Breast Research Articles

Exposure to ambient polycyclic aromatic hydrocarbons and early-onset female breast cancer in a case-control study in Ontario, Canada.

Ambient polycyclic aromatic hydrocarbons (PAHs) are a class of toxicologically important and understudied air pollutants. Epidemiologic evidence suggests that chronic exposure to PAHs increases breast cancer risk; however, there are few studies in nonoccupational settings that focus on early-onset diagnoses. The relationship between residentially-based ambient PAH concentrations and female breast cancer, among those 18-45 years of age, was characterized in the Ontario Environment and Health Study (OEHS). The OEHS was a population-based case-control study undertaken in Ontario, Canada between 2013 and 2015. Primary incident breast cancers were identified within 3 months of diagnosis, and a population-based series of controls were recruited. Concentrations of ambient PAHs, using fluoranthene as a surrogate, were derived using a chemical transport model at a 2.5 km spatial resolution. These estimates were assigned to participants' residences at the time of the interview and 5 years prior. Logistic regression was used to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) based on a quartile categorization of fluoranthene exposure while adjusting for a series of individual- and area-level risk factors. The shape of the exposure-response trend was evaluated using cubic splines. Median fluoranthene exposure for cases and controls was 0.0017 µg/m3 and 0.0014 µg/m3, respectively. In models adjusted for a parsimonious set of risk factors, the highest quartile of exposure was associated with an increased risk of breast cancer (OR = 2.16; 95% CI = 1.22, 3.84). Restricted spline analyses revealed nonlinear dose-response patterns. These findings support the hypothesis that ambient PAH exposures increases the risk of early-onset breast cancer.

5α-reductase inhibitor exposure for dermatologic conditions does not increase the risk of female breast or gynecologic cancers: A population-based propensity score-matched cohort study

5α-reductase inhibitor exposure for dermatologic conditions does not increase the risk of female breast or gynecologic cancers: A population-based propensity score-matched cohort study

A study of the prevalence of PGR gene expression with ER and PR Receptor markers positivity in female breast cancer cases in Al-Najaf province, Iraq

A study of the prevalence of PGR gene expression with ER and PR Receptor markers positivity in female breast cancer cases in Al-Najaf province, Iraq

Development of a Nomogram-Integrated Model Incorporating Intra-tumoral and Peri-tumoral Ultrasound Radiomics Alongside Clinical Parameters for the Prediction of Histological Grading in Invasive Breast Cancer

To develop a comprehensive nomogram to predict the histological grading of breast cancer and further examine its clinical significance by integrating both intra-tumoral and peri-tumoral ultrasound radiomics features. In a retrospective study 468 female breast cancer patients were analyzed from 2017 to 2020 at the Second Affiliated Hospital of Harbin Medical University. Patients were grouped into high-grade (n = 215) and low-grade (n = 253) categories based on pathological evaluation. Tumor regions of interest were defined and expanded automatically to peri-tumor regions of interest. Ultrasound radiomics features were extracted independently. To ensure rigor, cases were randomly divided into 80% training and 20% test sets. Optimal features were selected using statistical and machine learning methods. Intra-tumor, peri-tumor, and combined radiomics models were constructed. To determine the best predictors of breast cancer histological grading, we screened the features using single- and multi-factor logistic regression analyses. Finally, a nomogram was developed and evaluated for its predictive value in this context. By applying logistic regression, we integrated ultrasound, clinicopathologic, and radiomics features to generate a nomogram. The combined model outperformed others, achieving areas under the curve of 0.934 and 0.812 in training and test sets. Calibration curves also showed high accuracy and reliability. A nomogram constructed through the integration of combined intra-tumor-peri-tumor ultrasound radiomics features along with clinicopathologic characteristics exhibited remarkable performance in distinguishing the histologic grades of invasive breast cancer.

Estimation of Radiation Equivalent Dose and Lifetime Attributable Risk from Pediatric CAP CT Examination

Aim: This study aims to estimate equivalent doses (EqDs) and life attributable risks (LARs) for pediatric patients who underwent chest–abdominal–pelvic (CAP) CT examinations in Madinah, Saudi Arabia. Methodology: This retrospective study collected data from 120 pediatric patients who underwent CAP CT examinations. The data were categorized by the age and gender of the pediatric patients. Then, the EqDs were computed using the NCICT (National Cancer Institute dosimetry system for computed tomography) program, and LARs were estimated from the equivalent dose (EqD) results using age- and gender-specific cancer risk models found in the Committee on the Biological Effects of Ionizing Radiation (BEIR) VII Phase 2 (2006). Results: The EqD range was 0.9 to 7.55 mSv for the prostate and colon (males and females), respectively. LARs for female breast and lung cancers were considered to have the highest values among the age groups. Nevertheless, LARs of the colon, liver, and leukemia cancers were higher for males than females. The LAR range of cancer incidence was 0.6 to 63.1 per 100,000 cases for prostate (aged 10–≤15 years) and breast (females aged 1≤–<5 years), respectively. The LAR range of cancer mortality was 0.1 to 41.9 per 100,000 cases for prostate (aged 10–≤15 years) and lung (females aged 1≤–<5 years). Conclusions: LARs of all cancer incidence and mortality from CAP CT examination were higher for pediatric females than males (with an average of 54%). This highlights the importance of considering pediatric patient gender and implementing optimization and protective measures in CAP CT examinations. LARs of breast and lung (for females) and colon (for males) cancers were found to have the highest values among the age groups. However, LARs of cancer incidence and mortality for colon, liver, and leukemia for males were higher than those for females.

Predictors of receiving work accommodations among employed breast cancer survivors with adult and child dependents at home.

211 Background: Many cancer survivors experience challenges returning to work, yet there is limited knowledge about factors that influence receiving accommodations in their jobs (e.g., flexible work hours and reduced workloads), which could affect the ability to maintain employment In the current study, we analyze if having adult and/or child dependents at home is associated with receiving accommodations and if this association is modified by occupational factors (e.g., having taken a work leave, job tenure). Methods: We analyzed self-reported, cross-sectional survey data from the PinkWorks Study consisting of 150 female breast cancer survivors. Participants were ≥18 years of age, fluent in English, had completed treatment within the past 36 months, and were working ≥ 20 hours per week both at the time of their cancer diagnosis and currently. Univariate and multiple Logistic Regressions were performed to identify job, personal, and demographic correlates with receipt of work accommodations (yes=67, no=87). Structural Equation Modelling will be performed to identify direct and indirect effects with the outcome. Results: About half of the participants were granted work accommodations. In multivariate logistic regression, we observed suggestive evidence that receiving accommodations was associated with having adult dependents at home compared to those without dependents and, identifying as Caucasian compared to non-Caucasian (aOR=1.69 CI 0.76-3.72, p=0.20; aOR=3.12 CI 0.91-10.87, p=0.07; respectively). In stratified analyses by having taken a leave from work or not, the association with adult dependents at home and receipt of work accommodations reached statistical significance among those who worked continuously (aOR=4.85, CI 1.15-20.44, p=0.03). However, for those who had taken a leave, job tenure of ≥5 years was associated with receipt of accommodations compared to those with <5 years of employment at their current job (aOR = 9.68, CI 2.00-46.91, p=0.005). The suggestive finding of a disparity by race in the full sample was maintained in both strata. Conclusions: We observed that receipt of work accommodations varied whether or not a leave of absence was taken. Additional analyses will be presented regarding other potential work-related influences on receipt of accommodations such as employer size, job type (i.e., clerical vs managerial). Familiarity of physicians with potential needs for workplace accommodations can help survivors maintain employment and subsequent quality of life. Interpretation of findings from these analyses is limited by the cross-sectional design and small sample sizes in this exploratory study.

Beyond breast cancer: An exploration of the experiences of middle-aged female breast cancer survivors in Australia

ObjectivesMiddle-aged women (i.e., aged 40–65 years) who live with, through and beyond breast cancer (survivors) are an under-researched population, particularly within an Australian context. The unmet needs reported within this population include fatigue, psychological distress, body image concerns, early-onset menopause, and a lack of information on these issues. This study explores how the experiences of breast cancer survivorship impact the lives of Australian middle-aged women. Study designQualitative analysis of written comments in an open text field of a survey completed by 644 women reporting breast cancer in the middle-aged cohort of the Australian Longitudinal Study of Women's Health gathered between 1996 and 2013. Data was collected from any participants who reported breast cancer in any survey. Researchers conducted a thematic analysis using consensus coding on data and identified key themes. Main outcome measuresAny data where participants described their experiences of breast cancer survivorship. ResultsThis cohort reported a unique experience of breast cancer survivorship due to their age group. Analysis developed the following themes: the middle-aged context of breast cancer; care and support, body changes, overcoming fears and maintaining balance; and finding a ‘new normal’. ConclusionsBreast cancer survivorship is a diverse experience. For many it involves chronic limitations and challenges. Investigation and application of survivorship care plans in Australia could benefit breast cancer survivors by including multidisciplinary health professionals in their care. Unmet needs and psychological distress were described by participants rather than biomedical concerns. Further recommendations include development of online support groups providing access to rehabilitation professionals, especially for otherwise isolated rural women.

The effect of female breast surface area on skin stiffness and tactile sensitivity at rest and following exercise in the heat.

Female development includes significant morphological changes across the breast. Yet, whether differences in breast surface area (BrSA) modify breast skin stiffness and tactile sensitivity at rest and after exercise in the heat remain unclear. We investigated the relationship between BrSA and skin stiffness and tactile sensitivity in 20 young to middle-aged women (27±8years of age) of varying breast sizes (BrSA range: 147-502cm2) at rest and after a submaximal run in a warm climatic chamber (32 ± 53%±1.7% relative humidity). Skin stiffness above and below the nipple and tactile sensitivity from the nipple down were measured. Associations between BrSA and both skin stiffness and tactile sensitivity at rest were determined via correlation analyses. Effects of exercise and test site were assessed by a two-way ANOVA. Skin stiffness was positively correlated with BrSA 3cm above the areola edge (r=0.61, P=0.005) and at the superior areola border (r=0.54, P=0.016), but not below the nipple (P>0.05). The area 3cm below the areola was also significantly stiffer than all other test sites (P<0.043). Tactile sensitivity did not vary with BrSA (P>0.09), but it varied across the breast (i.e., the area 3cm below the areola was more sensitive than the inferior areola edge; P=0.018). Skin stiffness and tactile sensitivity across the breast decreased after exercise by ∼37% (P<0.001) and ∼45% (P=0.008), respectively. These findings expand our fundamental understanding of the mechanosensory properties of the female breast, and they could help to inform sportswear innovation to better meet the support needs of women of different breast sizes at rest and following exercise.

Influence of Obesity and Sociodemographic Features on the Physical Fitness of Breast Cancer Survivors.

Obesity is a chronic, relapsing, and progressive disease. The issue of obesity affects 50 to 80% of patients who have been diagnosed with breast cancer. The aim of this study is to assess the scale of the problem of obesity among breast cancer survivors (BCS) older than 60 years, evaluate their physical fitness, and study the relationship between the occurrence of obesity and levels of fitness among breast cancer survivors. The relationship between fitness and sociodemographic factors has also been analyzed. This original epidemiological clinical study included a cohort of 88 female breast cancer survivors treated in 2022 in Holycross Cancer Center, Kielce, Poland. A questionnaire involving demographic information and medical data was utilized. The Senior Fitness Test (SFT) battery has been used to assess the physical fitness of the patients. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were also analyzed. More than 70% of the studied breast cancer survivors were classified as overweight or obese, according to BMI and WC indices. Depending on the SFT trial, the regression coefficients indicated worse results in participants who were older, lived in urban areas, were professionally active, less educated, and had higher obesity indices. The analysis of the relationship between obesity indices and fitness components revealed that all obesity indices were significantly associated with lower body flexibility (BMI p = 0.0118, WC p = 0.0092, WHR p = 0.0364, WHtR p = 0.0095). Upper body flexibility was significantly correlated with BMI indices (p = 0.0091, p = 0.0193) and WHtR (p = 0.0095). Agility and balance were significantly associated with WC (p = 0.0193), WHR (p = 0.098), and WHtR (p = 0.0095). Lower body strength was significantly correlated with the WHR index (p = 0.0487). Significant differences were found in upper body strength depending on the WHtR category. In the studied group of breast cancer survivors, there is a high prevalence of overweight and obesity. With increasing obesity rates, older age, and lower education levels, physical activity measured by the SFT decreases. Living in urban areas and being professionally active also predispose to lower physical activity levels. As obesity indices increase, physical fitness decreases in trials assessing upper and lower body strength, upper and lower body flexibility, as well as agility and dynamic balance.

Near-field metasurface sensor for an early-stage breast cancer detection

In this paper, a novel and highly sensitive metasurface sensor for microwave breast tumor detection is proposed. The proposed sensor array comprises 8 × 8 small-size sensor elements that are capable of reacting to changes in both electric and magnetic fields. This allows the sensor to detect even minor variations in the surrounding medium, resulting in improved sensitivity. Additionally, designing a sensor array improves sensitivity by covering all areas of the breast tissues with multiple small sensor elements. Numerical studies have been conducted to assess the sensor sensitivity using realistic healthy and non-healthy breast models with diagnosed tumors placed at different locations within healthy breast models in the CST simulation environment at varying stand-off distances. An experiment was conducted to validate the sensor’s concept. It involved testing a metasurface sensor with phantoms resembling both healthy female breast tissues and those with a 10 mm tumor. The results from simulations and experiments demonstrate that the metasurface sensor is capable of detecting breast tumors at different distances. For safety compliance, specific absorption rate (SAR) values were obtained through both simulation and experimentation. The simulated SAR values were calculated to be 0.357 W/kg and 0.216 W/kg at 1 g and 10 g, respectively, using 17 dBm for safety. The measured SAR values were 0.101 W/kg and 0.1 W/kg at 1 g and 10 g, respectively.

Mucormycotic late seroma after Poland syndrome correction with implant-enhanced latissimus dorsi flap – A case report

Introduction. Breast malformation correction with implants is a com-mon procedure, and a potential complication is the development of a late seroma, defined as occurring more than one year post-implan-tation. Etiologies include infectious, auto-inflammatory, and neoplastic factors. This case report presents an unusual case of seroma due to mycosis emerging 15 years after amastia correction using a latissimus dorsi flap (LD) and implants. Materials and methods. In 2006, a 44-year-old patient underwent amastia correction with an LD flap and implants in Ecuador. She pre-sented with sudden breast volume increase, tension, and pain in the left breast. Urgent intervention involved implant removal, collection evacuation, and total capsulectomy. Cytological/histological analysis ruled out neoplasia, while microbiological examination identified Muco-rales as the cause. After an uneventful postoperative period, a definitive breast prosthesis was implanted two years later, following ultrasound evaluation and inflammation indices. Discussion. Mucorales are opportunistic pathogens, particularly in im-munocompromised or uncontrolled diabetes patients, causing infections in sinuses, brain, and lungs. Mucormycosis linked to breast implants in immunocompetent individuals is rare and poorly defined in literature. Conclusions. Late seroma onset post-breast implants is rare, and a prompt differential diagnosis is crucial due to potential malignancies like BIA-ALCL. Mucormycosis, a potentially lethal condition, requires medical and sometimes surgical intervention. The incidental discovery of Mucorales infection facilitated complete eradication of the patholo-gy, resulting in full recovery.

The regional cancer spectrum in Uganda: a population-based cancer survey by sub-regions (2017-2020).

Accurate estimation of the burden of cancer in developing countries is a major public health concern for cancer prevention and control because of the limited coverage of population-based cancer registries (PBCRs). The cancer registration coverage status of Uganda was 11.90% and was not uniformly distributed in all regions of Uganda. This population-based survey was conducted to assess the burden of cancer in all the sub-regions of Uganda by site, sex and age group to accurately determine the cancer profile of Uganda by sub-region for a tailored intervention to mitigate cancer risk factors and burden. This study used existing administrative units of Uganda from which 55 districts emerged, forming 10 sub-regions as satellite population-based cancer registry study sites. Data on newly diagnosed cancer cases were retrospectively collected for the period 2017-2020 using a cancer notification form, entered into CanReg5 Software, exported to spreadsheets and univariate analysis was performed to determine the cancer spectrum, their proportions and crude rates by site, sex, age group and geographical location. A total of 25,576 cancer cases were registered, up to 14,322 (56%) were in females and, male cancers were 11,254 (44%). The top five female cancers in all the sub-regions included cervical cancer (43%, n = 6,190), breast (22%, n = 3,200), esophagus (5.6%, n = 800), ovary (5.2%, n = 746), Kaposi Sarcoma (KS) (4.7%, n = 666) and other less common cancers (18.5%, n = 2,720). In males, the top five cancers included prostate cancer 25.1 % (n = 2,820), esophagus 15.1% (n = 1,704), KS 12.4% (n = 1,395), liver 8.8% (n = 989) and stomach 4.8% (n = 539), with other less common male cancers accounting for 33.8% (n = 3,807).In all the sub-regions of Uganda, cancers of the esophagus, liver and KS are common in both males and females, but the number of males with these cancers is twice that of their female counterparts. In Rwenzori, Kigezi and Bugishu sub-Regions, there seems to be an increased risk of developing other skin cancers in females, while stomach cancers have been reported in both males and females. Most of the other sub-regions register emerging cases of only ovarian cancer in females. In children, the top three cancers included lymphoma, 33.9% (n = 653); soft tissue sarcomas, 20.8% (n = 400); malignant bone tumors, 15.8% (n = 305); myeloid-type leukemia, 13.8% (n = 265); and the other less common childhood cancers combined, 15.7% (n = 303). The proportion of childhood cancers is higher in the male child compared to the female at a ratio of 1.3:1. The sub-regional cancer spectrum in Uganda ranges from cervical cancer to breast, esophageal, ovarian and KS in females. Male cancers include prostate, esophageal, KS, liver and stomach cancers. Although the cancer profile is similar in most sub-regions of Uganda, except Ankole subregions with mountainous topography (Rwenzori, Kigezi, Bugisu), there has been significant variation in cancer profile, especially for males, where Non-Hodgkins Lymphomas is one of the cancers reported for Uganda by PBCRs in Gulu, and Kampala has been replaced by stomach cancers as one of the common male cancers in the sub-regions. These findings emphasize the need for the establishment and support of additional regional PBCRs and periodic population-based cancer surveys to accurately determine the burden of cancer, inform the establishment of regional cancer centers and guide national and sub-national cancer control programs in Uganda. Cancer surveillance systems using PBCRs should be part of the national cancer control program. Periodic population-based cancer surveys should also be conducted as part of Uganda's demographic and health surveys in areas without PBCRs to inform the country comprehensively and accurately on the cancer burden to design robust cancer mitigation measures.

Is LVH a must in an amyloid heart?

Abstract Background Transthyretin amyloidosis (ATTR), an infiltrative cardiomyopathy, is characterized by the infiltration of transthyretin-derived amyloid fibrils into the cardiac extracellular space, which causes morphological and functional heart damage. Because of the vast range of symptoms that can accompany ATTR cardiac amyloidosis, the illness remains unknown. However, misdiagnosis or delayed diagnosis due to inconsistencies between clinical findings and the severity of the underlying disease hampers treatment methods. Aim and objectives This article investigates the intricate relationship between ATTR amyloidosis pathogenesis and clinical signs to understand better the challenges and advancements in early discovery, treatment, and prognosis of this concealed sickness. Methods &amp; Results Between November 2022 and April 2024, we conducted a prospective analysis on a cohort of 71 patients diagnosed with ATTR cardiac amyloidosis utilizing PYP imaging at our institution (Al Hada Armed Force Hospital, Taif, Saudi Arabia). The Medical Ethics Review Committee of the hospital accepted this project (2023-720). During our study, we faced two cases without LVH and both cases have grade II-III cardiac uptake. 1st case A 66-year-old male patient who is a known case of ischemic cardiomyopathy with EF 35% since 2018, he underwent PCI in 2018. The patient is following the cardio clinic since 2018 and on every visit he was asymptomatic, The Patient in 2021 experienced new shortness of breath within six minutes’ walk distance less than 400 meters. The patient experienced erectile dysfunction and underwent intervention for his carpal tunnel syndrome. ECG showed old Q in anterior leads. Echo showed the same EF 35% and old wall motion abnormalities. Diagnostic coronary angiography showed patent stents and no residual ischemia. When we revised his old echo study that was done in 2017, we found EF 55%, concentric LVH. PYP bone scintigraphy was decided and showed grade II-III cardiac uptake. 2nd case A 53-year-old hypothyroid female patient and she has metastatic left breast cancer. During her workup bone scan, grade III cardiac uptake was accidentally discovered using an HMDP isotope. The patient was referred to the cardio clinic where the patient denied any cardiac or non-cardiac symptoms. All her labs, ECG and Echo were within normal range. CMR showed diffuse subendocardial LGE suggestive of infiltrative disease. Conclusion Based on unique pathological features of CA that would present as morphological LVH with /without ECG evidence of LVH. We hypothesized that LVH would occur in the later stages of the disease or may be decreased due to other pathology as coronary artery disease. Clinical suspicion remains the cornerstone for early diagnosis and workup.

Dosimetric analysis of LAD dose in left-sided breast cancer radiotherapy with deep inspiratory breath hold

Objectives To analyze the dose to the left anterior descending artery (LAD) in patients who have received radiotherapy for left breast cancer with Deep Inspiratory Breath Hold (DIBH) technique and compare it with other cardiac dosimetric parameters, as well as the accepted dose constraints. Materials and Methods 20 patients (10 prospective and 10 retrospective) were selected for this study. All patients underwent 2 non-contrast radiation planning CT scans of 2.5 mm thickness - one with DIBH and one with free breathing. Contouring was done using the Radiation Therapy Oncology Group (RTOG) guidelines. LAD was delineated and given a PRV of 3 mm and 5 mm. Dose-volume histograms (DVH) were used to obtain the data from the approved plans. Results The lung volume receiving 17 Gy in percentage, Dmean of the heart, LAD Dmean and Dmax, and the Dmean and Dmax received by 3 mm and 5 mm PRVs were both very well achieved when compared to the dose constraints given by the DBCG HYPO trial. The study found a higher correlation between the mean heart dose and the 5 mm PRV dose (R2 = 0.81 and 0.71 respectively for the mean and max dose) than the 3 mm PRV, and a positive correlation between the heart dose and LAD making it a useful structure for predicting acute cardiac events. Conclusion The study of 20 patients found that DIBH is effective to minimize cardiac dose and potentially cardiac toxicity, with heart and LAD doses being comparable or lower compared to other studies. The LAD doses recorded were significantly less than those in non-DIBH studies, demonstrating the feasibility of routine contouring and recording LAD dose in left-sided breast radiation patients. Further research is needed to determine the dosimetry and clinical consequences of the Dmean and Dmax of the 5mm PRV to the LAD.

Neoadjuvant Immunotherapy and De-Escalation of Surgery in Locally Advanced Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T cell lymphoma diagnosed in patients with a history of breast implants. Most patients develop a periprosthetic effusion at early stages of disease while less common presentations include a palpable mass, severe capsular contracture, lymphadenopathy, or cutaneous erythema. Due to the complex nature of this disease, a multidisciplinary approach is necessary for optimal management, particularly in locally advanced disease or inoperable patients. We present the successful use of neoadjuvant therapeutic protocols in two cases of locally advanced BIA-ALCL. The first case, a 52-year-old patient with a left breast mass-like stage III disease who underwent combined targeted immunotherapy and chemotherapy (BV-CHP). Following a complete radiological and metabolic response, the patient underwent bilateral implant removal, right total intact capsulectomy, left en bloc capsulectomy and skin resection from the left inframammary fold in continuity with the capsule. The second case, a 65-year-old patient with a right breast swelling and mass-like stage IIA disease who received targeted immunotherapy, Brentuximab vedotin (BV). Following a complete metabolic response, she underwent bilateral implant removal and en bloc capsulectomy. A literature review and the reported cases suggest the effectiveness of targeted immunotherapy as monotherapy or in combination with chemotherapy in locally advanced BIA-ALCL in disease downstaging, surgical de-escalation, reduction of significant post-operative complications and an acceptable tolerance profile. Although surgery is an essential part of treatment, timing and type of intervention should be carefully planned, especially when primary, radical resection is uncertain.

Clinical and sociodemographic determinants of older breast cancer survivors’ reports of receiving advice about exercise

PurposeExercise offers various clinical benefits to older breast cancer survivors. However, studies report that healthcare providers may not regularly discuss exercise with their patients. We evaluated clinical and sociodemographic determinants of receiving advice about exercise from healthcare providers among older breast cancer survivors (aged ≥65 years).MethodsWe used data from the Surveillance, Epidemiology, and End Results cancer registries linked to the Medicare Health Outcomes Survey (MHOS) from 2008 to 2015. We included female breast cancer survivors, aged ≥65 years, who completed the MHOS survey ≥2 years after a breast cancer diagnosis in a modified Poisson regression to identify clinical and sociodemographic determinants of reportedly receiving advice about exercise from healthcare providers.ResultsThe sample included 1,836 breast cancer survivors. The median age of the sample was 76 years (range: 72–81). Overall, 10.7% of the survivors were non-Hispanic Black, 10.1% were Hispanic, and 69.3% were non-Hispanic White. Only 52.3% reported receiving advice about exercise from a healthcare provider. Higher body mass index (BMI) and comorbid medical history that included diabetes, cardiovascular, or musculoskeletal disease were each associated with a higher likelihood of receiving exercise advice. Lower education levels, lower BMI, and never having been married were each associated with a lower likelihood of receiving exercise advice.ConclusionsNearly half of breast cancer survivors aged ≥65 years did not report receiving exercise advice from a healthcare provider, suggesting interventions are needed to improve exercise counseling between providers and survivors, especially with women with lower educational attainment who have never been married.

Cosmetic implant placement in the female breast yields an altered local and systemic immune response: evidence for breast cancer immunosurveillance.

Women with cosmetic implants have lower rates of future breast cancer than the general population. We hypothesized the implant foreign body response could induce a local protective anti-cancer immunosurveillance. We expanded on our previous finding which showed women with breast implants have elevated antibody responses to certain breast cancer proteins. Blood samples and breast tissue were collected from women undergoing first time breast augmentation (implant-naive, IN) and revision breast augmentation (implant-exposed, IE). Sera were collected and antibody levels to common breast cancer proteins were quantified by enzyme-linked immunosorbent assay (ELISA). RT-PCR was performed on breast tissue samples to quantify immune-related gene expression levels between IN and IE. Bulk RNA sequencing was performed to identify differentially expressed genes and altered signaling pathways in the breasts of IN versus IE. In total, 188 patients were recruited (117 IN, 71 IE). Data demonstrated that IE patients had higher levels of antibodies to MUC-1, ER, and mammaglobin A compared to IN patients. MUC-1 expression was found to be higher in IE compared to IN breast tissue. RNA-seq analysis demonstrated upregulated pathways in IE breast tissue for B cell activation and development, Th2 related genes, T cell activation, chemotactic factors, and responses to estrogen. This is the first study to demonstrate that peri-implant inflammation extends beyond the implant capsule to breast parenchyma. Women with breast implants have more activated B cells in the breast parenchyma and elevated antibody responses to breast cancer antigen.

Effect of using bolus on the efficiency of the 3DCRT of the breast cancer after mastectomy.

To assess the effect of using bolus on the efficiency of three-dimensional conformation radiation treatment of breast cancer post-mastectomy. The prospective, clinical study was conducted at Al-Amal Center for Radiation Therapy and Nuclear Medicine, Iraq, from November 2020 to April 2021, and comprised patients with synchronous bilateral breast cancer with regional lymph nodes who underwent mastectomy. The three-diensional conformation radiation treatment technique was used to evaluate the dose received by the planning target volume and the organs at risk. The plans were generated using a treatment planning system, the plans were then fed into a linear accelerator. The plans had one isocenter for both breasts to avoid the errors that may cause the overlapping of the radiation fields with and without the use of bolus. Data was analysed using SPSS 24. There were 23 female patients with mean age 49.28±8.79 years (range: 35-62 years). There were 7(30.4%) females residing in rural areas, while 16(69.6%) lived in urban areas. The use of bolus increased the radiation dose coverage percentage of the planning target volume of the right (p=0.0002) and left (p=0.0164) breasts, while the right (p=0.3977) and left (p=0.7940) supraclavicular nodes were not significantly covered by the radiotherapy dose. The use of bolus showed a strong significant decrease of the mean dose that was received by the left lung (p=0.00001). Also, the use of bolus caused significant reduction in the amount of the mean scattered dose that reached the heart (p=0.00001) and larynx (p=0.00004). The use of bolus provided a complete radiotherapy dose coverage for the right and left breasts, as well as an excellent protection for the left lung, heart and larynx.

Does the Surgeon's Handedness Affect the Complications Rate in the Inframammary Approach Breast Augmentation?

Humans show a preference for left or right handedness in most cases. For this reason, surgeons might find it more difficult to operate on the "nondominant breast", i.e. the breast opposite to the surgeon´s dominant hand (left breast for right-handed surgeons and right breast for left-handed surgeons). The nondominant breast might therefore potentially be prone to a higher complication rate. Retrospective data of all consecutive patients who underwent breast augmentations by the first author over the past 15years was reviewed. In all cases, the entire operation was carried out with the surgeon standing on the right side of the table. All the complications of the right and left breasts were analyzed individually. 1707 patients with a minimum follow-up of sixmonths were reviewed. Mean breast implant volume was 305.6 cc and mean follow-up was 16.12months. A total of 151 complications were found (8.8%), including rotational deformity, capsular contracture, hematoma, seroma, bottoming out, high riding implant, double bubble deformity, implant rupture and infection. Of these complications, 77 (4.51%) affected the left breast, 48 (2.87%) were found on the right breast and 25 (1.46%) were bilateral. This difference was statistically significant. Surgeons´ handedness seem to have an impact on the rate of complications after breast augmentation. As a result of some sort of unease when operating on the nondominant breast, this side might be prone to less precision during the dissection and, consequently, to more complications. Our study found that the rate of complications was higher in the nondominant breast. 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 .

Global, reginal, national burden and risk factors in female breast cancer from 1990 to 2021

This study was to assess the burden, trends, and risk factors associated with female breast cancer from 1990 to 2021 based on the Global Burden of Disease (GBD) 2021 study. In 2021, there were 20.32 million prevalent cases, 2.08 million incident cases, 0.66 million death cases, and 20.26 million disability-adjusted life years (DALYs). It presented an ascending trend in the age-standardized rates of prevalence and incidence over the past 32 years. The age-standardized DALYs rate (ASDR) increased slightly during 2012-2021. The DALYs increase was primarily driven by population aging and growth. High red meat intake accounted for the highest proportion of ASDR. Breast cancer burden attributed to metabolic risks increased, especially in the regions with low social-development index (SDI) and limited health systems. Dietary, behavior, and metabolic risk factors should be controlled to diminish breast cancer burden, especially in countries with lower SDI.