Evaluation Of Breast Cancer Patients Research Articles

CA15-3 Assay Contribution in the Management of Breast Cancer: Study of 177 Cases

Introduction: Breast cancer is the leading cause of cancer mortality in women worldwide. CA15-3 is the most widely used serum marker in this cancer. The aim of this study is to investigate the CA15-3 assay in breast cancer and its correlation with classical prognostic factors for the disease, as well as with the post-therapeutic evolution of patients. Materials and Methods: This is a retrospective study, carried out at the Clinical Biochemistry Laboratory of the Tangier university hospital center, involving 177 patients treated at the Tangier Oncology Center, having benefited from a CA15-3 assay according to the ELFA (Enzyme Linked Fluorescent Assay) immunoassay technique, with a threshold value of 30U/ml, as part of their therapeutic management, for a period of 10 months. Results: A statically significant correlation was found between the marker's level and TNM classification, the expression of hormonal receptors for estrogen (ER) and for progesterone (RP). The high value of CA15-3 is correlated with the number and location of metastatic sites, and also with an unfavourable outcome. Furthermore, monitoring and post-therapeutic evaluation of patients during the metastatic phase, using biomarker kinetics, shows that an increase in biomarker levels relative to the initial value correlates with radiological progression of metastasis and therefore with the advancement of disease. Conclusion: This study supports the interest of CA15-3 assay in the post-treatment follow-up and in the prognostic evaluation of breast cancer patients.

Treatment Outcomes Evaluation in Breast Cancer Patients with a Pathological Complete Response after Neoadjuvant Systemic Therapy Depending on Different Types of Local Treatment

Treatment Outcomes Evaluation in Breast Cancer Patients with a Pathological Complete Response after Neoadjuvant Systemic Therapy Depending on Different Types of Local Treatment

179 (PB-086) Poster - The Lowmag Trial: Magnetic procedure for sentinel lymph node detection and metastasis evaluation in breast cancer patients

179 (PB-086) Poster - The Lowmag Trial: Magnetic procedure for sentinel lymph node detection and metastasis evaluation in breast cancer patients

Dual-Energy CT Material Decomposition: The Value in the Detection of Lymph Node Metastasis from Breast Cancer.

To evaluate the diagnostic performance of a dual-energy computed tomography (DECT)-based material decomposition algorithm for iodine quantification and fat fraction analysis to detect lymph node metastases in breast cancer patients. 30 female patients (mean age, 63.12 ± 14.2 years) diagnosed with breast cancer who underwent pre-operative chest DECT were included. To establish a reference standard, the study correlated histologic repots after lymphadenectomy or confirming metastasis in previous/follow-up examinations. Iodine concentration and fat fraction were determined through region-of-interest measurements on venous DECT iodine maps. Receiver operating characteristic curve analysis was conducted to identify the optimal threshold for differentiating between metastatic and non-metastatic lymph nodes. A total of 168 lymph nodes were evaluated, divided into axillary (metastatic: 46, normal: 101) and intramammary (metastatic: 10, normal: 11). DECT-based fat fraction values exhibited significant differences between metastatic (9.56 ± 6.20%) and non-metastatic lymph nodes (41.52 ± 19.97%) (p < 0.0001). Absolute iodine concentrations showed no significant differences (2.25 ± 0.97 mg/mL vs. 2.08 ± 0.97 mg/mL) (p = 0.7999). The optimal fat fraction threshold for diagnosing metastatic lymph nodes was determined to be 17.75%, offering a sensitivity of 98% and a specificity of 94%. DECT fat fraction analysis emerges as a promising method for identifying metastatic lymph nodes, overcoming the morpho-volumetric limitations of conventional CT regarding lymph node assessment. This innovative approach holds potential for improving pre-operative lymph node evaluation in breast cancer patients, offering enhanced diagnostic accuracy.

Axilla View of Mammography in Preoperative Axillary Lymph Node Evaluation of Breast Cancer Patients: A Pilot Study

PurposeThis study aimed to explore a novel position of mammography named axilla view in axillary lymph node (ALN) evaluation in breast cancer. Patients and MethodsPatients were prospectively enrolled and scheduled for mammography before surgery. Investigated imaging patterns included mediolateral oblique (2D-MLO) and axilla view (2D-axilla) of mammography, and axilla view of digital breast tomosynthesis (3D-axilla). The correlation of ALN numbers between imaging and pathology was analyzed. Diagnostic performance was analyzed via AUC. Results75 patients were included. A larger and clearer axillary region was displayed in axilla view. The total number of ALNs detected under 2D/3D-axilla view was significantly higher than that under 2D-MLO view (4.6 vs. 2.5, P < .001; 5.6 vs. 4.6, P = .034). Correlations between number of positive ALNs detected under 2D/3D-axilla view and pathologically confirmed metastatic ALNs were stronger than 2D-MLO view (Pearson correlation coefficients: 0.7084,0.7044 and 0.4744). The proportion of cases with ≥5 positive ALNs detected under 3D-axilla view was significantly higher than that under 2D-MLO (38.2% vs. 14.7%, P = .028). The overweight and obese group showed a higher AUC value than the underweight and lean group in ALN evaluation, although not significantly (2D-MLO: 0.7643 vs. 0.6458, P = .2656; 2D-axilla: 0.8083 vs. 0.6586, P = .1522; 3D-axilla: 0.8045 vs. 0.6615, P = .1874). This difference was more pronounced in axilla view. ConclusionAxilla view exhibited advantages over conventional MLO view in the extent of axilla displayed by mammography in breast cancer. Further studies with larger sample sizes are needed.

A Novel Artificial Intelligence Model for Symmetry Evaluation in Breast Cancer Patients.

Artificial intelligence (AI) is a milestone for human technology. In medicine, AI is set to play an important role as we progress into a new era. In plastic surgery, AI can participate in breast symmetry assessment, which until now has been mainly subjective, allowing for inconsistencies. This study aims to improve this evaluation process by integrating a novel trained neural network with the breast symmetry calculator, BAS-Calc. We combined the BAS-Calc tool with a custom-made neural network trained to automatically detect key features of the breast. This integrated system was tested on 81 images of patients who had undergone breast reconstruction post-breast cancer treatment. Its performance was evaluated against two human observers using statistical analysis. Our model successfully detected 399/405 (98.51%) of landmarks. Spearman and Pearson correlation indicated a strong positive relationship while Cohen's kappa demonstrated moderate to strong agreement between human observers and AI model. Notably, the average calculation time for the AI was 0.92 seconds, 16 times faster than the 14.09 seconds for humans. Our AI model successfully calculated breast symmetry from images of patients who had undergone reconstructive oncological breast surgery, demonstrating high correlation with human assessments and a markedly reduced processing time. As AI continues to evolve, it is poised to become a pivotal tool in Medicine. Therefore, it is crucial for medical professionals to proactively engage in implementing AI technologies safely and effectively. Further studies are required to broaden our understanding and maximize the potential benefits in this area. Takeaway bullet points Artificial intelligence (AI) is an upcoming force to be reckoned with. AI should find its way into practical applications in plastic surgery. AI can be applied to improve patient care and evaluate aesthetic results. In this work, we present a novel AI model that automatically evaluates breast symmetry. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Role of Diffusion-Weighted Imaging Based on Maximum-Intensity Projection in Young Patients with Marked Background Parenchymal Enhancement on Contrast-Enhanced Breast MRI.

Diffusion-weighted imaging (DWI) utilizing maximum-intensity projection (MIP) was suggested as a cost-effective alternative tool without the risk of gadolinium-based contrast agents. The purpose of this study was to investigate whether DWI MIPs played a supportive role in young (≤60) patients with marked background parenchymal enhancement (BPE) on contrast-enhanced MRI (CE-MRI). The research included 1303 patients with varying degrees of BPE, and correlations between BPE on CE-MRI, the background diffusion signal (BDS) on DWI, and clinical parameters were analyzed. Lesion detection scores were compared between CE-MRI and DWI, with DWI showing higher scores. Among the 186 lesions in 181 patients with marked BPE on CE-MRI, the main lesion on MIPs of CE-MRI was partially or completely seen in 88.7% of cases, while it was not seen in 11.3% of cases. On the other hand, the main lesion on MIPs of DWI was seen in 91.4% of cases, with only 8.6% of cases showing no visibility. DWI achieved higher scores for lesion detection compared to CE-MRI. The presence of a marked BDS was significantly associated with a lower likelihood of a higher DWI score (p < 0.001), and non-mass lesions were associated with a decreased likelihood of a higher DWI score compared with mass lesions (p = 0.196). In conclusion, the inclusion of MIPs of DWI in the preoperative evaluation of breast cancer patients, particularly young women with marked BPE, proved highly beneficial in improving the overall diagnostic process.

Chronic pain evaluation in breast cancer patients using the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS): a single center cross-sectional retrospective study

Chronic pain evaluation in breast cancer patients using the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS): a single center cross-sectional retrospective study

Sleep quality, mental health, and quality of life in women with breast cancer.

Breast cancer is the most frequent malignancy among women and its prevalence keeps growing. Today, it is important to optimize the quality of life of breast cancer patients because the survival rates increase with early diagnosis and treatments. Our aim was to examine the sleep quality of patients with breast cancer, compare them with the healthy control group, and evaluate the relationship between quality of life and mental health. This cross-sectional study included 125 patients diagnosed with breast cancer and 125 healthy control patients who were admitted to the general surgery department of a university. In 60.8% of breast cancer patients, sleep quality was poor and sleep subscale scores were high. In addition, these patients had a poorer sleep quality, higher score of anxiety and depression, and lower quality of life (in terms of physical subcomponent) compared with the control group. Moreover, although age, marital status, education status, time of cancer diagnosis, menopausal status, surgical method did not have any effect on sleep quality in patient group; low income, accompanying chronic diseases, and increased levels of anxiety and depression worsened sleep quality and increased the risk. In patients with breast cancer, poor sleep quality, score of anxiety and depression were higher, and worsened the quality of life. In addition, low income, presence of concomitant chronic diseases, and anxiety score posed an increased risk for poor sleep quality. Therefore, physical and mental evaluation of breast cancer patients during and after treatment should not be ignored.

Daily dose evaluation based on corrected CBCTs for breast cancer patients: accuracy of dose and complication risk assessment

ObjectivesThe goal of this study is to validate different CBCT correction methods to select the superior method that can be used for dose evaluation in breast cancer patients with large anatomical changes treated with photon irradiation.Materials and methodSeventy-six breast cancer patients treated with a partial VMAT photon technique (70% conformal, 30% VMAT) were included in this study. All patients showed at least a 5 mm variation (swelling or shrinkage) of the breast on the CBCT compared to the planning-CT (pCT) and had a repeat-CT (rCT) for dose evaluation acquired within 3 days of this CBCT. The original CBCT was corrected using four methods: (1) HU-override correction (CBCTHU), (2) analytical correction and conversion (CBCTCC), (3) deep learning (DL) correction (CTDL) and (4) virtual correction (CTV). Image quality evaluation consisted of calculating the mean absolute error (MAE) and mean error (ME) within the whole breast clinical target volume (CTV) and the field of view of the CBCT minus 2 cm (CBCT-ROI) with respect to the rCT. The dose was calculated on all image sets using the clinical treatment plan for dose and gamma passing rate analysis.ResultsThe MAE of the CBCT-ROI was below 66 HU for all corrected CBCTs, except for the CBCTHU with a MAE of 142 HU. No significant dose differences were observed in the CTV regions in the CBCTCC, CTDL and CTv. Only the CBCTHU deviated significantly (p < 0.01) resulting in 1.7% (± 1.1%) average dose deviation. Gamma passing rates were > 95% for 2%/2 mm for all corrected CBCTs.ConclusionThe analytical correction and conversion, deep learning correction and virtual correction methods can be applied for an accurate CBCT correction that can be used for dose evaluation during the course of photon radiotherapy of breast cancer patients.

Progressive Transformation of Germinal Centers Simulating Malignant Axillary Lymphadenopathy in a Breast Cancer Patient on FDG PET/CT.

A 64-year-old woman with breast cancer underwent FDG PET/CT for follow-up. The study revealed highly increased FDG uptake in newly diagnosed enlarged axillary lymph nodes, which were worrisome for malignancy. Histopathology revealed a rarely diagnosed benign disease of progressive transformation of germinal centers mimicking malignant lymphadenopathy. As imaging findings of this entity, which usually involves the axillary and cervical areas, have been reported in very few studies, nuclear medicine physicians should be familiar with this potential "false-positive" FDG uptake representing an interpretative pitfall, especially during evaluation of breast cancer patients.

Diagnostic Accuracy of Contrast-Enhanced, Spectral Mammography (CESM) and 3T Magnetic Resonance Compared to Full-Field Digital Mammography plus Ultrasound in Breast Lesions: Results of a (Pilot) Open-Label, Single-Centre Prospective Study.

Simple SummaryThe characterization of breast lesions by magnetic resonance imaging (MRI) is influenced by a high rate of false positives. Contrast-enhanced spectral mammography (CESM) is a promising modality that seems to compensate for the high costs, times and main limitations of MRI. The aim of our prospective study was to evaluate the diagnostic accuracy of CESM in comparison to 3T MRI imaging in the characterization of breast lesions. We enrolled 118 patients and histologically assessed 142 breast lesions. Patients underwent full-field digital mammography (FFDM), ultrasound (US), with CESM and MRI assessing the diagnostic accuracy of CESM. Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were considered as measures of accuracy of different diagnostic procedures in predicting the nature and characteristics of the examined breast lesions.Introduction: To assess the diagnostic accuracy of CESM and 3T MRI compared to full-field digital mammography (FFDM), plus US, in the evaluation of advanced breast lesions. Materials and Methods: Consenting women with suspicious findings underwent FFDM, US, CESM and 3T MRI. Breast lesions were histologically assessed, with histology being the gold standard. Two experienced breast radiologists, blinded to cancer status, read the images. Diagnostic accuracy of (1) CESM as an adjunct to FFDM and US, and (2) 3T MRI as an adjunct to CESM compared to FFDM and US, was assessed. Measures of accuracy were sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Results: There were 118 patients included along with 142 histologically characterized lesions. K agreement values were 0.69, 0.68, 0.63 and 0.56 for concordance between the gold standard and FFDM, FFDM + US, CESM and MRI, respectively (p < 0.001, for all). K concordance for CESM was 0.81 with FFDM + US and 0.73 with MRI (p value < 0.001 for all). Conclusions: CESM may represent a valuable alternative and/or an integrating technique to MRI in the evaluation of breast cancer patients.

A narrative review of research progress on FoxM1 in breast cancer carcinogenesis and therapeutics.

ObjectiveThe purpose of this review is to clarify the potential roles of forkhead box transcription factor M1 (FoxM1) in the occurrence and progression of breast cancer, as well as the predictive value of FoxM1 as a prognostic biomarker and potential therapeutic target for breast cancer.BackgroundBreast cancer, well-known as a molecularly heterogeneous cancer, is still one of the most frequently diagnosed malignant tumors among females worldwide. Tumor recurrence and metastasis are the central causes of high mortality in breast cancer patients. Many factors contribute to the occurrence and progression of breast cancer, including FoxM1. FoxM1, widely regarded as a classic proliferation-related transcription factor, plays pivotal roles in the occurrence, proliferation, invasion, migration, drug resistance, and epithelial-mesenchymal transition (EMT) processes of multiple human tumors including breast cancer.MethodsThe PubMed database was searched for articles published in English from February 2008 to May 2021 using related keywords such as “forkhead box transcription factor M1”, “human breast cancer”, “FoxM1”, and “human tumor”. About 90 research papers and reports written in English were identified, most of which were published after 2015. These papers mainly concentrated on the functions of FoxM1 in the occurrence, development, drug resistance, and treatment of human breast cancer.ConclusionsConsidering that the abnormal expression of FoxM1 plays a significant role in the proliferation, invasion, metastasis, and chemotherapy drug resistance of breast cancer, and its overexpression is closely correlated with the unfavorable clinicopathological characteristics of breast tumor patients, it is considerably important to comprehend the regulatory mechanism of FoxM1 in breast cancer. This will provide strong evidence for FoxM1 as a potential biomarker for the targeted treatment and prognostic evaluation of breast cancer patients.

Axillary Ultrasound Evaluation in Breast Cancer Patients: A Multidisciplinary Viewpoint and Middle Ground.

Over the past decade, there has been a trend toward de-escalation of axillary surgery. Certain patients may now forego axillary lymph node dissection even in the setting of a positive sentinel lymph node biopsy (SLNB), and some patients may not even undergo a SLNB. However, there is wide variability in the imaging approach to assessing axillary lymph nodes in patients with breast cancer. Approaches range from performing axillary US in all patients with newly diagnosed breast cancer to omitting axillary imaging evaluation in all patients. This article provides a multidisciplinary middle ground approach for axillary nodal evaluation. The clinical impact and rationale for appropriate axillary nodal imaging are discussed and an imaging algorithm is proposed.

Multicenter evaluation of breast cancer patients' satisfaction and experience with oncology telemedicine visits during the COVID-19 pandemic.

sIntroductionDuring the COVID-19 pandemic, teleconsultation was implemented in clinical practice to limit patient exposure to COVID-19 while monitoring their treatment and follow-up. We sought to examine the satisfaction of patients with breast cancer (BC) who underwent teleconsultations during this period.MethodsEighteen centres in France and Italy invited patients with BC who had at least one teleconsultation during the first wave of the COVID-19 pandemic to participate in a web-based survey that evaluated their satisfaction (EORTC OUT-PATSAT 35 and Telemedicine Satisfaction Questionnaire [TSQ] scores) with teleconsultation.ResultsAmong the 1299 participants eligible for this analysis, 53% of participants were undergoing standard post-treatment follow-up while 22 and 17% were currently receiving active anticancer therapy for metastatic and localised cancers, respectively. The mean satisfaction scores were 77.4 and 73.3 for the EORTC OUT-PATSAT 35 and TSQ scores, respectively. In all, 52.6% of participants had low/no anxiety. Multivariable analysis showed that the EORTC OUT-PATSAT 35 score correlated to age, anxiety score and teleconsultation modality. The TSQ score correlated to disease status and anxiety score.ConclusionPatients with BC were satisfied with oncology teleconsultations during the COVID-19 pandemic. Teleconsultation may be an acceptable alternative follow-up modality in specific circumstances.

Lineage-specific mechanisms and drivers of breast cancer chemoresistance revealed by 3D biomimetic culture.

To improve the success rate of current preclinical drug trials, there is a growing need for more complex and relevant models that can help predict clinical resistance to anticancer agents. Here, we present a three‐dimensional (3D) technology, based on biomimetic collagen scaffolds, that enables the modeling of the tumor hypoxic state and the prediction of in vivo chemotherapy responses in terms of efficacy, molecular alterations, and emergence of resistance mechanisms. The human breast cancer cell lines MDA‐MB‐231 (triple negative) and MCF‐7 (luminal A) were treated with scaling doses of doxorubicin in monolayer cultures, 3D collagen scaffolds, or orthotopically transplanted murine models. Lineage‐specific resistance mechanisms were revealed by the 3D tumor model. Reduced drug uptake, increased drug efflux, and drug lysosomal confinement were observed in triple‐negative MDA‐MB‐231 cells. In luminal A MCF‐7 cells, the selection of a drug‐resistant subline from parental cells with deregulation of p53 pathways occurred. These cells were demonstrated to be insensitive to DNA damage. Transcriptome analysis was carried out to identify differentially expressed genes (DEGs) in treated cells. DEG evaluation in breast cancer patients demonstrated their potential role as predictive biomarkers. High expression of the transporter associated with antigen processing 1 (TAP1) and the tumor protein p53‐inducible protein 3 (TP53I3) was associated with shorter relapse in patients affected by ER+ breast tumor. Likewise, the same clinical outcome was associated with high expression of the lysosomal‐associated membrane protein 1 LAMP1 in triple‐negative breast cancer. Hypoxia inhibition by resveratrol treatment was found to partially re‐sensitize cells to doxorubicin treatment. Our model might improve preclinical in vitro analysis for the translation of anticancer compounds as it provides: (a) more accurate data on drug efficacy and (b) enhanced understanding of resistance mechanisms and molecular drivers.

Outcomes of large panel genetic evaluation of breast cancer patients in a community-based cancer institute

IntroductionThe use of restricted versus expanded panel genetic testing in breast cancer is controversial, with some institutions offering predominantly abbreviated gene panel testing. Our community program has offered larger panel testing for several years. We sought to evaluate the outcomes of large panel genetic testing and understand their impact on patient care. MethodsA retrospective review of our multi-institutional tumor registry was performed from 2015 to 2018 for patients undergoing surgery for breast cancer. Referral to genetic counseling and outcomes of panel testing were examined. Results2237 patients met study criteria. Median age was 63 years (range 22–99). Eight hundred and thirty-eight patients (37.4%) were referred for genetic counseling. Of these patients, 509 (60.7%) had negative results, 108 (12.8%) had deleterious mutations (37 not included in abbreviated panels), and 221 (26.3%) had variants of undetermined significance (VUS). Bilateral mastectomy rates for patients with deleterious mutations were 53.7%, versus 31% for negative and 32.6% for VUS. DiscussionLarge panel testing finds a significant number of actionable mutations. The increased identification of VUS did not result in higher mastectomy rates.

1710P International multicentric evaluation of breast cancer patients’ satisfaction and experience with oncology telemedicine visits (TV) during the COVID-19 outbreak

The COVID-19 pandemic has dramatically changed the Health Care System organization in many European countries. Many Oncology departments have rapidly implemented telehealth in their clinical practice. For breast cancer (BC) patients (pts), up to 80% of all in-person visits have been transformed in TV.

Evaluation of the Preoperative Perception of Quality of Life and Satisfaction of Women With Breast Cancer Using the BREAST-Q™ Questionnaire

IntroductionAlmost 40% of women who undergo breast surgery are dissatisfied with the decision-making process as well as cosmetic results. Our objective was to demonstrate the usefulness of the BREAST-Q™ preoperative questionnaire to evaluate the satisfaction and health-related quality of life in women with diagnosis of breast cancer prior to surgery, as well as identifying satisfaction profiles. MethodsProspective cohort observational study in women with breast cancer, evaluating preoperative quality of life using the BREAST-Q™ questionnaire. Percentile measures for each domain and baseline physical characteristics were assessed for posterior analysis. ResultsThe average score in the breast satisfaction domain was 58.9±16.9. The average score in the preoperative psychosocial well-being domain was 70.5±16.1. Patients who were offered conservative surgery had a mean physical well-being score of 80.7±18.5, and those who were offered mastectomy had an average score of 79.9±17.7. The sexual well-being average score was 63.2±20.7. No statistically significant differences were found between low-score and high-score groups regarding epidemiological and clinical characteristics. ConclusionsPreoperative evaluation in breast cancer patients provides correct assessment of the effect of surgical treatment on patient satisfaction and quality of life. This information is useful for communicating with patients about their expectations and postoperative results.

Pre and post chemotherapy evaluation of breast cancer patients: Biochemical approach of serum selenium and antioxidant enzymes.

Background:Chemotherapy for treatment of breast cancer uses some drugs to target and destroy the cancer cells. However, most of antineoplastic treatments are non-specific and the innate cells will be damaged. In this study, the effect of adriamycin/cytoxan (AC) chemotherapy on the status of antioxidant enzymes and Se levels in breast cancer patients was evaluated.Methods:A prospective study, includes 50 breast cancer patients treated with AC chemotherapy (adriamycin 60 mg/m2, cytoxan 600 mg/m2) from July 2016 until March 2017. First sampling was obtained before chemotherapy and the second, after 3 cycles of the intervention. Antioxidant enzyme activities (catalase, glutathione peroxidase, glutathione reductase and superoxide dismutase) and selenium (Se) levels in serum were measured by spectrophotometry and atomic absorption methods, respectively. Age, BMI, familial history, stage and grade of cancer, tumor site, type of surgery, estrogen, progesterone and HER2 receptors, were recorded from each patient. Paired-t test was employed for comparing the data before and after chemotherapy. Age and disease stages were compared by independent t-test.Results:After 3 courses of chemotherapy, a significant decrease was observed in antioxidant enzymes and also Se (p<0.001). These studied indices were not significant in different age groups (≤48, >48) and stages of disease (early, advanced).Conclusion:Our findings show that the AC chemotherapy in the breast cancer patients result in drastic changes in oxidant/antioxidant system of the body, especially reduction of Se levels and antioxidant enzymes activities. However, it seems that these changes are not necessarily dependent on the age and disease stage.