Breast Disease - Volume 37, issue 4

Authors: Takuwa, Haruko | Tsuji, Wakako | Yotsumoto, Fumiaki

Article Type: Research Article

Abstract: BACKGROUND: As the aging population grows, the number of elderly breast cancer patients has rapidly increased especially in Japan; a suitable treatment for elderly patients, considering chronic comorbidities and treatment tolerance, is urgently needed. METHODS: In this retrospective study, 286 elderly breast cancer patients were investigated. Tumor characteristics and survival outcome were compared between 70–79-year-old and ≥ 80-year-old groups. Disease-free survival, overall survival, and breast cancer-specific survival were compared, and the effect of variables was analyzed statistically. For resectable cases, prognoses were compared based on treatment (standard therapy or undertreated). RESULTS: Tumor characteristics were similar …between groups, but the Ki-67 labeling index tended to be higher in older patients. Elderly patients with resectable cancer tended to be undertreated. During the median 59-month follow-up period, overall survival was significantly worse in the ≥80-year-old than in the 70–79-year-old group (p < 0.001), but disease-free and breast cancer-specific survivals were equivalent. Recurrence or death event hazard rates tended to be lower in patients receiving standard treatment. CONCLUSIONS: Standard multidisciplinary treatment for breast cancer prevents recurrence and metastasis and tends to extend breast cancer-specific survival even in elderly patients. Show more

Keywords: Breast cancer, comprehensive geriatric assessment, elderly, standard treatment, undertreated

DOI: 10.3233/BD-170280

Citation: Breast Disease, vol. 37, no. 4, pp. 177-183, 2018

Authors: Takuwa, Haruko | Saji, Shigehira | Takada, Masahiro | Takahara, Sachiko | Yamauchi, Akira

Article Type: Research Article

Abstract: BACKGROUND: Among estrogens, estradiol (E2) has the strongest physiological activity as a stimulator in estrogen receptor (ER)-positive breast cancer. The aim of this study is to investigate E2 dynamics during endocrine therapy and to explore the optimal environment in which tamoxifen (TAM) exhibits better efficacy for ER-positive premenopausal early breast cancer patients. METHODS: This is a retrospective study enrolled 194 patients with premenopausal ER-positive early-stage breast cancer who aging ≤45 years at onset and receiving luteinizing hormone-releasing hormone-agonist (LHRH-a) and TAM–therapy. Approximately half of the patients also received pre- or post-operative chemotherapy as adjuvant systemic therapy. We …studied the relationship between recurrence and serum hormonal dynamics during adjuvant therapy. We monitored the concentrations of E2 and, follicle–stimulating hormone (FSH) in the blood before, during, and after treatment. The median follow-up period was 80 (14–555) months. RESULTS: Forty–six (23.7%) patients developed recurrent breast cancer after surgery. The prognoses were favorable in the group receiving longer LHRH-a exposure if those patients did not receive chemotherapy as their adjuvant therapy. Paradoxically, patients with high serum E2 levels after LHRH-a showed a low recurrence ratio. This phenomenon might be explained by the similar mechanisms of estrogen therapy after estrogen depletion by aromatase inhibitor (AI) therapy for metastatic breast cancer. CONCLUSION: Among patients who received endocrine therapy without adjuvant chemotherapy, those with longer LHRH-a exposure had favorable prognoses. A potential association was observed between recurrence and E2 concentrations in women with premenopausal ER-positive early-stage breast cancer. Show more

Keywords: Estradiol, premenopausal, endocrine therapy, breast cancer

DOI: 10.3233/BD-170307

Citation: Breast Disease, vol. 37, no. 4, pp. 185-190, 2018

Authors: Alikhassi, A. | Hamidpour, Sh. F. | Firouzmand, M. | Navid, M. | Eghbal, M.

Article Type: Research Article

Abstract: BACKGROUND: The limitations of mammography as a screening and diagnostic tool, especially for younger women with dense breasts, makes it necessary to use an adjunctive modality to cover its shortcomings. Ultrasound and thermography both have potential role in this era. OBJECTIVES: We will compare the accuracy of thermography with ultrasound in breast cancer diagnosis in a clinical setting. PATIENTS AND METHODS: This study consisted of 78 women who underwent ultrasound and thermography on the same day, since evaluations were performed for both breasts in all patients separately, each breast was considered a distinct case. Biopsy was …performed in 14 suspicious cases with an outcome of 7 malignant results. All women were followed for one year. RESULTS: The average age of 78 patients was 41.0 ± 10.4 years. Sensitivity, specificity, PPV, NPV, and overall accuracy for ultrasound in diagnosing malignant breast lesions were 100%, 95.3%, 50.0%, 100%, 95.5% and for thermography 85.7%, 78.5%, 15.8%, 99.1%, and 78.8% respectively. CONCLUSION: We believe that thermography is a non-invasive, safe, and accepted method by patients; however, despite technical advances in it, its diagnostic abilities are still less than those of sonography, so we suggest that it be used as an adjunct in breast cancer diagnosis in selective situations. Show more

Keywords: Thermography, sonography, breast cancer, mammography

DOI: 10.3233/BD-180321

Citation: Breast Disease, vol. 37, no. 4, pp. 191-196, 2018

Authors: Clement, Zackariah | McLeay, William | Hoffmann, Clive | Shin, Peter | Kiu, Andrew | Eaton, Michael

Article Type: Research Article

Abstract: BACKGROUND/OBJECTIVE: This study aimed to analyse the local recurrence (LR) and breast cancer related mortality (BCRM) in older women who underwent breast-conserving surgery (BCS) with and without adjuvant radiotherapy (XRT). METHODS: This retrospective study included a total of 299 women who underwent BCS for early breast carcinoma, between the years of 2007 and 2011. Predictive risk factors, local recurrence (LR) and breast cancer related mortality (BCRM) were assessed with a mean follow-up period of 84 months. RESULTS: Women over the age of 65 in the XRT and No-XRT groups showed similar incidence of LR (5.8% vs …5%, p = 0.838). Women over 65 years old with XRT had a higher rate of BCRM (5.8% vs 0%, p = 0.05). Resection margins >5 mm had a lower rate of BCRM (HR 0.395, p = 0.05). Women under the age of 65, invasive ductal carcinoma, grade-3 tumours, HER-2 positive, triple negative, lympho-vascular invasion, axillary lymph node positivity, high breast density on mammography were associated with increased risk of LR and BCRM. CONCLUSIONS: XRT in women over the age of 65 did not decrease the risk of LR. Adjuvant XRT in older women should be offered to selective patients with high risk patient and tumour factors. Show more

Keywords: Breast cancer, breast conserving surgery, older women, radiotherapy, recurrence, mortality

DOI: 10.3233/BD-180340

Citation: Breast Disease, vol. 37, no. 4, pp. 197-205, 2018

Authors: Ghaffari, Hadi | Nafissi, Nahid | Hashemi-Bahremani, Mohammad | Alebouyeh, Mahmoud Reza | Tavakoli, Ahmad | Javanmard, Davod | Bokharaei-Salim, Farah | Mortazavi, Helya Sadat | Monavari, Seyed Hamidreza

Article Type: Research Article

Abstract: BACKGROUND: The etiology and molecular mechanisms involved in the development of breast cancer still remain poorly understood. Some epidemiological studies have shown an association between human papillomavirus (HPV) and breast cancer. However, the findings are controversial. OBJECTIVE: Our study was aimed to investigate the presence of HPV DNA in breast carcinomas of Iranian women. METHODS: In total, 72 samples of formalin-fixed paraffin-embedded (FFPE) tissues of breast cancer collected between December 2014 and April 2016 were examined. HPV DNA detection was performed by nested-PCR assay. Next, positive samples were subjected to genotyping by the CLART HPV2 microarray …system. All statistical analysis was carried out using SPSS v.18.0. RESULTS: HPV DNA was detected in 4/72 (5.55%) samples. Clinical factors were not statistically associated with HPV presence. However, CLART HPV2 microarray assay failed to determine the genotype of any positive samples. CONCLUSION: The low frequency of HPV detected in our study does not support an association between breast carcinoma and HPV infection. However, it is possible that HPV may be responsible for breast carcinogenesis only in small percentage of all breast cancer. Show more

Keywords: Human papillomavirus, Breast carcinoma, Iran, HPV, Breast cancer

DOI: 10.3233/BD-180333

Citation: Breast Disease, vol. 37, no. 4, pp. 207-213, 2018

Authors: Nakata, Bunzo | Kuroda, Kenji | Yoshida, Yasuhiko | Iimori, Nozomi | Masuda, Go | Lee, Tomihiro | Tendo, Masashige | Hori, Takeshi | Sato, Hiroshi | Ishikawa, Tetsuro

Article Type: Case Report

Abstract: Here we report the case of a 77-year-old woman with a huge cancer of the right breast for which size was measured on computed tomography in our hospital preoperatively and in other hospital 3 years earlier. During the 3-year untreated interval, the tumor grew from 4 cm to 13 cm in maximum diameter, and the tumor-volume doubling time (TVDT) was calculated as 209 days. The patient underwent mastectomy with axillary lymph node dissection, with the large skin defect covered by autologous skin graft. The pathological diagnosis was pure mucinous carcinoma (MC) of the breast with a low MIB-1 index, no …vessel invasion, and no lymph node metastasis. Breast MC has been known to show a slow growth rate, but the TVDT of this current tumor was not markedly different from that of common breast cancers described in previous reports. This short TVDT notwithstanding the low aggressiveness may be due to abundant mucin occupying the majority of the tumor volume. To the best of our knowledge, no previous reports have provided accurate TVDTs for breast MC. Show more

Keywords: Pure mucinous carcinoma, breast cancer, computed tomography

DOI: 10.3233/BD-170300

Citation: Breast Disease, vol. 37, no. 4, pp. 215-218, 2018

Authors: Salemis, Nikolaos S.

Article Type: Case Report

Abstract: Intracystic breast carcinoma is a rare clinical entity accounting for 0.5–2% of all breast cancers. It represents a distinctive clinical form rather a histological subtype of breast cancer and can either be in situ or invasive tumor. We herein describe a rare case of intracystic breast carcinoma arising from the wall of a cyst in a postmenopausal patient, who presented with a rapidly growing complex breast cyst. Diagnostic evaluation and management of the patient are discussed along with a review of the literature. Complex breast cysts may represent a diagnostic and therapeutic challenge. An underlying malignancy has been reported …in 21–31% of the cases. Preoperative diagnosis is challenging. Complex breast cysts with thick wall, thick inner septations, and intracystic solid components should undergo histological evaluation in order to rule out an underlying malignancy. The cytological analysis may be inconclusive. Ultrasound-guided biopsy is the diagnostic modality of choice. The correlation of clinical features, with imaging and histopathological findings is very important for the optimal treatment. In cases of discordance, a complete surgical excision is necessary with careful assessment of the extent of the disease and appropriate treatment. Show more

Keywords: Intracystic, carcinoma, breast, complex, cyst

DOI: 10.3233/BD-170316

Citation: Breast Disease, vol. 37, no. 4, pp. 219-224, 2018

Authors: Denariyakoon, S. | Watcharakul, C. | Techanitisawat, P. | Chulakadabba, A. | Sampatanukul, P. | Boonjunwetwat, D. | Chatamra, K.

Article Type: Case Report

Abstract: Recurrent hemorrhagic cyst is an uncommon presentation of breast disease. The ordinary imaging could not demonstrate the malignant features of the cyst. However, the non-contrast dedicated breast computerized tomography could support the malignancy concern. Although tissue diagnosis cannot show the malignant cell, Surgical excision could be offered without uncompromising. Eventually, ductal carcinoma in-situ was diagnosed and further adjuvant treatment could be given. We reported the first case report of ductal carcinoma in-situ , hypersecretory type, presented by a hemorrhagic cyst.

Keywords: Hypersecretory DCIS

DOI: 10.3233/BD-180328

Citation: Breast Disease, vol. 37, no. 4, pp. 225-227, 2018