Stage Breast Cancer Research Articles

The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility

BackgroundButaro Cancer Center of Excellence (BCCOE) was founded to serve Rwanda’s rural low-income population, providing subsidized cancer diagnosis and treatment with transport stipends for the lowest-income patients. We examined whether travel distance to BCCOE was associated with advanced-stage diagnoses and treatment completion.MethodsWe conducted a retrospective cohort study using medical record data from BCCOE patients with pathologically-confirmed breast cancer from 2012–2016. Women with no prior surgery were included in the stage analysis; those with non-metastatic disease were included in the treatment analysis. We calculated travel distances using spatial analytic software and used multivariable logistic regression to examine the association of distance and other patient characteristics with late-stage diagnoses and treatment completion within one year of diagnosis.ResultsThe analytic cohort for stage included 426 patients; 75.1% had late-stage (stage 3 or 4) disease. In univariable analyses, patients residing in BCCOE’s surrounding district had a lower proportion of late-stage diagnoses compared to those residing outside the district (57.9% v 76.8%, p = 0.02). In adjusted analyses, odds of late-stage diagnosis were 2.46 (95% CI:1.21–5.12) times higher among those in distance quartile 4 (> 135.8 km) versus 1 (< 55.7 km); the effect of distance was less strong in sensitivity analyses excluding patients from BCCOE’s surrounding district. Patients from sectors with > 50% poverty had 2.33 times higher odds of late-stage diagnoses (95% CI:1.07–5.26) relative to those with poverty < 30%. In the treatment completion cohort (n = 348), 49.1% of patients completed surgery and chemotherapy within a year. In adjusted analyses, travel distance and poverty were not linearly associated with treatment completion.ConclusionsAt Rwanda’s first public cancer facility, sector-level poverty and longer travel distances were associated with late-stage breast cancer diagnoses, but less clearly associated with treatment completion, perhaps partly due to travel stipends provided to the lowest-income individuals undergoing treatment. Our findings support further investigation into wider use of travel stipends to facilitate early diagnosis and treatment completion.

Breast cancer outcomes after skin- and nipple-sparing mastectomy in BRCA pathogenic mutation carriers versus non-BRCA carriers.

The study was approved by the institutional ethics committee. Data collected included patient- (e.g., age), tumour- (e.g., subtype, stage), and treatment-related factors and outcomes. LR was defined as ipsilateral chest wall recurrence. P value ≤ 0.05 was considered statistically significant. A total of 255 patients (127 BRCA, 128 non-BRCA) was included. Patients who did not receive RT had an earlier disease stage (most N0). No differences were found for LR rate in non-BRCA versus BRCA groups per involved breast and per patient. Comparing the subgroup of patients who did not receive RT, there were no statistically significant differences in LR between non-BRCA versus BRCA (p-value > 0.05). Similarly, there were no significant differences in LR for the subgroup of patients who did receive RT (p-value > 0.05). Regardless of BRCA status, patients who received RT had significantly lower LR rates. No differences in overall survival were noted between the groups. Our results confirm high LR rates after SSM and NSM in patients who are not treated with RT, independent of BRCA-status. This mandate further investigation, as previous studies did not show a benefit of postmastectomy RT in the early breast cancer stage of those patients.

Radiation therapy in the combined/complex treatment of patients with breast cancer I–IIA, in stages after subcutaneous/skin-preserving mastectomies with simultaneous reconstruction

Background. Currently, after subcutaneous/skin-preserving mastectomies with simultaneous reconstruction in cancer of stages I–II, the need for radiation therapy is debatable, especially in the presence of favorable subtypes or when complete clinical regression is achieved after neoadjuvant polychemotherapy.Materials and methods. A retrospective non-randomized study was conducted, which included 1135 breast cancer patients who received treatment at the P.A. Herzen Moscow State Medical Institute from 2014 to 2023, in all patients the surgical stage included subcutaneous/skinpreserving mastectomies with simultaneous reconstruction. The patients were divided into 2 groups – with and without radiation therapy.Results. Relapses were analyzed by groups depending on the clinical and morphological features of tumors, with a detailed analysis of the data obtained.Conclusion. Among patients I–IIA, In the stages of breast cancer after PME/CME with reconstruction included in the study, the risk of recurrence over 5 years was 4.3± 0.1% of cases. The recurrence in the group with radiation therapy was 2.5±0.6%, without radiation therapy 6.9±1.2% (p0.05), thus radiation therapy reduces the risk of recurrence by 4.4%. In our study, the following criteria were identified for the appointment of radiation therapy in the postoperative period: resection margin R1, luminal/non-luminal NONR2 positive type, rN1.

The role of a «short-term» preoperative endocrine therapy for adjuvant therapy guidance in early HR+ HER2-negative breast cancer

In the absence of widespread access to genomic tests there is an urgent need for additional methods that influence the choice of adjuvant therapy in patients with early luminal Her2-negative subtype of breast cancer (BC). The IMPACT and POETIC trials have shown that Ki67 level decrease up to ≤10% after a “short-term” (2–4 weeks) preoperative endocrine therapy (ET) is a favorable prognostic factor. This test allows some patients to avoid adjuvant chemotherapy associated with immediate and delayed adverse events.Aims of the study. To evaluate the impact of “short-term” preoperative endocrine therapy for guidance of further treatment for patients with primary operable luminal Her2-negative breast cancer stages T1–3 N0–1 M0.Results. The study included 123 patients, 76 (60.8%) received tamoxifen and 47 (37.6%) – aromatase inhibitors (AI). Most patients – 69 (55.2%) were &gt;50 years old, premenopausal – 58 (46.4%), menopausal – 67 (53.6%). The average age was 52 years (30–82). With the initial Ki67 level&gt;10% (N= 107), Ki67 decreased in 24 (22.4%) up to ≤10% after “short-term” ET, and remained &gt;10% in 83 (77.6%). According to the PREDICT calculator, the benefit of adjuvant chemotherapy (AChT) was assessed as high in 35 (28.5%) patients, and 10 of them (27.8%) were able to avoid Ch T. In 86 patients with a relatively low estimated AChT benefit (&lt;5% at 10 years) there was no response to “short-term” ET, which led to the AChT prescription in 13 cases (15.1%).Conclusions. “Short-term” course of preoperative endocrine therapy is a simple, accessible and reproducible method for personalizing of adjuvant therapy in patients with luminal HER2-negative breast cancer.

Evaluation of Ki67 in pathological prognostic staging of breast cancer: a tertiary care center study

ABSTRACT Background The rising global burden of breast cancer demands early detection and effective treatment, with a focus on prognostic and predictive markers. The eighth edition of the American Joint Committee on Cancer staging manual introduced a new prognostic staging system to increase the predictive power of the existing anatomical staging system of breast cancer. The current study aimed to establish the correlation between Ki67 expression with molecular subtypes and with the pathological prognostic stage of invasive ductal carcinoma. Materials and Methods A total of 40 patients were included in the study with samples from 32 modified radical mastectomies and 8 biopsies. Hematoxylin and Eosin staining, histopathological analysis and Ki67 immunostaining were conducted. Descriptive and inferential statistical analyses were performed. Results Bloom Richardson Grade II was the predominant histological grade. In Grade II cases, 15 of 24 had a Ki67 labeling index of 26–45%, while 6 exceeded 45% (p = 0.001). Pathological prognostic staging reclassified 27 cases, with 24 (75%) downstaged, 3 (9.38%) upstaged, and 5 (15.63%) retaining their clinical stage. Conclusions Ki67 immunohistochemistry is an effective tool for assessing proliferative activity of invasive ductal carcinoma, aiding in pathological prognostic stage stratification and offering insights into tumor biology.

An experimental study on breast cancer discrimination using metasurface-based microwave technology

Multifocal (MF) breast cancer tends to be more aggressive than unifocal (UF) ones, with higher probabilities of recurrence, lymph node metastases, and lower survival rates. Given the inherent limitations of current medical imaging techniques, there is a pressing need for the development of more precise and sensitive alternatives. Microwave imaging (MWI) has emerged as a promising method for breast cancer detection due to its portability, non-ionizing nature, and cost-effectiveness. To our knowledge, this is the first study aimed at distinguishing MF breast cancer from UF one using MWI. In our previously published theoretical paper [1], we introduced a 2×2 planar metasurface-based array antenna operating at 2.4 GHz to differentiate between these critical stages of breast cancer. In this experimental study, we aim to validate and extend those theoretical predictions through a series of meticulously designed experiments. Our experimental data strongly support the theoretical model. The performance of the proposed array is experimentally verified using an N5227A vector network analyzer (VNA). The arrayed antenna demonstrated full breast coverage, enhancing its sensitivity for detecting deeper tumors with a phase difference of 11∘. Analysis of the phase shift across the Sij parameters achieved a distinguishing level of 29∘, highlighting its significant potential in addressing the spread of metastatic MF breast tumors.

Disparities in Triple Negative Breast Cancer Among Hispanic Population Living in Latin America Versus the United States.

Triple-negative breast cancer (TNBC) has a prevalence of 12%-24% in the Hispanic population. Previous research has demonstrated that disparities in healthcare access significantly influence patient outcomes. We aimed to compare the clinicopathological characteristics and outcomes of Hispanic females with TNBC living in Latin America (HPLA) to the Hispanic population in the United States (HPUS). We evaluated two retrospective cohorts: patients diagnosed with TNBC at the Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru, during 2000-2015, and HPUS patients with TNBC from the Surveillance, Epidemiology, and End Results Program (SEER). A total of 2007 HPLA and 8457 HPUS patients were included. The HPLA patients were younger and more frequently lived in nonmetropolitan areas. HPLA had higher T and N (p < 0.001) stages. HPLA patients were more likely to present with Stage III disease (51.6% vs. 20.8%), while Stage IV presentations were similar 6.6% vs. 6.8%. HPLA patients with Stages I and II more frequently underwent mastectomy compared to HPUS (56.2 vs. 48.0%). HPLA patients received neoadjuvant chemotherapy (p < 0.001), adjuvant chemotherapy (p < 0.001), and radiotherapy (p < 0.001) more often. While early breast cancer stages had similar overall survival (OS) rates for both populations, HPLA patients had worse 5-year OS rates compared to HPUS patients in Stages III (39.9% vs. 52.3%, p < 0.001) and IV (4.6% vs. 10.7%, p < 0.001). Hispanic females living in Latin America were more frequently diagnosed with advanced stages of TNBC and more often underwent mastectomy, even in early-stage disease. When analyzing advanced stages, HPLA had worse OS rates compared to HPUS.

Clinical impact of PTEN rs701848 as a predictive marker for breast cancer.

The incidence of Breast cancer (BC) is currently augmented and it has become the most common malignant cancer in females. Phosphatase and tensin homolog (PTEN) is a tumor suppressor gene as a result of blocking the phosphorylation of PIP3 in PI3K pathway. The computational bioinformatics tools were performed to determine the link between PTEN rs701848T/C genetic variants and breast cancer progression. 50 healthy matched controls and 100 Egyptian women with breast cancer were enrolled in the study. The PTEN rs701848T/C polymorphism was assessed using qRT-PCR. Then the proteomic level of PTEN was measured by ELISA technique. Breast cancer patients had considerably higher (TC) genotype frequency than controls, p = 0.03. Moreover, TC carriers had a higher chance of developing tumors with advanced stage, big tumor size, and metastasis at further sites. Regarding proteomic level of PTEN, a remarkable decline was correlated significantly with disease progression. Moreover, the ROC curve analysis showed that the PTEN protein showed comparable diagnostic accuracy in distinguishing between different BC stages. The current research provides insight into the impact of PTEN as a predictive marker for BC development and progression at genomic and proteomic levels.

8-OHdG and Nrf2 Protein are Expressed Consistently in Various T Stages of Invasive Breast Carcinoma.

Oxidative stress prompts breast cancer cells to adapt by raising the lethal threshold and enhancing the antioxidant mechanism, thereby enabling survival and continuous proliferation that facilitates tumor progression. Nrf2 and 8-OHdG are indicative of oxidative stress activity and impact the progression of breast cancer. We aimed to analyze the expression of Nrf2 and 8-OHdG in various T stages of breast cancer in our hospital. This observational study employed a cross-sectional design and included patients with invasive breast carcinoma of no special type diagnosis from histopathology examination who underwent modified radical mastectomy without neoadjuvant chemotherapy at Dr. Soetomo General Academic Hospital between January 2019 and December 2022. Medical records and paraffin blocks that met these criteria were obtained. 8-OHdG and Nrf2 were assessed using immunohistochemistry. There was no significant difference and correlation between 8-OHdG (p=0.578) and Nrf2 (p=0.694) expression with various T stages of IBC-NST and no significant correlation between 8-OHdG/Nrf2 expression and T stage (p=0.242 and 0.625 respectively). Consistent expression of 8-OHdG and Nrf2 in various T stages of breast cancer represents a continuation of the oxidative stress process in breast cancer that is not influenced by the tumor size. The existence of consistent oxidative stress at all tumor sizes (T stage) stimulates breast cancer cells to continue proliferating.

Advancements in understanding the role and mechanism of sirtuin family (SIRT1-7) in breast cancer management.

Breast cancer (BC) is the most prevalent type of cancer in women worldwide and it is classified into a few distinct molecular subtypes based on the expression of growth factor and hormone receptors. Though significant progress has been achieved in the search for novel medications through traditional and advanced approaches, still we need more efficacious and reliable treatment options to treat different types and stages of BC. Sirtuins (SIRT1-7) a class III histone deacetylase play a major role in combating various cancers including BC. Studies reveal thateach sirtuin has a unique and well-balanced biology, indicating that it regulates a variety of biological processes that result in the initiation, progression,and metastasis of BC. SIRT also plays a major role in numerous vital biological functions, including apoptosis, axonal protection, transcriptional silencing, DNA recombination and repair, fat mobilization, and aging. As per the current demand, we wish to outline the structural insights into sirtuin's catalytic site, substantial variations among all SIRT types, and their mechanism in BC management. Additionally, this review will focus on the application of SIRT modulators along with their clinical significance, hurdles, and future perspective to develop successful SIRT-based drug candidates to conquer the BC problem.

Early Outcomes of Modified Round Block Technique for Early Stage of Upper Outer Quadrant Breast Cancer

Early Outcomes of Modified Round Block Technique for Early Stage of Upper Outer Quadrant Breast Cancer

Immune Microenvironment in Breast Cancer Metastasis.

Metastatic disease is the final stage of breast cancer that accounts for vast majority of patient death. Mounting data over recent years strongly support the critical roles of the immune microenvironment in determining breast cancer metastasis. The latest single-cell studies provide further molecular evidence illustrating the heterogeneity of this immune microenvironment. This chapter summarizes major discoveries on the role of various immune cells in metastasis progression and discusses future research opportunities. Studies investigating immune heterogeneity within primary breast cancer and across different metastasis target organs can potentially lead to more precise treatment strategies with improved efficacy.

Exercise as a Therapeutic Strategy to Improve Cerebrovascular Function and Cognition in Breast Cancer Survivors: A Scoping Review.

Breast cancer is the most diagnosed cancer globally. While the breast cancer prevalence continues to rise, so too do patient survival rates, thus resulting in a large survivor population. Up to 75% of this population report experiencing cancer-related cognitive impairment during their cancer journey, thus reducing their quality of survivorship. This review systematically evaluates the effect of physical activity and exercise training on cerebrovascular function and cognition in breast cancer survivors. Cross-sectional, intervention or observational studies that examined the effect of acute or chronic exercise training or physical activity levels on cerebrovascular function and cognition in female breast cancer survivors were searched for systematically. The 11 included studies were tabulated and described narratively. The included studies primarily focused on aerobic exercise training, while only four studies investigated the effect of resistance exercise training or concurrent training on cerebrovascular function and/or cognition in breast cancer survivors. Collectively, these studies provide preliminary evidence supporting the positive effect of exercise training on cerebrovascular function and cognition in breast cancer survivors, irrespective of their age, stage of breast cancer and treatment regimen. However, more research is required to comprehensively evaluate the effect of exercise training on cerebrovascular function and cognition in breast cancer survivors and the mechanisms leading to these potential improvements.

MiR-Cabiner: A Universal microRNA Sensing Platform Based on Self-Stacking Cascaded Bicyclic DNA Circuit-Mediated CRISPR/Cas12a.

CRISPR/Cas12a-based diagnostics have great potential for sensing nucleic acids, but their application is limited by the sequence-dependent property. A platform termed miR-Cabiner (a universal miRNA sensing platform based on self-stacking cascaded bicyclic DNA circuit-mediated CRISPR/Cas12a) is demonstrated herein that is sensitive and universal for analyzing miRNAs. This platform combines catalytic hairpin assembly (CHA) and hybrid chain reaction (HCR) into a unified circuit and finally cascades to CRISPR/Cas12a. Compared with the CHA-Cas12a and HCR-Cas12a systems, miR-Cabiner exhibits a significantly higher reaction rate. Panels of miRNAs (miR-130a, miR-10b, miR-21, and miR-1285), which are associated with diagnosis, staging, and prognosis of breast cancer, are designed to demonstrate the universality of miR-Cabiner. Four miRNAs can be detected to the fM-level by simply tuning the sequence in CHA components. Additionally, miRNA panel analysis also shows high accuracy in practical samples. This universally applicable platform for detecting miRNA may serve as an excellent tool for clinical diagnosis.

Current Concepts in Molecular Breast Imaging.

Molecular breast imaging (MBI) is a functional imaging modality that utilizes technetium 99m sestamibi radiotracer uptake to evaluate the biology of breast tumors. Molecular breast imaging can be a useful tool for supplemental screening of women with dense breasts, for breast cancer diagnosis and staging, and for evaluation of treatment response in patients with breast cancer undergoing neoadjuvant systemic therapy. In addition, MBI is useful in problem-solving when mammography and US imaging are insufficient to arrive at a definite diagnosis and for patients who cannot undergo breast MRI. Based on the BI-RADS lexicon, a standardized lexicon has been developed to aid radiologists in MBI reporting. In this article, we review MBI equipment, procedures, and lexicon; clinical indications for MBI; and the radiation dose associated with MBI.

The THE RELATIONSHIP OF TUMOUR BUDDING AND TUMOUR INFILTRATING LYMPHOCYTES IN DIAGNOSTIC BREAST CORE BIOPSIES WITH PATHOLOGICAL RESPONSE IN RESECTION SPECIMENS

Background: Breast cancer, ranks as the second-leading global cancer-related cause of death. This article highlights prognostic significance of tumour budding and tumour infiltrating lymphocytes, emphasizing their roles in guiding treatments. Recent discoveries support their pivotal contribution in enhancing risk assessments and refining management strategies in breast cancer. Methods: A retrospective study of 80 in house at Shaukat Khanum Memorial Cancer Hospital diagnosed with invasive ductal carcinoma in the year 2014. Patients were categorized into two groups based on receptor status: Group 1 (ER/PR positive, Her2 negative, or ER/PR/Her2 positive) and Group 2 (Triple negative and ER/PR negative, Her2 positive). Each group had 40 cases. Pathologists evaluated tumour budding, tumour infiltrating lymphocytes, Nottingham Grading, and receptor status on core biopsies. Study aimed to determine the relationship of TB and TILs assessed on core biopsies on corresponding resection specimen in terms of pathological tumour stage and overall survival after therapy. Results: In Group I, TILs &gt;50% correlated with lower pathological tumour stage, while &lt;50% correlated with higher post- treatment tumour stage. In Group II, most had &lt;50% TILs, but some responded well. Low TB-Status in Group I linked to higher rates of ypT0, while in Group II, high TB-Status corresponded with high PT stage, i.e., yPT1 suggesting prognostic value for TILs and TB in breast cancer response and staging. Conclusions: Study suggests that higher TILs percentages correlate with improved treatment response and survival in contrast to lower TILs. Similarly, lower TB-status is associated with complete treatment response (y PT0) and higher TB- status is directly related to poor treatment response and higher tumour stage.

Screen-detected breast cancer and cancer stage by area-level deprivation: a descriptive analysis using data from the National Cancer Registry Ireland.

Breast cancer screening programmes can lead to better disease outcomes, but women from deprived backgrounds are less likely to participate and more likely to present with late-stage cancer. This study aimed to explore associations between deprivation and breast cancer screening outcomes in Ireland during 2009-2018. Data on all female breast cancer cases diagnosed in Ireland during 2009-2018 were extracted from the National Cancer Registry Ireland. Associations between area-level deprivation, using the Pobal Haase-Pratschke deprivation index, and detection of breast cancer through BreastCheck, Ireland's breast screening programme, and stage of screen-detected breast cancer were explored. Unadjusted risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. Among screening eligible women in Ireland in 2009-2018, there was no difference in risk of breast cancer detection through BreastCheck across deprivation quintiles (RR for most compared to least deprived group: 1.01, 95% CI: 0.96-1.06). In women with screen-detected breast cancer, the risk of late-stage cancer detection increased with deprivation in 2009-2013 (RR for most compared to least deprived group: 1.45, 95% CI: 1.10-1.93), but no association was observed between deprivation and cancer stage in 2014-2018. Notwithstanding its limitations, including the risk of confounding by uncontrolled variables, this study suggests screening eligible women in Ireland have had similar outcomes from breast cancer screening, regardless of deprivation level, since the national roll-out of BreastCheck. Associations between deprivation and screening outcomes should continue to be monitored to ensure Ireland's breast cancer screening programme is helping to reduce health inequities.

Social vulnerability is associated with advanced breast cancer presentation and all-cause mortality: a retrospective cohort study

BackgroundDisparities in breast cancer mortality persist despite improvements in screening and therapeutic options. Understanding the impact of social determinants of health on disparate breast cancer outcomes is challenging due to heterogeneity of prior assessments. We examined the association between social vulnerability and breast cancer stage at diagnosis and mortality using a standardized measure of population risk for external stressors on health.MethodsUsing institutional cancer registry data, female patients aged 18 or older diagnosed with breast cancer between 2012 and 2019 were assigned a 2018 Social Vulnerability Index (SVI) rank based upon home address census tract. We used multinomial logistic regression and Cox proportional hazards model to examine the relationships between SVI and breast cancer stage at diagnosis and all-cause mortality. Covariates included age and, when assessing mortality, cancer stage, comorbidities, body mass index, insurance type, and treatment regimen.ResultsA total of 3,499 women with a median age of 59 (IQR 48–69) were included. 60% were White and 31% were Black. Median SVI was 0.36 (IQR 0.14–0.68) and median follow-up was 58 months (IQR 37.3–83.9). On adjusted analyses, each decile increase in SVI resulted in an 11% (OR 1.11, 95% CI 1.06–1.16, p < .001) and 15% (OR 1.15, 95% CI 1.09–1.21, p < .001) greater odds of presenting with Stage III or IV breast cancer, respectively, compared to DCIS. For patients who underwent surgery (N = 2916), each decile increase in SVI was associated with a 6% increase in all-cause mortality risk (HR 1.06, 95% CI 1.01–1.12, p = .01). Mortality risk was 1.5 times (HR 1.52, 95% CI 1.02–2.26, p = .04) greater for those in the most vulnerable quartile compared to the least vulnerable quartile.ConclusionsWomen living in socially vulnerable communities presented with more advanced breast cancers and suffered worse survival. The SVI can be used to identify patients at risk for delayed cancer presentation and increased mortality. This tool can inform geographically targeted resource allocation and interventions aimed at reducing breast cancer care disparities.

Changes to the US Preventive Services Task Force Screening Guidelines and Incidence of Breast Cancer

The 2009 US Preventive Services Task Force breast cancer screening guideline changes led to decreases in screening mammography, raising concern about potential increases in late-stage disease and more invasive surgical treatments. To investigate the incidence of breast cancer by stage at diagnosis and surgical treatment before and after the 2009 guideline changes. This population-based, epidemiologic cohort study of women aged 40 years or older used 2004 to 2019 data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Age- and stage-specific breast cancer incidence rates and the proportion of breast cancers treated by partial mastectomy, total mastectomy, and total mastectomy with reconstruction were calculated. Data analyses were conducted from August 2023 to February 2024. Age group (40-49, 50-74, and ≥75 years). Annual percent changes (APCs) in stage-specific breast cancer incidence and proportions of cases treated with each surgery type. This cohort study included 2 022 250 women (354 263 [17.5%] aged 40-49 years, 1 279 542 [63.2%] aged 50-74 years, and 388 445 [19.2%] aged ≥75 age group, from a total of 2 023 541 women) diagnosed with breast cancer. Rates of in situ breast cancer decreased since 2009 (eg, APC, -0.69 [95% CI, -2.77 to -0.18] for women aged 50-74 years). Localized breast cancer rates increased steadily during 2004 to 2019 in women aged 40 to 74 years (eg, APC, 1.18 [95% CI, 1.02-1.34] for women aged 50-74 years), with no evidence of a change in trend during the study period. Regional cancer rates decreased or did not change. Distant cancer rates were flat since 2012 among women aged 40 to 74 years and increased steadily for those 75 years or older during 2004 to 2019 (APC, 1.40 [95% CI, 1.00-1.82]). The proportion of cases treated with partial mastectomy decreased during 2004 to 2012 (eg, APC, -0.77 [95% CI, -2.96 to -0.03] among women aged 50-74 years with localized cancer), whereas the proportion of cases treated with total mastectomy with reconstruction increased (eg, APC, 20.17 [95% CI, 16.50-33.16]). During 2012 to 2019, the proportion of cases treated with total mastectomy decreased (eg, APC, -2.44 [95% CI, -3.45 to -1.61] for women aged 50-74 years with localized cancer), and the proportion of cases treated with partial mastectomy increased (eg, APC, 1.70 [95% CI, 0.90-4.08] for women aged 50-74 years). In this cohort study, in situ breast cancer decreased since 2009, consistent with decreasing use of screening mammography since the 2009 guideline changes, but this decrease did not appear to have translated to more advanced breast cancer stages at diagnosis or decreases in the proportion of cases treated with partial mastectomy. Further research is needed to understand the long-standing increase in localized invasive breast cancer and the decrease in regional invasive breast cancer observed during the past 20 years in the context of decreased breast cancer screening.

Correlation of CD44 Protein Expression with Larger Tumor Size and Advanced Stage of Breast Cancer Patients.

This study aimed to determine the expression of CD44 in breast cancer and its association with patients' clinicopathological data, particularly in Bali. This was a cross-sectional study in the Integrated Biomedical Laboratory and Biochemistry Laboratory of the Faculty of Medicine Udayana University, during January-December 2022, which lasted 12 months with 46 samples. The study showed that the age range of our subjects was 38-86 years old, with the majority of the parity being less than three. The mean CD44 expression in all samples was 1177.83 ± 268.47 ng/mL. Based on the clinicopathological data, there was a significant difference in CD44 expression based on the patient's menstrual status (p=0.016), tumor size (p=0.003), and stage (p=0.002). Based on the analysis using the chi-square test with a cut-off CD44 expression of 85.81, significant results (p=0.001) were obtained on the association of CD44 expression with tumor size. The cut-off value with the stage of breast cancer was 99.66 and showed a significant association between CD44 expression advanced stage (p = 0.001) in breast cancer patients. Other variables showed insignificant results. CD44 protein expression in breast cancer patients is between 35.47-1407.83 ng/mL. This study showed a significant association between CD44 expression with tumor size and the advanced stage of breast cancer patients.