the SEER database, higher rates of LCIS and IDC and lower rates of ILC and mixed histology in the study population were noted. LCIS and IDC were more prevalent in our cohort than SEER data (p=0.005, p=0.05, respectively), although we noted less ILC and mixed histology (p=0.03 and p=0.04).

These data are the first reported for Hispanics in our state and highlight the need for larger studies to better serve this growing demographic.

The reactive oxygen species (ROS) generated in the biological systems play an important role in pathological conditions and specific normal cellular processes, such as signaling pathways and drug sensitivity.

Intracellular ROS was determined using (2'-7'dichlorofluorescin diacetate) DCFH-DA fluorimetric probe, malondialdehyde as lipid peroxidation index detected by the Thiobarbituric acid reactive substances method. Cells' protein carbonyl contents were assessed with 2,4-Dinitrophenylhydrazine (DNPH) derivatization spectrophotometrically at 360-385 nm.

The oxidative stress induces ROS (p˂0.05), MDA (Malondialdehyde) (p˂0.05), and protein carbonylation (p˂0.01) was significantly higher in HER2- positive BT-474, SK-BR-3, and MDA-MB-453 compared to the HER2-negative MDA-MB-231 and MCF-7 cell lines.

We hypothesized that increased oxidative stress in HER2-positive cell lines is due to the oncogenic function of the HER2 and PI3K/Akt signaling activation, resulting in glycolysis induction. It is assumed that HER2-positive cell lines with high ROS levels are more vulnerable to further damage by increased ROS levels induced by pro-oxidant anticancer agents.

Pre-operative localization options in the axilla are limited. This study aimed to explore the utility of pre-operative localization of axillary lymph nodes using tattoo ink with multidisciplinary correlations.

In this prospective, Institutional Review Board (IRB)-approved study, 19 lymph nodes in 17 patients underwent pre-operative localization with ultrasoundguided injection of Spot tattoo ink. The success rate of intraoperative identification of the tattooed node as well as the frequency in which the tattooed node was also a sentinel node were recorded. Radiologic, surgical and pathologic images were collected.

Tattoo ink localization was successful in 16/17 (94.1%) of patients. Tattoo ink did not hinder pathologic evaluation in any cases but was taken up by additional adjacent nodes in 1/17 successful localizations (5.9%). Successful sentinel lymph node biopsy (SLNB) occurred in 13 patients in whom 14 lymph nodes underwent pre-operative tattoo ink localization. Nine of the 14 (64.2%) tattooed lymph nodes were also a sentinel node.

In this study, pre-operative localization of axillary lymph nodes with tattoo ink was highly successful In patients undergoing SLNB, a significant number of the tattooed nodes were not sentinel nodes (35.8%), suggesting the importance of targeted lymph node excision in addition to SLNB.

Breast-conserving therapy (BCT) with partial-breast irradiation (PBI) has become a standard alternative to whole-breast irradiation. Recently, neoadjuvant chemotherapy (NACT) has been widely performed for early breast cancer. Although BCT using perioperative PBI decreased invasiveness and geographic miss, risks of adverse events and local recurrence remain a concern for patients receiving NACT. Thus, a prospectively registered study, the Clinical Outcome of Multicatheter BrAchyTherapy after NEOadjuvant chemotherapy (COMBAT-NEO), was conducted.

Patients who underwent BCT using multicatheter-interstitial brachytherapy (MIB) by intraoperative catheter implant were analyzed. Early and late adverse events (AEs) including higher grade skin toxicities and wound complications, and tumor control of patients receiving NACT were evaluated in comparison with adjuvant chemotherapy (ACT) and no chemotherapy (no-CT).

Between April 2017 and February 2020, 265 consecutive patients who received single-stage BCT were evaluated, including 13 NACT (4.9%), 68 ACT (25.7%), and 184 no-CT (69.4%). The median follow-up time and age were 30.0 months and 59.0 years, respectively. All patients were followed up for at least 12 months. Although AEs in NACT, ACT, and no-CT were observed in 1 (7.7%), 5 (7.4%), and 11 (6.0%) patients, respectively (p = 0.91) and there was no acute AE in NACT patients. Overall, 3 (1.1%) ipsilateral and 1 (0.4%) contralateral breast tumor recurrences were observed in no-CT patients. There were no regional and distant recurrences.

Although this pilot study was based on a small sample size with short follow-up, these preliminary results support the study of a single-stage BCT with MIB-PBI following NACT.

Autoimmune/inflammatory syndrome (ASIA) constitutes a set of related immune mediated diseases that share a common clinical picture and a history of a previous exposure to an adjuvant agent. From a clinical standpoint, patients present with none specific manifestations such as myalgia, arthralgia, chronic fatigue and dry mouth as well as neurological manifestations such as cognitive disturbances, memory loss and neurologic disabilities. .

A previously healthy 25-year-old patient who underwent breast augmentation 3 years ago, with an asymptomatic rupture of the silicone breast implant, presented with three major criteria of ASIA, and improved after bilateral implant removal. She also had pleuritis and pericarditis, rarely described in such disease. A literature review on complications related to breast implants, their questionable relationship to the onset of autoimmune pathologies, and basic aspects of the diagnosis and management of ASIAwas carried out.

The silicone presented in breast implants should be considered as an adjuvant, with the potential to cause chronic stimulation to the immune system. This can lead to systemic manifestations that can be severe in patients genetically predisposed and potentially not reversible even after surgical removal of the implants. When facing patients with breast implants and systemic clinical symptoms, lymph node disorders, neurological manifestations, or serositis as in the case presented, without other defined etiology, the possibility of ASIA should be considered in the differential diagnosis.