Management Of Breast Cancer Patients Research Articles

The Impact of Non-pharmacologic Traditional Chinese Medicine on Health-Related Quality of Life and Symptom Management in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Background: Breast cancer remains a prevalent malignancy among women globally. Survivors often experience diminished quality of life, pain, and sleep disturbances after treatment and suffer feelings of isolation. Non-pharmacological traditional Chinese medicine (NP-TCM) interventions have been increasingly applied in clinical practice, yet their efficacy requires further clarification. Objective: This meta-analysis aimed to evaluate the impact of NP-TCM interventions (e.g. Qigong, Tai Chi, Baduanjin) on the health-related quality of life (HRQOL) in breast cancer patients. Methods: Randomized controlled trials published between 1999 and 2024 were retrieved from various databases. Studies comparing NP-TCM and control groups in quality of life and other outcomes were included. Meta-analysis was performed using RevMan 5.4 software. 14 RCTs with 688 patients were included. Results: NP-TCM interventions significantly improved overall quality of life (SMD=0.13, 95%CI 0.24~0.51, P<0.001). Specifically, Baduanjin demonstrated substantial benefits (SMD=0.82, P<0.001). NP-TCM also enhanced sleep (SMD=1.16, P=0.04) and alleviated anxiety (SMD=-0.46, P<0.05). Conclusion: NP-TCM interventions effectively improved the HRQOL and certain symptoms for breast cancer patients, providing practical adjunctive therapies. However, study qualities require optimization.

The patterns of presentation, management and outcomes of breast cancer patients at a tertiary health facility in Sierra Leone

BackgroundBreast cancer is the leading cause of cancer among women globally and the most common cancer among women in Sierra Leone. This study aimed to evaluate the patterns of clinical presentation, management and outcomes among breast cancer patients who presented at the Connaught Teaching Hospital Complex in Sierra Leone.MethodA retrospective, cross-sectional study was conducted at the specialist outpatient clinic at the Connaught Hospital. The medical records of 253 breast cancer patients were selected through convenience sampling on the basis of the completeness of their data from 2018 to 2021. The patients’ sociodemographics, obstetrics-gynecological history, clinicopathological characteristics, treatment modalities, and outcomes were analysed via SPSS version 24.ResultsAmong the 253 patients with breast cancer, 246 (97.2%) were female, and the mean age of the patients was 47 ± 14 years. The mean age at menarche was 12 ± 3 years, and 35 (13.8%) patients had a family history of breast cancer. The left breast of 130 (51.2%) patients was the most commonly affected; approximately 119 (47%) patients presented with stage III B disease, and 35 (13.8%) presented with metastasis. With respect to treatment modalities, surgery, chemotherapy, and hormonal therapy were provided to patients — with 120 (48%) mastectomies, 73 (29.2%) neoadjuvant chemotherapy, 84 (33.6%) adjuvant chemotherapy, 98 (39.2%) hormonal therapy, 35 (14.0%) palliative care and approximately 38 (15.2%) refused or did not initiate any treatment. Among the outcomes of breast cancer patients, 19 (32.8%) was the highest mortality rate in 2019, and 10 (27.8%) was the lowest in 2018.ConclusionOur study revealed that over half of our breast cancer patients presented with advanced-stage disease, and mastectomy was the most common modality of treatment. Further studies are needed to understand the factors responsible for their late presentation and improve histological services and access to radiotherapy facilities for our patients.

Effect of the COVID-19 Pandemic on the Management of Breast Cancer Patients.

Background: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, single-center study included 414 patients who underwent surgery for breast cancer at the Inonu University General Surgery Clinic between March 2018 and June 2021. The patients were divided into two groups: pre-pandemic (Pre-COVID-19; n = 240) and pandemic (COVID-19 Era; n = 174) periods. The groups were compared in terms of demographic, clinical, and histopathological variables. Results: During the pandemic period, the use of neoadjuvant therapy (from 21.3% to 34.5%) and preoperative PET-CT imaging (from 80.4% to 90.8%) rates increased, while breast-conserving surgery (from 27.9% to 19.0%) and the presence of comorbid diseases (from 45.0% to 29.9%) decreased significantly. While there was no significant difference between the groups in terms of the time from diagnosis to surgery (25 vs. 28.5 days, p = 0.121), the time to report the pathology result after surgery decreased during the pandemic period (28 vs. 23 days, p < 0.001). There was no significant difference between the groups in terms of immunohistochemical (ER, PR, Ki-67, E-cadherin, and c-erbB2), histopathological (lymphovascular invasion, perineural invasion, comedo necrosis, modified Bloom-Richardson grade, and TNM classification), and clinical (recurrence, metastasis, and axillary lymph node metastasis) features of the tumor. The mortality rate in the Pre-COVID-19 group (7.1%) was significantly higher than in the COVID-19 Era group (2.3%) (p = 0.049). Finally, in terms of the survival analysis, a statistically significant difference was found between the Pre-COVID-19 and COVID-19 Era groups in terms of the mean follow-up duration of the patients (p = 0.044). Conclusions: The study results show that the use of neoadjuvant therapy and radical surgery preference increased in breast cancer treatment during the pandemic period, but there was no significant change in tumor biology and histopathological features. Breast-conserving surgery rates, comorbidity rates, and pathology reporting times were significantly shortened. Long-term follow-up periods of 3 and 5 years are needed to see the impact of the pandemic on breast cancer patients.

Outcomes and Trends in Axillary Management of Stage cN3b Breast Cancer Patients.

There is limited data regarding sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) for cN3b patients, who present with both axillary and ipsilateral internal mammary node involvement. We examined trends in the use of SLNB in cN3b patients and survival by axillary procedure for those with nodal pathologic complete response (nPCR). Adult women with nonmetastatic cN3b invasive breast carcinoma between 2012 and 2021 were selected from the National Cancer Database. These patients were compared based on type of axillary surgery, specifically SLNB, SLNB with axillary lymph node dissection (ALND), and ALND alone. Kaplan-Meier analysis was used to compare overall survival. A total of 4,236 patients were included. In 2012, 8.5% of these patients underwent SLNB alone and 18.3% underwent SLNB+ALND. In 2021, this increased to 35.1% for SLNB alone and 23.0% for SLNB with subsequent ALND (p < 0.0001). For patients who received NAC, the rate of nPCR was overall found to be 24.9%. Overall survival of patients receiving SLNB or SLNB+ALND with nPCR was not statistically significantly different from the ALND only group with nPCR (p = 0.22 and 0.57, respectively). There has been increasing use of the SLNB procedure for patients with cN3b breast cancer over the past decade. In patients with nPCR, SLNB was not associated with reduced survival. For well-selected cN3b patients with an excellent clinical response to NAC, including nPCR, axillary de-escalation strategies, such as SLNB with omission of completion axillary dissection, may be considered.

The relationships among illness perceptions, dyadic coping and illness management in breast cancer patients and their spouses: A dyadic longitudinal mediation model.

To describe and compare dyads' illness perceptions, dyadic coping and illness management among breast cancer patients and their spouses. In addition, we explore the direct actor and partner effects of illness perception on illness management, and whether this association is mediated by dyadic coping. A descriptive and longitudinal study. Baseline illness perceptions and dyadic coping during hospitalization were measured by using the Illness Perception Questionnaire-revised (IPQ-R) and the Dyadic Coping Inventory (DCI). At the 3rd month after discharge, the Cancer Self-Management Assessment Scale (CSMAS) and the Caregiver's Contribution to the Cancer Patient's Self-Management Scale (CC-CPSMS) were used to test the dyads' illness management. Then, the actor-partner interdependence mediation model (APIMeM) was constructed to explore intrapersonal and interpersonal effects. A total of 225 postsurgical breast cancer patients and their spouses completed the questionnaires. It revealed that patients' or spouses' illness perceptions had both positive and negative direct actor effects on their own illness management (positive: personal control and illness coherence dimension; and negative: timeline acute/chronic, consequence, emotional representation and causes-uncontrollable factors dimension). The significant direct partner effects were only displayed in the timeline acute/chronic dimension. Moreover, dyadic coping had mediating effects on these paths, and only the actor-actor and partner-actor indirect effects were statistically significant. This study demonstrates the significance of illness perceptions in influencing dyads' illness management and reveals the underlying mediating mechanism of dyadic coping. It can provide more specific guidance for dyadic interventions to optimize dyads' behaviour among breast cancer patients and their spouses.

Treatment of metastatic breast cancer by stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS)

Background and purposeThe role of local ablative radiotherapy (stereotactic body radiotherapy (SBRT)/stereotactic radiosurgery (SRS)) in the management of metastatic breast cancer (mBC) patients remains unclear. This study aimed to assess the efficacy of SBRT/SRS in oligometastatic and oligoprogressive breast cancer patients.MethodsTotally 80 mBC patients with oligometastatic disease (OMD) and 80 with oligoprogressive disease (OPD) to ≤5 metastatic lesions were retrospectively analyzed. The endpoint was overall survival and progression-free survival, and univariate and multivariate analyses were performed for survival analysis.ResultsTotally 160 mBC cases (80 OMD and 80 OPD cases) were analyzed, with a total of 291 treated metastases. In the study of OMD, we analyzed 30 cases with oligo-recurrence and 50 cases with sync-oligometastases. The median follow-up time was 46 months, and 1-, 2-, and 3-year OS rates for all patients were 89.8%, 77.6%, and 67.3%, respectively, and the 1-, 2-, and 3-year PFS rates were 71.4%, 44.9%, and 34.7% respectively. In multivariate analysis (MVA), treatment for oligometastases and non-triple-negative status predicted favorable OS. In patients with oligometastases, median OS was 58 months, and 1-, 2-, and 3-year OS rates were 100%, 91.7%, and 83.3%, respectively; median OS in patients with oligoprogression was 35 months, and 1-, 2-, and 3-year OS rates were 80%, 64%, and 52%, respectively. In mBC cases with limited brain metastases administered SRS, poor OS was detected in patient age under 45 years (P = 0.041), triple-negative cases (P = 0.025), and those with OPD (P = 0.022). In OMD, a significant improvement in PFS was observed in the oligo-recurrence group compared to the sync-oligometastases group (P = 0.013).ConclusionPatients administered local ablative radiotherapy (SBRT/SRS) for oligometastases have better overall survival than those treated for oligoprogression. SBRT/SRS may be beneficial for young and non-triple-negative mBC cases. The presence of oligo-recurrence can predict a favorable prognosis of oligometastases in patients with mBC treated with SBRT/SRS.

Disparities in Genetic Management of Breast and Ovarian Cancer Patients.

Hereditary breast and ovarian cancer syndrome (HBOC) is most often caused by pathogenic variants in the BRCA1 or BRCA2 genes. Guidelines exist for genetic testing in patients at high risk, yet significant disparities in genetic testing and management remain. These disparities result in missed opportunities for cancer prevention and treatment. This review details the multiple layers of disparities in genomic knowledge, testing referral, completion, and posttesting risk reduction for at-risk populations. A comprehensive search of the PubMed database was conducted in September 2023 for studies addressing disparities at all points of HBOC risk assessment and risk reduction. Disparities in genomic knowledge, referral and testing, and in cancer risk reduction exist by race, ethnicity, insurance status, socioeconomic status, age, and care setting in the United States. Many mitigation strategies have been explored with some success. Each component contributes to a "leaky pipe" in BRCA testing and management whereby patients eligible for intervention trickle out of the pipe due to inequities at each step. Implementation of proven strategies aimed at disparity reduction in this setting is essential, as well as additional strategy development. This review provides clinicians with a comprehensive understanding of disparities in the identification and management of individuals at risk for or diagnosed with HBOC and strategies to reduce disparities in their own practice.

A narrative review of the challenges and impact of breast cancer treatment in older adults beyond cancer diagnosis.

Breast cancer is the most prevalent cancer among women worldwide, with 45% of them over 65 years old. Older breast cancer patients tend to be underrepresented and understudied in major clinical trials. This narrative review provides a comprehensive overview of the current evidence regarding treatment decision-making, treatment toxicities, and proposed survivorship management recommendations for geriatric cancer patients. A literature search was conducted on PubMed and Google Scholar. The search strategy included a combination of keywords related to clinical management and treatment toxicities of older cancer breast cancer patients. English articles published between May 1990 to May 2024 were included. Older breast cancer patients represent a heterogeneous group with specific needs and treatment considerations. Treatment decisions for geriatric cancer patients should be based on a comprehensive geriatric assessment (CGA), which considers the patient's functional status, comorbidities, and preferences, rather than relying solely on chronological age. Breast cancer surgery is generally well tolerated in older patients, with a low rate of systemic complications and 30-day post-surgery mortality. In selected elderly patients, axillary surgery may be omitted to minimize side effects. The choice of endocrine therapy should take into account the side effect profile, patient's comorbidities, concomitant medications, and preferences. While aromatase inhibitors provide better efficacy, musculoskeletal side effects and osteoporosis may be a concern for older patients. CDK4/6 inhibitors have a similar efficacy in elderly patients as younger patients, but the incidence of neutropenia and dose modifications or interruptions are more frequent. Reported radiotherapy side effects are similar across age groups, although the occurrence of radiation-induced pulmonary toxicities was found to be associated with old age. Chemotherapy is reserved for triple-negative and HER2-positive disease in elderly patients due to known side effects. such as neutropenia, cardiotoxicity, and cognitive impairment. Data on the efficacy and safety of immunotherapy use in older patients are limited. Physicians should make additional efforts to evaluate age-specific treatment efficacy and treatment-induced toxicities. Further efforts to enhance the representation of older patients in breast cancer trials are warranted.

Does virtual reality affect breast cancer patients' pain?: A literature review

Purpose: To comprehensively analyze scientific evidence regarding the effect of virtual reality on pain in breast cancer patients. Method: This is literature study using PubMed, ScienceDirect and Cochrane Library databases. The inclusion criteria in this literature review are articles published in the last 5 years (2020-2024), articles using Indonesian and English in journals of national or international reputation and research articles. The selected articles are articles that the author can download or open access. Result: Of the total 493 articles, there were 9 articles that were duplicates or the same article. After that, it was found that the titles of 457 articles did not match the topic. There were 14 articles that did not meet the inclusion criteria and 7 articles had inappropriate interventions and methodology. Finally, 5 articles were obtained that were suitable for analysis. Conclusion: The use of VR can effectively reduce levels of pain, anxiety, fatigue and depression in breast cancer patients, as well as improve their quality of life. These findings suggest that VR has the potential to be a valuable adjunct in the pain management of breast cancer patients.

Evaluation of the Axillary Reverse Mapping Technique in Preventing Breast Cancer-Related Post Operative Lymphedema, Ain Shams University Initial Experience

Abstract Background Management of breast cancer patients with clinically positive nodes is a field of research and axillary lymph nodes dissection is still an acceptable option for them. However it affects the patient quality of life in the form of breast cancer related lymphedema. Axillary reversed mapping technique is used to spare the arm lymph nodes during Axillary surgery aiming to reduce the rate of breast cancer related lymphedema. Objective To study the feasibility of using patent blue dye to perform axillary reverse mapping procedure in breast cancer patients with positive axillary lymph nodes scheduled for axillary lymph node dissection. Patients and Methods A prospective study including 20 patient with clinically positive axillary lymph nodes planed by MDT Committee at Ain Shams university hospital to perform axillary lymph nodes dissection. Results Identification rate of lymphatics and lymph nodes was 75% and 80% respectively and 60% of the stained LNS were seen below the axillary vein and lateral to the thoracodorsal bundle. Correlation between identification rate of the lymphatics and the lymph nodes with regard to N-staging and Neoadjuvant therapy wasn't statistically significant. BMI and number of lymph nodes removed were a confounding variables related to lymphedema. Conclusion Axillary Reverse mapping procedure using patent blue dye is simple idea to preserve arm lymph nodes and so, decreases the incidence of lymphedema, however there are a lot of variables related to lymphedema development which needs to be investigated well on larger group of patients and further multicentrs studies with long term follow up. The operative technique is quite challenging and need longer learning curve with well orientation to the axillary anatomy.

Breast Cancer: The Psychological Impact of Diagnosis, Treatment, and Remission.

Breast cancer affects millions of people worldwide. With physical manifestations being the predominant feature of management, healthcare professionals can overlook the psychological toll that the disease can have on the patients and their support network. This literature review examines the vast multi-factorial approach that must be taken when managing breast cancer patients from initial screening to diagnostic investigations, treatment, and remission. A literature search in PubMed from January 2000 to April 2024 was executed. Data sets in the studies filtered during the literature search were collected and analysed, looking not only at the data itself but also the entirety of the study. This included its limitations and possible biases.From screening, the possibility of cancer as a diagnosis can trigger mixed emotions including fear, depression, and anxiety. During diagnostic, patients may find themselves subject to fear of negative body image evaluation and fear of judgment. Medical professionals must be prepared to support the patient when they experience these feelings. The treatment stages can be the most difficult for the patient as side effects and complications of treatment can impact their lives in numerous ways, making management challenging. These include pain, sexual dysfunction, and alopecia. Overall, the analysis of the selected literature showed areas in clinical practice that can be optimised when providing psychological support for a patient's cancer diagnosis, management, and treatment. Being able to counsel prior to the presentation of these, and ideally prevent unnecessary cases of these can substantially increase a patient's quality of life during treatment. This literature review hopes to identify and promote awareness and further implementation of support systems by healthcare professionals.

Prediction of non-sentinel lymph node metastases in T1–2 sentinel lymph node-positive breast cancer patients undergoing mastectomy following neoadjuvant therapy

BackgroundAxillary lymph node dissection (ALND) is the standard axillary management for breast cancer patients with positive sentinel lymph node biopsy (SLNB) after neoadjuvant therapy. Nevertheless, when that happens, the frequency of additional positive nodes is not properly evaluated. We aim to develop a prediction model to assess the frequency of additional nodal disease after a positive sentinel lymph node following neoadjuvant therapy.MethodsWe retrospectively analyzed the ultrasound and clinicopathological characteristics of breast cancer patients with 1–3 positive sentinel lymph nodes (SLN) undergoing mastectomy after neoadjuvant therapy (NAT) at our institution, and performed univariate and multivariate logistic analyses to confirm the factors affecting non-SLN metastasis. These factors were included to establish a nomogram, and the area under receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were utilized to assess the validity of this model.ResultsA total of 126 breast cancer patients were ultimately included in our study, 38 (53.5%) patients were diagnosed with non-SLN metastases of all 71 patients in training set. The results of multifactorial logistic analysis suggested that lymph node metastasis ratio (LNR), short axis of lymph node and progesterone receptor (PR) were strongly associated with non-SLN metastasis. We established a nomogram using the above three variables as predictors, which yielded an area under the curve of 0.795, and validated with a favorable AUC of 0.876.ConclusionThe nomogram we constructed can accurately predict the likelihood of non-SLN metastasis in our patients with 1–3 positive SLN after NAT, which may help guide decision making regarding axillary management.

Expression of Ki-67 in Invasive Breast Carcinoma and Its Correlation With Different Clinicopathological Features.

Introduction Worldwide, breast cancer is still the most common cancer that affects women. Breastcancer prognosis is based on a number of clinical and pathological indicators. Further features are needed to predict early metastasis andprognosis of patients with breast carcinoma, as the current pathological characteristics, such as tumor differentiation, vascular infiltration, and TNM (tumor, node, and metastasis) staging, cannot fully describe the early metastatic biological behavior in breast carcinoma. High Ki-67 expression is seen to be associated with worse survival in cancer patients. Hence, this study was conducted to study the utility of Ki-67as a prognostic marker in invasive breast carcinoma and its association with known clinicopathological factors. Methodology The study was a hospital-based cross-sectional study carried out in the Histopathology Section of the Department of Pathology, Shri BM Patil Medical CollegeHospital and Research Centre, Bijapur Lingayat District Education (BLDE) (Deemed to be University), Vijayapura. The study was conducted between September 1, 2022, and April 30, 2024. The study population consisted of 55 cases of mastectomy specimens of primary breast cancer admitted to our hospital. Data regarding the patient's age, tumor size, histological type, histological grade, lymph node status, and vascular invasion were noted from medical records. Immunohistochemical staining for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2/neu (HER2/neu) proto-oncogene, and Ki-67 markers was performed according to standard protocol. The relationship of Ki-67with these clinicopathological parameters was analyzed statistically. Results In the current study, high-grade Ki-67 nuclear positivity was seen in 30 cases out of 55 cases, and low-grade Ki-67 was seen in the remaining 25 cases. The association of Ki-67 with tumor size and histological grade showed statistical significancewith a p-value of less than 0.05 and 0.001, respectively. However, no statistical significance was seen with lymph node status, vascular invasion, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2/neu (HER2/neu)proto-oncogene status with p-values greater than 0.05. Conclusion The expression of Ki-67 was statistically significant with histological grading and tumor size in our study. Immunohistochemical determination of the Ki-67 proliferation index should be performed in routine cases of breast cancerto obtain clinically useful information on tumor aggressiveness as reflected in their proliferative rate. Hence, Ki-67 can be used as a predictive and prognostic marker in managing breast cancer patients.

Impact of Chemotherapy and Hormone Therapy on Lipid Metabolism in Breast Cancer Patients: A Case Report and Literature Review

Breast cancer has become the leading cause of cancer-related death among women, partly due to therapeutic resistance and treatment-related complications. Chemotherapy and hormone therapy play a crucial role in managing breast cancer patients, providing essential treatment for both disease control and overall survival. However, as new therapeutic approaches are introduced and life expectancy continues to increase, the use of these treatments has been associated with persistent adverse effects, including dyslipidemia. This article presents the case of a breast cancer patient treated with chemotherapy and tamoxifen-based hormone therapy who developed severe mixed dyslipidemia. It also reviews lipid metabolism alterations observed in breast cancer patients, emphasizing the importance of monitoring lipid levels in these patients, particularly those undergoing hormone therapy or chemotherapy, to prevent cardiovascular complications.

Management of BRCA-associated breast cancer patients in low and middle-income countries: a review.

Breast cancer poses a significant global health challenge, with higher incidence rates in developed countries. However, low- and middle-income countries (LMICs) suffer from higher mortality rates due to various factors, including limited screening programs, delayed diagnosis and inadequate access to healthcare and advanced treatments. Approximately 5%-10% of breast cancer cases stem from germline mutations in BRCA-1/2 genes. A positive BRCA1/2 status obtained through genetic testing significantly influences surgical and medical treatment decisions. Therefore, genetic counseling, proper surveillance and customized interventions for BRCA1/2 carriers are essential to maximizing the benefits of monitoring, chemoprevention and risk-reducing surgeries for breast and ovarian cancers. Identification of BRCA mutations also impacts treatment strategies, leading to the integration of chemotherapeutic agents like platinum-based chemotherapy and PARP inhibitors. However, implementing these advanced treatment guidelines in LMICs with complex, fragmented and underfunded healthcare systems presents numerous challenges. In this review, we explore the current status and obstacles associated with managing BRCA1/2-associated breast cancer in LMICs.

Peritumoral edema enhances MRI-based deep learning radiomic model for axillary lymph node metastasis burden prediction in breast cancer

To investigate whether peritumoral edema (PE) could enhance deep learning radiomic (DLR) model in predicting axillary lymph node metastasis (ALNM) burden in breast cancer. Invasive breast cancer patients with preoperative MRI were retrospectively enrolled and categorized into low (< 2 lymph nodes involved (LNs+)) and high (≥ 2 LNs+) burden groups based on surgical pathology. PE was evaluated on T2WI, and intra- and peri-tumoral radiomic features were extracted from MRI-visible tumors in DCE-MRI. Deep learning models were developed for LN burden prediction in the training cohort and validated in an independent cohort. The incremental value of PE was evaluated through receiver operating characteristic (ROC) analysis, confirming the improvement in the area under the curve (AUC) using the Delong test. This was complemented by net reclassification improvement (NRI) and integrated discrimination improvement (IDI) metrics. The deep learning combined model, incorporating PE with selected radiomic features, demonstrated significantly higher AUC values compared to the MRI model and the DLR model in the training cohort (n = 177) (AUC: 0.953 vs. 0.849 and 0.867, p < 0.05) and the validation cohort (n = 111) (AUC: 0.963 vs. 0.883 and 0.882, p < 0.05). The complementary analysis demonstrated that PE significantly enhances the prediction performance of the DLR model (Categorical NRI: 0.551, p < 0.001; IDI = 0.343, p < 0.001). These findings were confirmed in the validation cohort (Categorical NRI: 0.539, p < 0.001; IDI = 0.387, p < 0.001). PE improved preoperative ALNM burden prediction of DLR model, facilitating personalized axillary management in breast cancer patients.

Copy number alterations in metastatic and early breast tumours: prognostic and acquired biomarkers of resistance to CDK4/6 inhibitors

BackgroundCopy number alterations (CNA) are acquired during the evolution of cancers from their early stage to metastatic stage. This study aims at analysing the clinical value of the identified metastasis-associated CNAs both in metastatic breast cancers (mBCs) and early breast cancers (eBCs).MethodsSingle-nucleotide polymorphism (SNP)-array was performed on 926 biopsies from mBC patients, enrolled in SAFIR02-BREAST prospective trial. CNA profiles of eBCs from The Cancer Genome Atlas Breast Invasive Carcinoma (n = 770), Molecular Taxonomy of Breast Cancer International Consortium (n = 1620) and PACS04 trial (n = 243) cohorts were used as references for comparing mBCs and eBCs CNA profiles. Overall survival was the considered survival endpoint.ResultsAmong the twenty-one genes frequently altered in ER + /HER2− mBCs: focal amplification of TERT was associated with poor outcome in the ER + /HER2− mBC population. Among the ER + /HER2− mBCs patients for whom CDK4/6 inhibitors information before biopsies collection was available: we identified seven genes on post-treatment biopsies, including the cyclin-dependent kinase 4 (CDK4), which was amplified in 9.8% of the ER + /HER2− mBCs pretreated population, as compared to 1.5% in the ER + /HER2− mBCs unpretreated population (P = 2.82E-04) as well as the 3 eBC populations. CDK4 amplification was associated with poor outcome in the ER + /HER2− eBCs.ConclusionsThis study provides insights into the biology of mBCs and identifies clinically useful genomic features for future improvement of breast cancer patient management.

Axillary management and long-term oncologic outcomes in breast cancer patients with clinical N1 disease treated with neoadjuvant chemotherapy

BackgroundLow false negative rates can be achieved with sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients with clinical N1 (cN1) disease. We examined changes in axillary management and oncologic outcomes in BC patients with cN1 disease receiving NAC.MethodsBC patients with biopsy proven cN1 disease treated with NAC were selected from our institutional cancer registry (2014–2017). Patients were grouped by axillary management, axillary lymph node dissection (ALND), SLNB followed by ALND, or SLNB alone. Univariable and multivariable survival analysis for recurrence-free survival (RFS) and overall survival (OS) were performed.Results81 patients met inclusion criteria: 31 (38%) underwent ALND, 25 (31%) SLNB + ALND, and 25 (31%) SLNB alone. A SLN was identified in 45/50 (90%) patients who had SLNB. ALND was performed in 25/50 (50%) patients who had SLNB: 18 for a + SLNB, 5 failed SLNB, and 2 insufficient SLNs. 25 patients had SLNB alone, 17 were SLN- and 8 SLN+. In the SLNB alone group, 23/25 (92%) patients received adjuvant radiation (RT). 20 (25%) patients developed BC recurrence: 14 distant (70%), 3 local (15%), 2 regional + distant (10%), and 1 contralateral (5%). In the SLNB alone group, there was 1 axillary recurrence in a patient with a negative SLNB who did not receive RT. Univariable survival analysis showed significant differences in RFS and OS between axillary management groups, ALND/SLNB + ALND vs. SLNB alone (RFS: p = 0.006, OS: p = 0.021). On multivariable survival analysis, worse RFS and OS were observed in patients with TNBC (RFS: HR 3.77, 95% CI 1.70–11.90, p = 0.023; OS: HR 8.10, 95% CI 1.84–35.60, p = 0.006).ConclusionsSLNB alone and RT after NAC in BC patients with cN1 disease who have negative SLNs at surgery provides long-term regional disease control. This analysis provides support for the practice of axillary downstaging with NAC and SLNB alone.

Management and outcomes of breast cancer patients with radiotherapy interruption.

Many cancer patients have not received timely treatment or even had treatment interruptions due to the COVID-19 pandemic. The objective of this investigation was to evaluate whether the prognosis of patients with breast cancer after surgery was affected by any interruptions in radiotherapy. The healthcare documents for breast cancer patients experiencing radiotherapy interruption after surgery, including treatment-related characteristics, and time of interruption, type of disease progression, and survival status, were collected between January and April 2020 during the Wuhan blockade. The final number of patients included was 148, and neither the Kaplan-Meier (KM) survival curve nor the cross-tabulation analysis found statistical significance. Cox regression analysis also did not identify risk factors associated with PFS. The prognosis of patients with postoperative breast cancer may not be significantly impacted by the interruption of radiotherapy, given its integration with additional treatments like targeted and endocrine therapies.

Harnessing Fusion Modeling for Enhanced Breast Cancer Classification through Interpretable Artificial Intelligence and In-Depth Explanations

Integrating Artificial Intelligence (AI) into healthcare has shown tremendous promise in several domains, such as prediction, decision-making, and diagnosis. Nevertheless, the widespread belief that AI is incomprehensible and mysterious has restricted its practical use, particularly in medicine. This skepticism highlights the need for methods that provide precise predictions and clear explanations for these projections. The present study presents a hybrid method “BC2” (Breast Cancer Classification) that combines deep learning techniques to accurately detect breast cancer and provide detailed explanations for its predictions. “BC2” exploits the collaborative effects of Convolutional Neural Networks (CNN) and the Light Gradient Boosting Model (LGBM). The automated feature learning process of the model is integrated into many convolutional layers, and LGBM then follows it to provide predictions for class labels. To evaluate the effectiveness of the proposed approach, the authors performed experiments with real-world Breast Cancer Data. The results demonstrate substantial enhancements compared to the current methods in key metrics such as accuracy, precision, recall, and F1 score. The proposed technique obtains an accuracy of 0.982906, a precision of 0.987179, a recall of 0.987179, and an F1-score of 0.987179, demonstrating its exceptional performance. After generating exact forecasts, authors use the “SHAP” (SHapley Additive exPlanation) approach at local and global levels to explain the reasoning behind each projection. This guarantees clarity and improves the comprehensibility of the predictions made by the proposed model. The proposed hybrid model consists of three main components: a feature learning module, a diagnostic module, and an explanation-generating module. The proposed model can improve medical professionals’ diagnostic skills in managing breast cancer patients by clearly explaining its forecasts.