Treatment Of Breast Cancer Research Articles

Beyond pink ribbons: The unmet needs of women with breast cancer.

Breast cancer is the most frequently diagnosed cancer worldwide. The treatment options for breast cancer can cause side effects and adversely impact quality of life. Side effects, including fatigue, pain, cognitive changes, and psychosocial complications, can be life altering and continue beyond treatment into survivorship. Traditionally, health professionals focused almost entirely on achieving cancer survival; however, due to significant success in cancer treatment outcomes, most women now live beyond their breast cancer treatment. Consequently, addressing side effects and compromises in quality of life are becoming more important issues to include in a comprehensive approach to breast cancer treatment. For women, these unmet needs may involve body image concerns, sexual dysfunction, and other lifestyle challenges, and may not have previously been given sufficient recognition or priority. It is necessary for us, as oncology healthcare professionals, to modify our delivery of cancer care and ensure that more comprehensive care is provided to women. By addressing women's unmet needs, we can contribute to achieving the United Nations' Sustainable Development Goals regarding improving health and equality. This commentary seeks to emphasise the advantages of providing comprehensive care for women with breast cancer and advocates for cancer care professionals to actively participate in initiating and implementing this care.

Assessing the causal relationships between circulating metabolic biomarkers and breast cancer by using mendelian randomization

ObjectivePrevious studies have established a causal relationship between metabolites and breast cancer (BC), but the underlying mechanisms remain unclear. Thus, we aimed to investigate the genetic relationship between metabolites and BC, including its subtypes, using Mendelian randomization (MR) analysis.MethodsUtilizing the latest and most comprehensive summary statistics from genome-wide association studies we conducted an Mendelian randomization study. Data on 233 metabolites, used as exposure variables, were obtained from a study involving 136,016 participants. BC data, used as outcome variables, were sourced from a study comprising 122,977 cases and 105,974 controls. We used the inverse-variance weighted method as the primary approach, along with three supplementary methods, to assess the causal relationship. We also used Cochran’s Q test to detect heterogeneity and MR-Egger regression to examine the presence of horizontal pleiotropy.ResultsUpon analyzing 233 metabolites across 11 classes in relation to BC, we found six classes of metabolites (fatty acids glycerides and phospholipids, lipoprotein subclasses, lipids, apolipoproteins, and lipoprotein particle size) associated with overall BC. Five classes of metabolites (fatty acids glycerides and phospholipids, lipoprotein subclasses, lipids, and lipoprotein particle size) were related to estrogen receptor (ER) + BC, and eight classes of metabolites (fatty acids, amino acids, glycerides and phospholipids, lipoprotein subclasses, lipids, apolipoproteins, glycolysis-related metabolites, and lipoprotein particle size) were linked to ER- BC.ConclusionOur study demonstrates a genetic causal relationship between most metabolites and BC, confirming the link between these factors. This research provides a significant foundation for the prevention and treatment of BC.

Value of using ultrasonic shears in reducing seroma formation after axillary lymph node dissection in breast cancer patients

BackgroundAxillary lymph node dissection (ALND) is an essential step in the management of breast cancer. ALND is conventionally performed using radio frequency electrosurgery. The post-operative complications of utilizing such energy (such as prolonged drainage time, seroma, or infection) lead to prolonged recovery. Hence, it may delay the initiation of adjuvant chemo/radiotherapy for this critical category of patients. Using ultrasound shears provides a wide spectrum of tissue effects via mechanical oscillation. The absence of an electric circuit in ultrasound shears reduces thermal injury and accordingly cellular damage.ObjectiveComparing utilization of ultrasound shears in axillary lymph node dissection to conventional radio frequency electrosurgery in terms of operative time, post-operative drainage amount and days, post-operative pain, the incidence of seroma or infection, and lymph node yield.MethodsThis study is a randomized control trial. It includes 56 breast cancer ALND cases performed in conjunction with either BCS or MRM; being upfront surgery cases or post-neoadjuvant therapy cases, 28 patients underwent ALND using ultrasound shears and 28 underwent ALND using radio frequency electrosurgery.ResultsThe mean age of the study population was 51 ± 11.7 years, with a mean BMI of 39. The mean operative time in the ultrasound shear group was 29.4. ± 7.6 min and 31.6 ± 5.1 min in the conventional group. The mean amount of drainage in the ultrasound shear group was 319.6 ± 75.4 ml and 407.5 ± 75.2 ml in the conventional group. The mean drainage days in the ultrasound shear group were 8 ± 1 day and 12 ± 2.2 days in the conventional group. Seroma formation was recorded in 6 of the ultrasound shear groups and 9 in the conventional group. Seroma followed by infection was found in 10% of the ultrasound shear group versus 21% in the conventional group. Seroma formation and wound infection were significantly related to the conventional group (p-value = 0.01).ConclusionOur study recommends the utilization of ultrasound shears in ALND as it is a safe and accurate method that allows faster post-operative recovery with shorter drainage time and lower incidence of seroma or infection, without affecting operative time or lymph node yield.Trial registrationTrial no.: PACTR202402831197428. Date of approval: 19/02/2024

Effect of Dual-Doped Hydroxyapatite Nanoparticles Loaded with 5-Fluorouracil on Breast Cancer Treatment Through the Disruption of DNA Replication: In Vitro Drug Release and Kinetics Study

Effect of Dual-Doped Hydroxyapatite Nanoparticles Loaded with 5-Fluorouracil on Breast Cancer Treatment Through the Disruption of DNA Replication: In Vitro Drug Release and Kinetics Study

The role of circRNA in breast cancer drug resistance

Among women with cancer, breast cancer has surpassed lung cancer to become the most prevalent type of cancer globally. High-throughput sequencing of breast cancer tissues from many patients has revealed significant variations in circRNA expression across different types of breast cancer. Chemotherapy is currently a very important method for treating breast cancer; however, as the number of chemotherapy sessions increases and considering factors such as the patient’s immune response, drug resistance has become a challenging issue in treating breast cancer. It is well known that drug resistance is associated with multiple factors, and different resistance mechanisms involve different roles of circRNA. This review consolidates literature from the past 5 years and addresses the shortcomings in the broad description of circRNA’s role in breast cancer drug resistance. It categorizes and describes the drug resistance and its mechanisms in different types of breast cancer, as well as the roles of circRNA and signaling pathways in drug resistance.

Does FDG PETCT have a predictive value for neoadjuvant chemotherapy response in nonmetastatic breast cancer?

A pathological complete response (pCR) rate after neoadjuvant chemotherapy (NAC) is important for the prognosis of early-stage breast cancer. The prediction of an NAC response plays a key role in managing neoadjuvant treatment. The aim of this study is to investigate the predictive value of the baseline PETCT FDG (F-18 fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography) SUVmax (the maximum standardized uptake value) for pCR after NAC in early-stage breast cancer. The patients who performed PETCT before NAC were included in this retrospective study. The basal PETCT SUVmax values were divided into two categories based on the cutoff points of ≥ 8.77 or < 8.77, namely the low SUV max group and the high SUV max group. These two groups were compared according to the general characteristics. The impact of the PETCT SUVmax values on pCR was determined with logistic regression analyses. One hundred forty-eight patients who performed PETCT before NAC were included in this retrospective study. Eighty-one patients were in the low SUV max group and 67 patients were in the high SUVmax group. The pCR trended toward a higher rate in the high SUVmax group than in low SUVmax group but it was not statistically significant (p = 0.052). The baseline PETCT SUVmax value was an independent predictive factor for pCR. (p = 0.025). PETCT SUVmax may be a factor for the predicting complete response to neoadjuvant treatment in early-stage breast cancer.

Vitamin A and D3 combinations reduce breast cancer tumor load in a postmenopausal MCF-7 xenograft mouse model in a dose- and time- dependent manner

Introduction: Earlier, we documented that a combination of vitamins A and D3 synergistically inhibited the growth of MCF-7, T48:A18 and SKBR3 breast cancer cells with the best activity seen in the ER+ cell line MCF-7. Transcriptomic analysis of treated MCF-7 cells also showed that the combination significantly upregulated the apoptosis and unfolded protein response canonical pathways, and reduced estrogen signaling. Objective: This study aimed to explore the impact of increasing vitamin A and D3 dose combinations over time in a postmenopausal model of breast cancer using ovariectomized athymic female mice bearing MCF-7 xenografts and further analyze mechanisms of action in MCF-7 cells using RNA-seq analysis. Methods: MCF-7 breast cancer cells were grown in culture for the xenograft experiments. Athymic female mice were injected with MCF-7 cells (1 x 10^6 in 100 µl of 50% Matrigel mixed with sterile PBS) via subcutaneous injection. Once the tumors reached an average volume of 100 mm³, the mice were randomly divided into four groups and treated with different vitamin A and D3 combinations. Tumor sizes and mouse body weights were monitored on a biweekly basis. After the treatment period, the mice were euthanized, and the tumors were surgically removed and measured. RNA-seq data from the treated MCF-7 cells were then further evaluated using IPA. Results: As compared with controls, treatment with vitamin A (25,000 IU) and vitamin D (10,000 IU) led to a significant reduction in tumor volume &gt;70%, (p &lt; 0.05-0.01) in OVX athymic mice with MCF-7 xenografts as determined by a two-tailed Student T test. Over the treatment period, the tumor volume in mice treated with vitamin A (10,000 IU) and vitamin D (5,000 IU) or vitamin A (25,000 IU) and vitamin D (5,000 IU) also trended downward and was statistically significant using one-way analysis of variance (ANOVA) followed by Dunnett’s multiple comparison test (p&lt;0.05 and p&lt;0.0001, respectively) but was not significant using a two-tailed Student T test. In cultured MCF-7 cells, Ingenuity Pathway Analysis of mRNA-seq data showed that the vitamin A and D combination significantly altered the expression of 101 genes out of 864 in the molecular mechanisms in cancer canonical pathway, downregulating gene expression in the integrin/P13K/Akt/mTOR pathway. Conclusions: The findings showed that the combination of vitamins A and D3 effectively reduced tumor burden in a postmenopausal MCF-7 xenograft mouse model, with effects that were both dose-dependent and time-dependent. The combination also significantly altered the expression of genes in the molecular mechanisms of cancer canonical pathway in cultured MCF-7 cells. These preclinical data support the use of vitamins A and D3 in the management of estrogen-dependent breast cancers, with the caveat that higher doses and longer treatment periods may be needed to observe anti-tumor effects. Keywords: Apoptosis, autophagy, breast cancer, cell cycle, integrin, postmenopausal, P13K, tumor load, xenograft

Characteristics of positive and negative effects on the quality of life of breast cancer patients

BackgroundPostoperative and ongoing treatment of breast cancer is traumatic to women with breast cancer and may lead to positive and negative psychological diseases, which can affect the prognosis of patients with breast cancer. Positive affect (PA) and negative affect (NA) significantly impact the prognosis of postoperative breast cancer patients. However, the effects of specific emotions on patient prognosis and the relationships between them are still unclear.MethodsA case–control study was conducted to investigate the characteristics of PA and NA and their effects on Quality of Life (QoL) in breast cancer patients. 442 postoperative breast cancer patients and 444 healthy women were recruited from November to December 2021. For the observation group, participants were eligible if they (1) were aged between 16 and 80 years and (2) had a confirmed pathological diagnosis of breast cancer and (3) possessed the ability to read text, voluntarily agreed to participate, provided informed consent, and cooperated with the study procedures. The control group consisted of individuals without breast cancer who met all other criteria, as stated above. Patients were excluded from the study if they (1) had severe comorbid conditions causing functional impairment or life-threatening risks or (2) suffered from mental disorders or were unconscious at the time of the study. For the control group, individuals with a pathological diagnosis of breast cancer were also excluded. All other exclusion criteria were consistent with those for the observation group. The demographic information and clinicopathological information of the participants were collected. The Positive Affect and Negative Affect Scale (PANAS) is a scale containing 20 emotional scores related to emotion and is used to assess the level of positive and negative affect. The Quality of Life Questionnaire Core 30 (QLQ-C30) was used to assess the quality of life of cancer patients in 15 domains. SPSS 24.0 was used to analyze and process the data. Independent-sample t-tests, one-way ANOVA and Pearson correlation analysis, were used to analyze PA and NA in different treatment phases. Polynomial regression and response surface analysis were conducted to assess the relationships among PA, NA, and QoL. The results were considered statistically significant at P < 0.05.ResultsCompared with healthy women, breast cancer patients had lower scores on "alert" and "distressed" but higher scores on "inspired," "scared," and "afraid." There were no significant differences in the relationships between PA and NA between patients and healthy women (P > 0.05). During the initial treatment phase, the highest proportion of patients had an NA greater than the PA (PA < NA). In the rehabilitation phase, the highest proportion of patients had PA greater than or equal to the NA (PA ≥ NA). The relationship between PA and QoL was an inverted U-shaped curve (P < 0.05), whereas the relationship between NA and QoL was a positive U-shaped curve (P < 0.05). There was an interaction effect between PA and NA (P < 0.001). The relationships among PA, NA, and QoL varied across treatment phases. In the initial treatment phase, the presence of both positive and negative affect improved QoL. In the endocrine therapy phase, excessive positive effects decrease QoL. During the rehabilitation phase, QoL improved as positive affect increased relative to negative affect.ConclusionThere are significant differences in the distributions of positive and negative effects in breast cancer patients at different treatment phases. The impact of PA and NA on QoL varies by treatment phase. Our findings have important implications for tailoring emotional interventions for breast cancer patients at different stages of treatment.

The Sequence and Reconstructive Modality of Breast Cancer Treatments Affects Wait Times to Adjunctive Therapies in Patients Undergoing Mastectomy with Immediate Breast Reconstruction

Introduction: Breast cancer care requires both oncologists and plastic surgeons. Coordinating these specialists and combining extirpative and reconstructive procedures before adjunctive therapies can cause delays in care. For patients with less advanced disease, surgery is performed before adjunctive therapies, requiring early specialist coordination and the possibility of surgical complications. We compare these patients to those with more advanced disease requiring adjunctive therapies before surgery. Methods: A retrospective chart review identified 337 post-mastectomy + immediate breast reconstruction (IBR) patients. Patients were divided into surgery first (SF) and neoadjuvant chemotherapy (NC) first groups with reconstructive subgroups. Wait times between care pathway milestones were compiled and compared to national standards. Results: SF experienced longer wait times from consultation to treatment initiation (47 ± 51.5 vs 22 ± 22, P&lt;.001) and from first to second treatment modality (62 ± 35 vs 39 ± 17, P&lt;.001). Furthermore, only 29% of SF met the standard of receiving treatment within 4 weeks from consultation compared to 63% of NC ( P&lt;.001). Within subgroups, SF alloplastic reconstructions had shorter wait times compared to SF autologous reconstructions. For SF, only 31% of alloplastic and 24% of autologous reconstruction initiated treatment within 4 weeks of consultation. Conclusion: In this cohort of Canadian breast cancer patients, those receiving surgery first experienced prolonged wait times to treatment, particularly with autologous reconstruction. Patients should be informed of the potential impact on adjunctive therapies when considering reconstructive modality.

Genetic overlap between breast cancer and sarcopenia: exploring the prognostic implications of SLC38A1 gene expression

BackgroundSarcopenia, an age-related syndrome characterized by a decline in muscle mass, not only affects patients’ quality of life but may also increase the risk of breast cancer recurrence and reduce survival rates. Therefore, investigating the genetic mechanisms shared between breast cancer and sarcopenia is significant for the prevention, diagnosis, and treatment of breast cancer.MethodsThis study downloaded gene expression datasets and clinical data related to breast cancer and skeletal muscle aging from the GEO database. Data preprocessing, integration, differential gene identification, functional enrichment analysis, and construction of protein-protein interaction networks were performed using R language. Subsequently, COX proportional hazards model analysis and survival analysis were conducted, and survival curves and nomograms were generated. The expression levels of genes in tissues were detected using qRT-PCR, and the Radiant DICOM viewer software was used to delineate the pectoralis major muscle area in CT images.ResultsWe identified 152 differentially expressed genes (P < .05) and 226 sarcopenia-related genes (r > .4) associated with skeletal muscle aging. The TCGA-BRCA dataset revealed 106 genes associated with breast cancer (P < .05, logFC = 1). Functional enrichment analysis indicated significant enrichment in cell proliferation and growth pathways. The PPI network identified critical molecules involved in muscle aging and tumor progression. After dimensionality reduction, a strong correlation was observed between the expression of the muscle aging-related gene set and the prognosis of breast cancer patients (P < .01). The expression of SLC38A1 identified through multivariate COX analysis was significantly associated with poor prognosis in breast cancer patients (P = .03). Incorporating SLC38A1 expression, the prognostic model precisely forecasted breast cancer survival (P < .01). External validation confirmed the higher expression of the SLC38A1 gene in breast cancer tissues compared to adjacent non-cancerous tissues (P < .01). The SLC38A1 index, calculated in combination with the patient’s age and BMI, can optimize the prognostic prediction model, providing a powerful tool for personalized treatment of breast cancer.ConclusionHigh SLC38A1 gene expression was significantly associated with poor prognosis in breast cancer patients. The combination of SLC38A1 expression and the pectoralis major muscle area provided an optimized prognostic prediction model, offering a potential tool for personalized breast cancer treatment.

Potential Role of Bioactive Compounds of Purple Corn as Breast Cancer Drug Candidates Through Inhibition of Cyclin-Dependent Protein Kinase 6 (Cdk6): An In-Silico Approach

Cancer is characterized by disorderly cell proliferation. Upregulation and activation of the Cyclin-Dependent Protein Kinase 6 (CDK6) signalling pathway can induce uncontrolled proliferation of breast cancer cells. Therefore, inhibition of CDK6 persists to be developed as a target for the design and development of potential drugs to treat breast cancer. This study aims to predict the biofunction of anthocyanin compounds from purple corn extract as Cyclin- Dependent Protein Kinase 6 (CDK6) inhibitors in silico. The research methods used include data mining, ligand and receptor preparation, molecular docking, docking visualization, and data analysis. Our results show that six compounds of purple corn extract (cyanidin, cyanidin 3-glucoside, pelargonidin-3-glucoside, pelargonidin, peonidin, and peonidin-3-glucoside) can bind CDK6 at the C-terminal and N-terminal domains. The binding pattern indicated that cyanidin, cyanidin 3-glucoside, pelargonidin-3-glucoside, pelargonidin, peonidin, and peonidin-3-glucoside bind to the identical site CDK6 residues as Palbociclib (control). This finding indicated that compounds from purple corn are most likely competitive inhibitors of CDK6. Peonidin-3-glucoside showed the lowest binding energy of -282.5 kcal/mol, close to palbociclib (-329.4 kcal/mol).

Scientific mapping of the use of lecithin in breast cancer therapy

Lecithin, a natural phospholipid, possesses health-beneficial properties, recognized for its potential in breast cancer treatment. In recent years, it has been utilized in systems to enhance chemotherapy effectiveness, increase tumor penetration, and reduce side effects, offering less invasive and economically viable treatments. The aim of this study was to identify publication trends and patterns, leading journals, prominent authors, frequent keywords, and the influence of collaboration among researchers and institutions in scientific production on the topic. Employing a scientometrics approach, the study involved rigorous criteria for material search and selection to ensure data quality. A total of 241 studies were identified, with 81 selected after detailed filtering. Results indicate a rise in publications post-2012, peaking in 2020. 411 authors were identified, with Le, Ngoc Thuy Trang standing out, alongside three high-impact factor journals dominating the field. Strong collaboration among researchers and institutions was observed. Results were interpreted and discussed within the broader context of scientometrics. The study faced limitations, such as exclusive use of Bibliometrix potentially restricting analysis scope, and reliance on different databases yielding incomplete information. This study suggests future research to explore other natural substances with therapeutic potential and develop new methodologies to optimize drug delivery.

Anxiety, Depression, and Quality of Life in Women with Breast Cancer and Type 2 Diabetes: A Pilot Study in North Greece

Introduction: The incidence of breast cancer, as well as diabetes mellitus (DM), has continuously increased in recent years. The concurrent study of these diseases is particularly important, as there is a strong correlation between them due to hormonal, biochemical, and environmental factors. Moreover, the underlying metabolic dysfunction in this case could affect the treatment of breast cancer, as well as overall survival. In addition, the relationship of these two diseases with depression is not well studied. Patients with DM and cancer patients both experience depressive symptoms that have an impact on their mental health, as well as their quality of life. Personalized medicine offers a potential solution to these challenges by tailoring treatments to individual patient profiles. The present study will attempt to fill a gap in the existing literature regarding the relationship of patients with concurrent breast cancer and DM experiencing depression. More specifically, it will attempt to answer the question of whether there is a strong correlation between breast cancer, DM, and mental health in patients from a large geographical division of the country. Methodology: This was a cross-sectional study. A total of 120 female patients participated in the research, 60 with type 2 diabetes mellitus (T2DM) (group B) and 60 with T2DM and breast cancer (group A). The DASS-21 questionnaire was used to determine their levels of anxiety and depression, and ADDQoL-19 was used to measure the patients’ quality of life. Results: Regarding quality of life, women with T2DM and breast cancer showed a better quality of life (QoL) than women with T2DM. Women who were retired (p = 0.025) and consequently postmenopausal (p = 0.035) demonstrated the highest levels of QoL, while stage III cancer patients had lower ADDQoL-19 scores. Regarding mental health, in the women from group A, a positive correlation of treatment with the occurrence of anxiety and depression (p = 0.034) and a negative correlation of cancer stage with mental health was observed. The women in group B (those with T2DM only) showed better mental health outcomes related to their treatment (p = 0.009). However, both married and unmarried women in this study experienced mental health burdens, with no significant difference between the two groups in terms of mental health impact. These findings suggest that marital status did not significantly influence the mental health of the participants in this study. Conclusions: Women with T2DM and breast cancer generally presented a better clinical picture than women with T2DM alone. Therefore, the comorbidity of these two diseases did not seem to negatively affect the quality of life and mental health of these women.

Breast pericytes: a newly identified driver of tumor cell proliferation

IntroductionEffective treatment of breast cancer remains a formidable challenge, partly due to our limited understanding of the complex microenvironmental factors that contribute to disease pathology. Among these factors are tissue-resident perivascular cells, which play crucial roles in shaping vascular basement membranes, maintaining vessel integrity, and communicating with adjacent endothelial cells. Despite their essential functions, perivascular cells have been relatively overlooked. Identifying them by immunostaining has been challenging due to their low abundance, inherent heterogeneity, and shared marker expression with other cell types. These challenges have hindered efforts to purify pericytes and generate primary cell models for studying their biology.MethodsUsing a recently developed FACS method, we successfully identified and purified each cell type from breast tissues, allowing us to deep-sequence their transcriptomes and generate primary cell models of each cell type—including pericytes. Here, we used these data to analyze cell-type-specific gene expression in tumors, which revealed a strong association between pericyte-specific genes and breast cancer patient mortality. To explore this association, we defined the heterogeneity of breast pericytes using single-cell RNA sequencing and identified a broad marker for visualizing perivascular cells in breast tumors.ResultsRemarkably, we discovered perivascular cells dissociated from vessels and emerged as a dominant mesenchymal cell type in a subset of breast tumors that contrasted with their normal perivascular location. Moreover, when we purified pericytes from the breast and cultured them alongside breast tumor cells, we discovered that they induced rapid tumor cell growth significantly greater than isogenic fibroblast controls.DiscussionThese findings identify perivascular cells as a key microenvironmental factor in breast cancer, highlighting the critical need for further research to explore their biology and identify specific stimulatory mechanisms that could be targeted therapeutically.

SENP1 promotes deacetylation of isocitrate dehydrogenase 2 to inhibit ferroptosis of breast cancer via enhancing SIRT3 stability.

Breast cancer, one of the most prevalent malignant tumors in women worldwide, is characterized by a poor prognosis and high susceptibility to recurrence and metastasis. Ferroptosis, a lipid peroxide-dependent programed cell death pathway, holds significant potential for breast cancer treatment. Therefore, investigating the regulatory targets and associated mechanisms of ferroptosis is crucial. In this study, we conducted proteomic screening and identified isocitrate dehydrogenase 2 (IDH2) as an important player in breast cancer progression. Our findings were further supported by CCK-8 assays, transwell experiments, and scratch assays, which demonstrated that the elevated expression of IDH2 promotes breast cancer progression. Through both in vitro and in vivo experiments along with the erastin treatment, we discovered that increased expression of IDH2 confers resistance to ferroptosis in breast cancer cells. By employing Western blot analysis, Co-IP techniques, and immunofluorescence staining methods, we elucidated the upstream molecular mechanism involving SENP1-mediated SIRT3 de-SUMOylatase, which enhances IDH2 enzyme activity through deacetylation, thereby regulating cell ferroptosis. In conclusion, our study highlights the role of the SENP1-SIRT3 axis in modulating ferroptosis via IDH2 in breast cancer cells, providing valuable insights for developing targeted therapies aimed at enhancing ferroptosis for improved management of breast cancer.

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 &lt; 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.

Choice of therapy for HER2-positive metastatic breast cancer in real clinical practice: analysis of physician preferences in Russian Federation

Metastatic breast cancer still remains an incurable disease, requiring lifelong treatment. Introduction of targeted therapy into clinical practice has radically changed treatment approaches of HER2-positive breast cancer, making it possible to significantly increase the life expectancy. The treatment algorithm for HER2-positive metastatic breast cancer appears to be quite clear and is reflected in both international and Russian recommendations. To assess actual clinical practice in the Russian Federation, a survey study “Therapy of Her2-positive breast cancer” was conducted. This publication presents results dedicated to the treatment of metastatic HER2-positive breast cancer. 50 specialists from 43 cities took part in the survey. Only heads of departments or their deputies who were personally involved in determining the treatment for patients were allowed to participate. Expertise of this level allows us to reliably assess the actual clinical practice that has developed in the Russian Federation and determine directions for optimizing therapeutic approaches. Despite ongoing questions about the availability of drugs, doctors primarily focus on the effectiveness of treatment. The main first-line therapy in the Russian Federation is the combination of trastuzumab with pertuzumab. However, experts noted that in conditions of unlimited access to drugs, the number of prescriptions for this regimen in the first line would increase by 13%. Doctors also agree that the use of a subcutaneous form of this combination of drugs would optimize the treatment process. Trastuzumab emtansine remains the standard of second-line therapy and, according to the survey results, almost all patients for whom it is indicated receive this type of therapy. Experts predict more frequent use of trastuzumab emtansine in first-line therapy, given the widespread use of neoadjuvant regimens with pertuzumab. The most significant changes are expected in the third line of therapy with the introduction of the new conjugate – trastuzumab deruxtecan. The survey results demonstrate high awareness and commitment of physicians to modern principles of treatment of HER2-positive mBC.

Demographics and Health Characteristics Associated With the Likelihood of Participating in Digitally Delivered Exercise Rehabilitation for Improving Heart Health Among Breast Cancer Survivors: Cross-Sectional Survey Study.

Strong evidence supports the benefits of exercise following both cardiovascular disease and cancer diagnoses. However, less than one-third of Australians who are referred to exercise rehabilitation complete a program following a cardiac diagnosis. Technological advances make it increasingly possible to embed real-time supervision, tailored exercise prescription, behavior change, and social support into home-based programs. This study aimed to explore demographic and health characteristics associated with the likelihood of breast cancer survivors uptaking a digitally delivered cardiac exercise rehabilitation program and to determine whether this differed according to intervention timing (ie, offered generally, before, during, or after treatment). Secondary aims were to explore the knowledge of cardiac-related treatment side-effects, exercise behavior, additional intervention interests (eg, diet, fatigue management), and service fee capabilities. This cross-sectional study involved a convenience sample of breast cancer survivors recruited via social media. A self-reported questionnaire was used to collect outcomes of interests, including the likelihood of uptaking a digitally delivered cardiac exercise rehabilitation program, and demographic and health characteristics. Descriptive statistics were used to summarize sample characteristics and outcomes. Ordered logistic regression models were used to examine associations between demographic and health characteristics and likelihood of intervention uptake generally, before, during, and after treatment, with odds ratios (ORs) <0.67 or >1.5 defined as clinically meaningful and statistical significance a priori set at P≤.05. A high proportion (194/208, 93%) of the sample (mean age 57, SD 11 years; median BMI=26, IQR 23-31 kg/m2) met recommended physical activity levels at the time of the survey. Living in an outer regional area (compared with living in a major city) was associated with higher odds of uptake in each model (OR 3.86-8.57, 95% CI 1.04-68.47; P=.01-.04). Receiving more cardiotoxic treatments was also associated with higher odds of general uptake (OR 1.42, 95% CI 1.02-1.96; P=.04). There was some evidence that a higher BMI, more comorbid conditions, and lower education (compared with university education) were associated with lower odds of intervention uptake, but findings differed according to intervention timing. Respondents identified the need for better education about the cardiotoxic effects of breast cancer treatment, and the desire for multifaceted rehabilitation interventions that are free or low cost (median Aus $10, IQR 10-15 per session; Aus $1=US $0.69 at time of study). These findings can be used to better inform future research and the development of intervention techniques that are critical to improving the delivery of a digital service model that is effective, equitable, and accessible, specifically, by enhancing digital inclusion, addressing general exercise barriers experienced by chronic disease populations, incorporating multidisciplinary care, and developing affordable delivery models.

ChatGPT’s Agreement with the Recommendations from the 18th St. Gallen International Consensus Conference on the Treatment of Early Breast Cancer

ChatGPT’s Agreement with the Recommendations from the 18th St. Gallen International Consensus Conference on the Treatment of Early Breast Cancer

Evaluating high-sensitivity cardiac troponin I for early detection of treatment-related cardiotoxicity in HER2-positive breast cancer patients

Background: Trastuzumab-related cardiotoxicity is a common adverse effect of HER2-positive breast cancer treatment, especially when combined with anthracyclines. However, to date, no definitive prognostic markers have been found to predict trastuzumab-related cardiotoxicity. Methods: Patients diagnosed with HER2-positive breast cancer, scheduled to receive anthracyclines followed by 12 months of trastuzumab or with pertuzumab, were prospectively followed up for 27 months. Measurements of left ventricular ejection fraction LVEF, high-sesitivity troponin I hs-Tn I, and a full cardiac examination were performed at baseline, after anthracycline treatment, and after four cycles of anti-HER2 agents. Subsequently, LVEF measurement and full cardiac examination were conducted every 3 months until the end of the follow-up. Cardiotoxicity was defined as an absolute decrease in LVEF of ≥15%, or a drop in LVEF of ≥10% from the baseline to &lt;50%. Results: Among 78 patients, cardiotoxicity occurred in 13 (16.7%). A higher risk of cardiotoxicity was linked to hs-Tn I measured after four cycles of anti-HER2 agents (P &lt; 0.001), with a significant cutoff of &gt;84 ng/L. No short-term effects of the anthracycline agents (doxorubicin or epirubicin), were found. However, there was a slightly higher tendency to develop cardiotoxicity (P = 0.046) in patients treated with trastuzumab plus pertuzumab. Conclusion: Hs-Tn I measured after four cycles of trastuzumab in HER2-positive breast cancer patients could be an important predictor of cardiotoxicity induced by chemotherapy followed by anti-HER2 agents, particularly in the first year post-treatment, with a different cutoff value than that used in other cardiac conditions.