Breast Disease - Volume 43, issue 1

Authors: Hasanah, Uswatun | Ahmad, Mardiana | Prihantono, Prihantono | Usman, Andi Nilawati | Arsyad, Aryadi | Agustin, Dinah Inrawati

Article Type: Systematic Review

Abstract: OBJECTIVES: Research investigating the quality of life (QOL) of breast cancer patients undergoing chemotherapy has yielded useful knowledge regarding the effects of cancer treatment on the quality of life of patients. This study reviews the assessment of the quality of life for those diagnosed with breast cancer. DESIGN: A systematic review was conducted. DATA SOURCES: This systematic review utilized online databases, including PubMed, Web of Science, Scopus, and Google Scholar. A search ranging from 2018 to 2024 was carried out. REVIEW METHOD: Medical Subject Headings (MESH) were used for keyword selection along with other …target keywords, such as “Quality of life”, “Breast cancer”, “Chemotherapy”, “Treatment side effects”, “Patient experience”, “Psychosocial well-being”, “Physical functioning”, “Emotional distress”, and “Supportive care”. We reviewed and included all English-language publications. A narrative synthesis was conducted to present the results of the studies. RESULTS: A total of 300 studies were obtained from the search using the specified keywords. Each result underwent another filtering round after applying the inclusion and exclusion criteria. This process led to a final selection of 20 papers that met the requirements and were included in the systematic review. CONCLUSION: The use of instruments to measure the quality of life (QoL) of breast cancer patients is crucial in understanding the impact of breast cancer on patients’ lives, from physical and mental health to social aspects. Show more

Keywords: Breast, cancer, quality of life, assessment

DOI: 10.3233/BD-249008

Citation: Breast Disease, vol. 43, no. 1, pp. 173-185, 2024

Authors: Png, Nicholas Chen Yi | Goh, Winfred Xi Tai | Chan, Clement Wenhao

Article Type: Case Report

Abstract: An 85-year-old Chinese lady presented with a 5-day history of a painless left breast lump. There was no fever, nipple discharge, or history of trauma. She had a past medical history of atrial fibrillation that was managed with an oral anticoagulant. Mammography demonstrated a dense mass in the upper outer quadrant of the left breast. Ultrasound showed an irregular, heterogeneous 4.7 cm lesion containing debris and cystic spaces with raised peripheral vascularity at the 2 o’clock position, 3 cm from nipple. No internal vascularity was detected. This was managed as a haematoma and rivaroxaban was withheld. Follow-up imaging 3-weeks …later showed persistence of the lesion. Bedside needle aspiration yielded haemoserous fluid with immediate reduction in size of the lesion. However, 2 weeks after aspiration, there was recurrence of the ‘haematoma’. Multidisciplinary review of the clinical history, examination and imaging was sought, and biopsy of the irregularly thickened areas with vascularity along the periphery of the lesion was recommended. Vacuum-assisted biopsy was performed, and histology returned as metaplastic carcinoma. A recurring ‘haematoma’ should always prompt a search for a secondary cause, with features such as irregular thickened walls and papillary/nodular components requiring further evaluation with biopsy for histopathological correlation. Show more

Keywords: Breast cancer, recurrent breast haematoma

DOI: 10.3233/BD-240006

Citation: Breast Disease, vol. 43, no. 1, pp. 187-191, 2024

Authors: Singh, Keerti | Agrawal, Lokita | Gupta, Rhea | Singh, Divyam | Kathpalia, Meghavi | Kaur, Navkiran

Article Type: Review Article

Abstract: Efficient treatment of cancer has been a subject of research by scientists for many years. Current treatments for cancer, such as radiotherapy, chemotherapy and surgery have been used in traditional combination therapy, but they have major setbacks like non-specificity, non-responsiveness in certain cancer types towards treatment, tumor recurrence, etc. Epidemiological data has shown that breast cancer accounts for 14% of cancer cases occurring in Indian women. In recent years, scientists have started to focus on the use of natural compounds like lectins obtained from various sources to counter the side effects of traditional therapy. Lectins like Sambucus nigra Agglutinin, …Maackia amurensis lectin, Okra lectins, Haliclona caerulea lectin, Sclerotium rolfsii lectin, etc., have been discovered to have both diagnostic and therapeutic potential for breast cancer patients. Lectins have been found to have inhibitory effects on various cancer cell activities such as neo-angiogenesis, causing cell cycle arrest at the G1 phase, and inducing apoptosis. The major idea behind the use of lectins in cancer diagnostics and therapeutics is their capability to bind to glycosylated proteins that are expressed on the cell surface. This review focuses on an exploration of the roles of post-translational modification in cancer cells, especially glycosylation, and the potential of lectins in cancer diagnosis and therapeutics. Show more

Keywords: Cancer, radiotherapy, chemotherapy, surgery, lectins, Sambucus nigra Agglutinin, Maackia amurensis lectin, Okra lectins, Haliclona caerulea lectin, Sclerotium rolfsii lectin, no-angiogenesis, cell cycle, G1 phase, apoptosis, glycosylated proteins, post-translational modification

DOI: 10.3233/BD-230047

Citation: Breast Disease, vol. 43, no. 1, pp. 193-211, 2024

Authors: Debouki-Joudi, Saoussen | Ben Kridis, Wala | Trifa, Fatma | Ayadi, Wajdi | Khabir, Abdelmajid | Sellami-Boudawara, Tahia | Daoud, Jamel | Khanfir, Afef | Mokdad-Gargouri, Raja

Article Type: Research Article

Abstract: BACKGROUND: The PI3K protein is involved in the PI3K/AKT/mTOR pathway. Deregulation of this pathway through PIK3CA mutation is common in various tumors. The aim of this work is to identify hotspot mutation at exons 9 and 20 in Tunisian patients with sporadic or hereditary breast cancer. METHODS: Hotspot mutations in exon 9 and exon 20 of the PIK3CA gene were identified by QPCR-High Resolution Melting followed by COLD-PCR and sequencing in 63 (42 sporadic cases and 21 hereditary cases) tumor tissues collected from Tunisian patient with breast cancer. MCF7, and BT20 breast cancer cell lines harboring the …PIK3CA hotspot mutations E545K and H1047R in exon 9 and exon 20 respectively, were used as controls in HRM experiments. RESULTS: PIK3CA hotspot mutations were detected in 66.7% (28 out of 42) of sporadic BC cases, and in 14.3% (3 out of 21) of hereditary BC. The E545K and the H1048Y were the most prevalent mutations identified in patients with sporadic and hereditary BC, whereas the H1047R hotspot mutation was not found in our patients. Statistical analysis showed that PIK3CA mutation associated with an aggressive behavior in patients with sporadic BC, while it’s correlated with age, tumor stage and tumor size in the group patients with hereditary breast cancer. CONCLUSIONS: Our results showed a novel PIK3CA hotspot mutation in Tunisian breast cancer patients detected by HRM-COLD-PCR. Moreover, the absence of PIK3CA hotspot mutation associated with good prognosis. Show more

Keywords: Breast cancer, COLD-PCR, HRM, mutations, PIK3CA gene

DOI: 10.3233/BD-240005

Citation: Breast Disease, vol. 43, no. 1, pp. 213-221, 2024

Authors: Nakai, Taketo | Seki, Hirohito | Makino, Akitsugu | Kadota, Yoshie | Kaburagi, Takuji | Okumura, Takehiro | Karahashi, Tsuyoshi

Article Type: Case Report

Abstract: BACKGROUND: Neuro-Behcet’s disease (NBD) is a variant of Behcet’s disease (BD). To our knowledge, there have been no previous reports on concurrent NBD in breast cancer patients undergoing chemotherapy. CASE PRESENTATION: Our patient had a history of BD and was asymptomatic. She was diagnosed with human epidermal growth factor receptor 2-positive breast cancer by core needle biopsy and was administered neoadjuvant chemotherapy. After four courses, in addition to the aggravation of the existing adverse events, headache, fever, dysarthria, and muscle weakness in the upper left and lower extremities appeared. On admission, she was diagnosed with acute NBD, and …steroid therapy was initiated. After her symptoms improved gradually, she was discharged. Then, she underwent mastectomy and axillary lymph node dissection for breast cancer. Trastuzumab and pertuzumab plus tamoxifen were administered postoperatively. Two years postoperatively, no recurrence of breast cancer and NBD was noted. CONCLUSION: When chemotherapy is administered to breast cancer patients with a history of BD, it is necessary to select chemotherapy with as few adverse events as possible and to continue with treatment while paying attention to the risk of NBD. Show more

Keywords: Breast cancer, neuro-Bechet’s disease, autoimmune disease, human epidermal growth factor receptor 2, chemotherapy

DOI: 10.3233/BD-230026

Citation: Breast Disease, vol. 43, no. 1, pp. 223-229, 2024

Authors: Abdelwahab, Khaled M. | Elsaeed, Sara | Hamdy, Omar | Saleh, Mahmoud M. | Hosam, Amr

Article Type: Case Report

Abstract: Phyllodes tumor is an uncommon breast neoplasm that is present in variable sizes. Giant phyllodes are those larger than 10 cm in diameter. Clinically, giant phyllodes tumors present as a visible, rapidly growing mass distorting the breast contour. Such tumors with large size and rapid growth rate suggest a phyllode diagnosis of fibroadenoma. Planning a standard treatment strategy for these tumors is quite challenging. While adequate surgical excision with tumor-free resection margins is the standard of care for most giant phyllodes cases, borderline and malignant giant phyllodes tumors might require wider resections given their high recurrence rates. Some authors described total …mastectomy as the treatment option for giant borderline and malignant phyllodes to obtain wide, clear margins. Between March 2022 and September 2023, our surgical oncology department presented and operated on three cases of giant phyllodes. They underwent a nipple-sparing mastectomy and immediate breast reconstruction using pre-pectoral silicone implants. We think that with such a procedure, we can benefit from the wide, safe margins of mastectomy that have been proven to decrease local recurrence rates while considering the aesthetic outcome. Show more

Keywords: Giant phyllodes, breast reconstruction, pre-pectoral implant, recurrence

DOI: 10.3233/BD-240011

Citation: Breast Disease, vol. 43, no. 1, pp. 231-236, 2024

Authors: Vieira, Sabas Carlos | dos Reis, Cristiane Amaral | Holanda, Mariana Elvas Feitosa | da Silva Fontinele, Danilo Rafael | Leal, Alessandro Igor Cavalcanti | de Lima, Fernanda Teresa

Article Type: Research Article

Abstract: OBJECTIVE: We aim to evaluate the indication and use of genomic signatures in breast cancer patients and outcomes who in patients undergoing adjuvant chemotherapy or not. METHODS: This is a retrospective study of breast cancer patients managed in a private oncology clinic in Teresina, from November 2014 to February 2021. All patients with an indication of genomic signature were included. Clinical and pathological variables, use of genomic signatures, treatment and follow-up were obtained. The nomogram to predict Oncotype DX results (University of Tennessee Medical Center) was also calculated. Clinical risk calculation was based on MINDACT, using the modified …version of Adjuvant Online. The genetic signatures performed were: the Oncotype, MammaPrint and EndoPredict. RESULTS: Fifty (50) female patients were included in the study. The mean age of the participants was 57.1 years. Among the patients receiving a genomic signature (26–52.0%), there was a change in treatment in 8 (30.7%) cases. Chemotherapy was indicated in four patients, It was contraindicated in another four patients. Treatment changed in 30.7% of the tested patients. Chemotherapy was indicated for those who would not receive it before. It was contraindicated in patients who would previously undergo chemotherapy. Show more

Keywords: Breast neoplasms, chemotherapy, adjuvant, precision medicine, genomics, gene signatures

DOI: 10.3233/BD-230044

Citation: Breast Disease, vol. 43, no. 1, pp. 237-242, 2024

Authors: Burratti, Moira | Morano, Giuseppina | Pasquale, Chiara | Di Fonso, Grazia | Costabile, Loredana

Article Type: Research Article

Abstract: BACKGROUND: The management of mastodynia plays a central role in improving women quality of life. Despite its high occurrence, specific therapeutic guidelines for mastalgia are still lacking. Available therapies include unspecific anti-inflammatories, even though they may often expose to undesirable effects and low compliance. OBJECTIVE: The aim of this study was to highlight the efficacy of the topical application of combined natural molecules including Boswellia serrata, Betaine and myo-Inositol in improving cyclic mastalgia. METHODS: In this retrospective pilot clinical study, patients with cyclic mastalgia applied a specific breast gel for three months. The severity of the …pain was measured through the Visual Analogue Score (VAS) in the treated group compared to untreated one. Treated patients also filled in a questionnaire evaluating acceptance and safety of the breast gel. RESULTS: This pilot clinical study demonstrated for the first time the efficacy of the topical application of a breast gel based on Betaine, Boswellia serrata, and myo-Inositol in improving cyclic mastodynia. The completed questionnaires also revealed high levels of acceptance, as both safety and compliance. CONCLUSIONS: Besides confirming the positive effects of these natural molecules in the management of conditions affecting breast physiology – so far evaluated as oral supplementation – the obtained results pave the way for further studies supporting the use of such molecules as a tailored medical device in the management of breast pain, thus also opening toward a combined oral and topical approach. Show more

Keywords: Boswellia serrata, Betaine, Myo-Inositol, mastalgia, medical device, breast gel

DOI: 10.3233/BD-240012

Citation: Breast Disease, vol. 43, no. 1, pp. 243-249, 2024

Authors: Ben Kridis, Wala | Boudawara, Olfa | Khanfir, Afef

Article Type: Research Article

Abstract: INTRODUCTION: Alopecia is one of the main adverse events of chemotherapy in breast cancer. However, its impact is often ignored and underestimated by clinicians. Our aim was to evaluate the quality of life of breast cancer patients with chemotherapy induced alopecia. METHODS: We conducted a prospective study including 72 breast cancer patients who developed alopecia on or after stopping chemotherapy in the last 6 months. Clinical information and characteristics of alopecia were assessed using a self-prepared questionnaire. DLQI score was used to evaluate patients’ quality of life. RESULTS: We interviewed a total of 72 women with …a mean age of 53.5 ± 6 years. Alopecia appeared soon after the first course in 62.5%. All patients actively tried to hide induced hair fall (either by a hat in 6.9% or by a headscarf in 93.1%). Quality of life was impacted in 97.2% of patients with a median DLQI score of 6.5. Women who did not underwent mastectomy were significantly more bothered by hair loss than those who had radical surgery (78.1% vs 55%, p = 0.04). Working status was a significant predictor factor of a bad quality of life due to alopecia (100% in working women vs 58.3% in homemaker or retired patients, p = 0.006). CONCLUSION: Chemotherapy induced alopecia had a negative impact on quality of life of patients with breast cancer, especially in working women and those who did not have radical surgery. Prior wearing of headscarves did not impact significantly the DLQI score. Show more

Keywords: Chemotherapy induced alopecia, breast cancer, quality of life

DOI: 10.3233/BD-240019

Citation: Breast Disease, vol. 43, no. 1, pp. 251-255, 2024

Authors: Jain, Parul | Aggarwal, Shalini | Adam, Sufiyan | Imam, Mohsin

Article Type: Research Article

Abstract: Breast Cancer is the leading form of cancer found in women and a major cause of increased mortality rates among them. However, manual diagnosis of the disease is time-consuming and often limited by the availability of screening systems. Thus, there is a pressing need for an automatic diagnosis system that can quickly detect cancer in its early stages. Data mining and machine learning techniques have emerged as valuable tools in developing such a system. In this study we investigated the performance of several machine learning models on the Wisconsin Breast Cancer (original) dataset with a particular emphasis on finding which …models perform the best for breast cancer diagnosis. The study also explores the contrast between the proposed ANN methodology and conventional machine learning techniques. The comparison between the methods employed in the current study and those utilized in earlier research on the Wisconsin Breast Cancer dataset is also compared. The findings of this study are in line with those of previous studies which also highlighted the efficacy of SVM, Decision Tree, CART, ANN, and ELM ANN for breast cancer detection. Several classifiers achieved high accuracy, precision and F1 scores for benign and malignant tumours, respectively. It is also found that models with hyperparameter adjustment performed better than those without and boosting methods like as XGBoost, Adaboost, and Gradient Boost consistently performed well across benign and malignant tumours. The study emphasizes the significance of hyperparameter tuning and the efficacy of boosting algorithms in addressing the complexity and nonlinearity of data. Using the Wisconsin Breast Cancer (original) dataset, a detailed summary of the current status of research on breast cancer diagnosis is provided. Show more

Keywords: Breast cancer, deep learning, SVM, decision tree, Adaboost

DOI: 10.3233/BD-240018

Citation: Breast Disease, vol. 43, no. 1, pp. 257-270, 2024

Authors: Ben Kridis, Wala | Lajnef, Mayssa | Khanfir, Afef

Article Type: Brief Report

Abstract: Primary angiosarcoma (PAS) of the breast is an extremely uncommon variant of breast malignancies. Highly aggressiveness and dismal prognosis characterize this endothelial neoplasm. We report here an unusual case of PAS of the breast occurring in a 46-year-old woman associated with concurrent bilateral invasive ductal carcinoma and ovarian metastases.

Keywords: Angiosarcoma, breast cancer,  carcinoma, ovarian metastases

DOI: 10.3233/BD-240003

Citation: Breast Disease, vol. 43, no. 1, pp. 271-274, 2024