Archives of Breast Cancer

Online ISSN: 2383-0433
Print ISSN: 2383-0425
Publications
Background: The present study aimed to investigate breast cancer trend, incidence, and mortality among Iranian women and was one of the first provincial and population-based studies to investigate breast cancer changes during 14 years in the largest province of Iran, Kerman. Methods: This was a population-based longitudinal study. Information about women diagnosed with breast cancer from 2001 to 2014 was obtained from the Cancer Registry of Kerman University of Medical Sciences. Independent-samples t test, one-way analysis of variance, linear regression, time series graphs, and fitted line plots were performed using SPSS 22 and Minitab 17. Results: A total of 2771 women were diagnosed with breast cancer in Kerman province from 2001 to 2014. The mean age of female patients was 49.52±12.88 years. The total incidence rate was 13.5 per 100,000 women and there was an increasing trend for incidence and age at diagnosis. Also, 254 women died from breast cancer during these 14 years and the mean mortality age was 54.16±14.33 years. There was also an increasing trend for mortality and age of death. Conclusion: There is an increasing trend for incidence and mortality from breast cancer in Kerman province and this requires interventions such as appropriate screening programs. Also, enabling physicians and increasing patient awareness to identify breast cancer symptoms is necessary.
 
Disease-free survival based on hormone receptor. Y axis shows survival and X axis shows duration (months)
Baseline characteristics of 138 patients with recurrent breast cancer
Background: Nowadays breast cancer (BC) is the most common cancer in women. More than 1.5 million cases are detected yearly. Survival of patients is dependent on several factors. Metastasis and cancer recurrence of different types and in different locations have various outcome. Methods: This is a retrospective cohort study to describe survival of patients after diagnosis of breast cancer based on receptor subtypes and sites of metastasis among Iranian population. A total number of 2051 females with breast cancer were evaluated and among these, 138 patients with recurrent BC were investigated. Results: The 1-year survival of local, bone, visceral and brain metastasis were 64.99%, 63%, 32.83%, and 21.57%, respectively. Based on sites of metastasis, bone and local metastasis showed the best survival while brain and visceral metastasis had the worst survival and prognosis. Conclusion: Our study showed that Her2 enriched positive BCs had the worst survival and triple negative receptor BC showed the best survival. This may be due to the discovery of Herceptin drugs for Her 2 enriched receptor breast cancers which ameliorates their prognosis and survival. Also, drugs related to luminal A and B which are used to improve their survival and hormonal therapy could be associated with their better prognosis in comparison to triple negative receptor subtype. Since our patients have not consumed Herceptin drugs over the last 17 years, the difference between our findings and those of other studies could be related to the release of this category of drugs.
 
Patients' demographic and cancer-related characteristics.
Local Recurrence: Comparison between Conventional work up and PET/CT
Background: The aim of the present study was to investigate the added value of F-18 fludeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) compared with conventional imaging modalities for the evaluation of locoregional and distant sites of recurrence in breast cancer patients. Methods: From May 2013 to September 2016, 109 patients with suspected recurrent breast cancer who underwent conventional imaging and F-18 FDG PET/CT with an interval of 6 weeks were consecutively enrolled (mean age: 52.66 years; range: 29?79). Histopathologic results and clinical follow up based on the gold-standard imaging modality or serial imaging were considered as the reference for verification of F-18 FDG PET/CT findings. Results: Of 109 patients, 81 were found to have at least one site of recurrence (74.31%). Local recurrence was correctly identified in 32/32 patients following PET/CT, which was higher than that on conventional imaging (20/32, 62.5%). PET/CT detected 27 additional nodal metastases compared with conventional imaging (59 vs. 32, 45.76%), most frequently in the hilar/mediastinal region (n=27), followed by the supraclavicular lymph nodes (n=20, 62.5%), internal mammary lymph nodes (n=6, 18.77%), and axillary basin (n=6, 18.77%). Additional sites of distant metastasis were identified in 41 patients (37.61%) following F-18 FDG PET/CT imaging, 48.78% of which were localized in the skeletal system (n=20), 21.95% in the liver (n=9), 12.19% in the lungs (n=5), 12.19% in the brain (n=5), and 4.87% in the adrenal glands (n=2). Conclusion: F-18 FDG PET/CT serves as a useful supplement to conventional imaging techniques by identifying additional sites of disease recurrence in patients with breast cancer, which may change the preferred treatment strategy, particularly in regions that are not routinely evaluated by conventional imaging.
 
Background: Radiofrequency tags are used to localize breast lesions for surgery. During the Covid-19 pandemic, these offered the flexibility of inserting the Tags days or weeks before surgery. This made logistics of planning theatres lists easier, especially with most of the lists having been moved off site. Methods: In the 7 weeks following the first lockdown in the UK, we reviewed all planned admissions for breast surgery looking at the types of surgery offered, type of localization used and assessed which cases would not have been able to go ahead had radiofrequency tags not been available. Results: Out of 85 planned admission, 83 had surgery, 11 were for re-excision of margins and 72 for their first breast surgery excision (mastectomy or breast conservation). Out of the 54 that had breast conserving surgery, 40 needed localization, out of whom 27 had radiofrequency tags. Looking at theatre order list and location of surgery, 20 out of the 27 would not have had their surgery had radiofrequency tags not been available, which is 50% of the patients needing localization. Conclusion: Radiofrequency tags are new devices used for breast lesion localization that offer a much-needed flexibility especially as seen during the Covid-19 pandemic.
 
Highlighted recommendations for breast cancer care during COVID-19 pandemic published by recognized international societies
Background: In December 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), also named “COVID-19”, has produced a global pandemic and has seriously affected many health systems around the world. Since the World Health Organization (WHO) declared the novel COVID-19 outbreak as a global pandemic, many international societies and groups of experts have published clinical guidelines and recommendations for surgical management of breast cancer patients in this time of crisis and issued COVID guidelines to prioritize surgery where time is critical and it cannot be deferred. Methods: In this study, we review current recommendations for breast cancer surgery during the COVID-19 pandemic and propose a plan for future waves of the current pandemic while minimizing the risk of the contagious disease and oversaturating the health systems regarding the burden of accumulating untreated disease. Results: We create a critical and constructive vision from learnt lessons for similar future situations and propose a moving forward plan during and after the COVID-19 pandemic. Conclusion: Although in many parts of world, it would appear that now we are past the peak of the COVID-19 pandemic, we still face as uncertainty as to the future course of the pandemic and the challenges of the second wave. It is important to reappraise continuously the guidance and to emphasize the need for new protocols under new norms to continue to deliver breast cancer surgery safely.
 
Background: Nowadays breast cancer (BC) is the most common cancer in women. More than 1.5 million cases are detected yearly. Survival of patients is dependent on several factors. Metastasis and cancer recurrence of different types and in different locations have various outcome. Methods: This is a retrospective cohort study to describe survival of patients after diagnosis of breast cancer based on receptor subtypes and sites of metastasis among Iranian population. A total number of 2051 females with breast cancer were evaluated and among these, 138 patients with recurrent BC were investigated. Results: The 1-year survival of local, bone, visceral and brain metastasis were 64.99%, 63%, 32.83%, and 21.57%, respectively. Based on sites of metastasis, bone and local metastasis showed the best survival while brain and visceral metastasis had the worst survival and prognosis. Conclusion: Our study showed that Her2 enriched positive BCs had the worst survival, this may be due to Trastuzumab uncovered insurance till 10 years ago in our country. Also, drugs related to luminal A and B which are used to improve their survival and hormonal therapy could be associated with their better prognosis in comparison to triple negative receptor subtype. But this study showed that triple negative BC had better survival.
 
Reason for discussion at MDT and treatment recommendations during COVID-19 period of restriction (N=145)
Background: This study aimed to prospectively record changes to treatment for early breast cancer patients during the first wave of the COVID-19 pandemic in Australia. The purpose was to assess the impact on breast cancer outcomes and to determine the need for any mitigative actions. Methods: The study was conducted in the breast cancer unit of a tertiary referral hospital. Patients with early (non-metastatic) breast malignancy discussed in multidisciplinary team meetings between March and June 2020 were included. Patients were newly diagnosed, post-operative or post-neoadjuvant chemotherapy. Standard treatment was defined by Westmead Breast Cancer Institute protocols and any variations related to the pandemic were recorded. Results: In the study, 145 patients were included (median age 59 years). Pandemic-related changes to management were noted in 13 of 145 (9.0%) patients. Four patients experienced a delay to cancer treatments, four were not offered reconstructive/ symmetrisation surgical procedures, three had altered radiotherapy protocols and two patients were not offered enrolment to a clinical trial. These impacts affected the groups presenting with new cancers (n=7/86, 8.1%), post-operative cases (n=4/25, 16.0%) and post-neoadjuvant chemotherapy cases presenting for surgical planning (n=2/34, 5.9%). Conclusion: Most patients (91.0%) received standard treatment during the first wave of the pandemic. The minor variations from institutional protocols observed in this study are unlikely to affect local control or survival in this patient cohort, but close follow-up is required. Quality of life may have been affected for four patients who had downgraded or delayed reconstructive procedures.
 
Background: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with unknown etiology. Clinico-radiologic findings can mimic breast cancer. Further pathologic evaluation to rule out malignancy is mandatory. Recognizing the severity of the disease is crucial to choosing the most effective therapeutic modality. The aim of this study is to evaluate clinical and radio-pathologic features of IGM, and the treatment outcome in a large series of IGM patients in Iran.Methods: The retrospective charts of 243 patients suspicious of IGM, between December 2007 and September 2017 were reviewed. Patients with confirmed diagnosis of IGM were classified into four grades of severity. Demographic information, clinical and radio-pathologic findings, severity and treatment outcomes were collected.Results: Overall, 224 patients were confirmed to have IGM. Breast mass and erythema were the most common clinical findings. Mammographic findings mimicked malignancy in 34%. Lobulo-centric non-caseating granulomas were the most common pathologic finding. Also, 61.5% of the patients had mild to moderate symptoms and 49.5% of them recovered completely by observation. In addition, 53 (25.9%) patients had severe symptoms and 30.8% of them were resistant to treatment. Conclusion: IGM is a diagnostic challenge. Its diagnosis is based on exclusion and a close cooperation between the clinician, the radiologist and the pathologist. Mild to moderate cases can be managed conservatively; however, severe cases may need further aggressive medical or surgical treatments.
 
Percentage of normal cells, early apoptosis, late apoptosis and necrotic cells in MCF7 cell lines after 72 hours in treated SNA (Sambucus nigra), DOX (Doxorubicin) and SNA+DOX (Sambucus nigra + Doxorubicin) and control groups (mean ± SEM, n=3).
Background: The study aimed to assess the effect of anti-tumor and anti-proliferative properties of Sambucus nigra (SNA) on MCF-7 and MDA MB-231 breast tumor cell lines. Methods: The cytotoxicity of SNA was assessed based on dose/time by the MTT assay. Also, the influence of SNA on apoptotic pathways, cellular and metabolic resistance in these cell lines was examined by real-time PCR, lipid peroxidase was measured by malondialdehyde (MDA) and the effect of apoptosis and necrosis was determined by flow cytometry. Results: Our data showed that DOX, SNA, and DOX + SNA treatment induced the expression of p53, Bax, Bcl-2, Caspase-3, and 8 levels involved in the apoptotic pathways. ATP binding cassette subfamily B member 4 (ABCB4) gene expression was decreased in MDA‑MB-231 breast cancer cells compared to MCF-7. Also, we observed that DOX, SNA, and DOX + SNA treatment induced expression of Monocarboxylate transporters (MCTs) metabolic pathways such as MCT1 and MCT4. Conclusion: Overall, the outcomes of this investigation show that the combination of SNA-Doxorubicin (DOX) in different groups of these cancer cells, especially in the MDA‑MB-231 cell lines synergistically intensified the induction of apoptosis in them. SNA enhances the anti-cancer effects of DOX to induce cellular apoptosis, alter metabolic pathways, and reduce cellular resistance. The research highlights the promising use of SNA as a chemosensitizer in the chemotherapy.
 
Representation of the digital breast phantom adopted for MC simulations. The breast tissue (in pink colour), in which the mean glandular dose estimates are computed, is surrounded by the 1.45 mm thick skin envelope; for visual purposes, the skin thickness is emphasized in this image. Compressed breast thickness is varied in the range 3-7 cm. Compression paddles (upper and lower) and the detector surface are represented.
f(G) for normalized glandularities ranging from 0.01 to 1. Error bars are mainly affected by the uncertainties on the experimental-based 2ABD quantities (~20%), while uncertainties related to MC-based MGD quantities are negligible MC (less than 0.2%). Both MGD and 2ABD are normalized for their respective incident air kerma (Eq. (5)). Data refer to a 4.5 MC
Mean glandular dose values obtained converting the 2ABD estimates. kV and mAs are typical parameters automatically selected by the DBT unit for the specified breast thickness.
Comparison between the MGD values obtained by converting the 2ABD estimates, 2ABD and MGD values obtained with dedicated Monte Carlo simulations using the formalism described MC in the text. Both MGD2ABD and MGD are normalized for the respective incident MC 25 air kerma. Data provided by MC calculations are in good agreement with Sarno et al.
Background: In this work a new method for the Mean Glandular Dose evaluation in digital breast tomosynthesis (DBT) is presented. Methods: Starting from the experimental-based dosimetric index, 2ABD, which represents the average absorbed breast dose, the mean glandular dose MGD2ABD was calculated using a conversion function of glandularity f(G), obtained through the use of Monte Carlo simulations. Results: f(G) was computed for a 4.5 cm thick breast: from its value MGD2ABD for different compressed breast thicknesses and glandularities was obtained. The comparison between MGD2ABD estimates and the dosimetric index provided in the current dosimetry protocols, following the Dance's approach, MGDDance, showed a good agreement (
 
Craniocaudal(a) and mediolateral oblique(b) views of mammography show multiple hyperdense irregular shapes and margin lesions with coarse macrocalcification and a few coarse heterogenous microcalcifications.
Background: Mucinous carcinoma (MC) is a rare breast malignancy with a large extracellular mucin secretion. It has a good prognosis in comparison to other breast malignancies. Case presentation: We report a 32 years old female with multiple hard palpable masses in the left breast with rapid growth in 6 months. She was mentally retarded with lower limb varicose veins associated with mucocutaneous lesions on the face. She underwent ultrasound examination of the breast, thyroid and lower extremity veins. Core needle biopsy and fine needle aspiration from left breast lesions and right thyroid nodules showed MC and follicular lesion with hurtle cell change, respectively. Suspected metastasis in the left rib and calvarium in the subsequent bone scan survey and brain magnetic resonance imaging was reported. She underwent radical mastectomy and right hemi-thyroidectomy. Conclusion: Pure mucinous carcinoma with micropapillary pattern (MUMPC) is a new histology variant of Pure Mucinous Carcinoma (PMC) that shows favorable prognosis with less aggression and occurs in older patients. However, PMC in our patient occurred at a young age with greater aggression.
 
Background: Idiopathic Granulomatous Mastitis (IGM) is a chronic inflammatory disease of the breast. Although most of the studies have reported IGM as a rare disease, recent studies have shown an increase in the prevalence, especially in developing countries. The most important challenge is about the appropriate treatment of this disease that is not established yet. The aim of this cross-sectional study was to review the definite cases of IGM in terms of clinical characteristics and the result of treatment at Motamed Cancer Institute (MCI). Methods and Materials: This retrospective study was conducted on 383 women who were referred to Motamed Cancer Research Institute with a confirmed diagnosis of IGM for a two-year period from March 2015 to February 2018. The demographic and clinical characteristics and the result of treatment options were extracted from the patients’ medical records. The data was statistically analyzed using SPSS version 22. Results: Among 383 pathologically proven cases with IGM, the mean age was 35.6+7.593 years, 97% of them had a history of pregnancy and 95.2% had breastfed. The most common symptoms of the disease were palpable mass, pain, fistula to the skin and inflammation respectively. In response to the prescribed treatments, among 241 patients with available follow-up, the most commonly used treatment was Corticosteroids + Methotrexate (70.1%), the highest complete remission was in the group receiving Corticosteroid (100%) and Methotrexate (97%) respectively and the highest partial remission belonged to Corticosteroid+ Methotrexate with the frequency of 21.3%. The shortest time to complete remission belonged to Methotrexate regimen with a mean duration of 5.83 months and the highest recurrence rate was seen in the group receiving Corticosteroids alone (16.7%). Conclusion: According to the results of this study, among the prescribed treatments, the highest rate of complete remission with the lowest duration and recurrence rate belongs to Methotrexate regimen. Corticosteroids were associated with the high rate of complete remission but high rate of recurrence yet. Given the autoimmune nature of IGM, such results seem expectable and Methotrexate could be recommended especially in moderate to severe forms and as an additional treatment to taper Corticosteroids. Implementation of clinical trials regarding the best treatment options for IGM is recommended.
 
Background: 2-thio-6-azauridine (TAU) is a nucleoside analog and potential antiviral drug. The antiproliferative activity of TAU has been evaluated in limited cancer cell lines. The present study is aimed to evaluate the effect of TAU on drug sensitization mechanism in paclitaxel (PTX) resistant triple-negative breast cancer (TNBC) cells. Methods: The cell death mechanism was determined using MTT, BrdU incorporation, apoptosis, and DNA damage Western blot and RT-PCR assays. A specific ELISA method was used to determine the caspase-3 activity and expression levels of MRP1, MDR1, BCRP, and MRP8. Western blot analysis was used to assess the expression of CD151, MRP1, MDR1, and BCRP in CD151 overexpressing PTX-resistant TNBC cells. Results: The combination of TAU and PTX (10:20nM) synergistically inhibited the 50% viability of 12-fold PTX-resistant TNBC cells. Mechanistically, the combination inhibited the proliferation by arresting the cell cycle at the G2M phase and induced apoptosis by altering cell integrity and nuclear morphology as well as damaging DNA. The combination sensitized the PTX-resistant TNBC cells by increasing BAX and decreasing Bcl-2 expression, activating caspase-3, and reducing the expression of ABC transporters MRP1 and MDR1. The combination reduced the expression of MRP1 and MDR1 in CD151 overexpressing PTX-resistant TNBC cells, indicating the role of CD151in TAU mediated sensitization of PTX-resistant TNBC cells. The combination also reduced the mammosphere formation efficiency of PTX-resistant TNBC cells. Conclusion: Overall, the present study illustrated the promising ability of TAU in sensitizing drug-resistant TNBC cells to PTX.
 
Ultrasound images, transverse (a) and coronal (b) planes with confirmation in three dimensions of correct placement of the 3 electrodes.
Macroscopic appearance of breast specimen after ablation: central charring of the needle track through the center of the tumor (a) with a surrounding area of yellow, coagulated, adipose and breast tissue (white arrows in b). Red fat is seen in the area outside the zone of thermal destruction (green arrows).
Background: Current trends in breast cancer treatment include the use of less aggressive surgeries to reduce morbidity, shorten hospital stays and improve cosmetic results. The aim of the study is to assess tumor cell viability after percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for small breast cancer by a combination of staining techniques. Methods: A prospective study was conducted at a single institution from 2013 to 2017. Twenty women with invasive ductal carcinoma of the breast measuring ≤ 20 mm were treated with US-guided RFA followed immediately by surgical resection. Tumor viability pre- and post-RFA was assessed with Hematoxylin and Eosin (H&E), Nicotinamide adenine dinucleotide (NADH), Succinate dehydrogenase (SDH), Cytochrome c oxidase (COX), Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and Cytokeratin 18 and 19 (CK18/CK19) staining techniques. Outcomes and correlation with the different techniques were evaluated with principal component analysis Cronbach’s alpha. Results: Oxidative enzymes in frozen sections showed loss of SDH and NADH in 13 of the 16 tumors (81%) and COX in 11 of the 13 tumors (84%). In paraffin-embedded tissues, CK18 was negative or markedly reduced in 98% and CK19 in 100% of the cases. Lack of evidence of cell death was seen in 3 cases where the maximum temperature achieved at the center of the tumor was ≤ 70ºC. The reliability and internal consistency between the different staining techniques was high (Cronbach’s alpha, 0.8), with concordance between the staining results of the oxidative enzymes and of CK18/CK19. Conclusion: Loss of tumor viability in small breast tumors after US-guided percutaneous RFA could be assessed in our series with different staining methods. CK18 and CK19 could be used in paraffin-embedded tissues as surrogate markers of tumor cell viability after immediate RFA.
 
Selected nonrandomized phase 1/2 clinical trials with interstitial brachytherapy with longer follow-up
Background: Accelerated partial breast irradiation (APBI) is defined as applying high doses of radiation with a shorter interval to the lumpectomy cavity in the setting of breast-conserving therapy for early-stage breast cancer. This treatment strategy is attractive to patients, and its utilization has increased during recent years because of the shorter treatment schedule, better cosmetic outcomes, and acceptable local control rates in selected patients undergoing breast-conserving therapy. Here we provide an overview of various APBI techniques in terms of clinical and cosmetic outcomes, quality of life, and cost of treatment. We also review the current guidelines for selecting suitable breast cancer patients for APBI strategy. Methods: A comprehensive literature search of PubMed between 1996 -2019 that was made was made for case series and randomized studies with at least 2 years of follow-up in term of clinical and cosmetic outcomes, quality of life, and treatment costs. Results: Technological advances have made various APBI modalities, including intracavitary and interstitial brachytherapy, intraoperative radiation therapy, and external-beam radiation therapy, more accessible in the community. Mature data from several randomized and prospective nonrandomized trials have contributed to the development of consensus guidelines for selecting the most appropriate candidates ABPI. Conclusion: APBI represent an attractive treatment option for appropriately selected patients with early breast cancer. Irrespective to various techniques used for APBI it is very important to select the most appropriate patient population according to reliable guidelines for this treatment strategy that could be non-inferiority to whole breast irradiation especially in high-volume radiation centers with long waiting lists and for patients who live far away from the radiotherapy centers.
 
The importance of designated referral pathways for preference-sensitive treatments
Background: This study aimed to document referral-based barriers impeding Australian women's informed decision-making about breast reconstruction (BR) and to propose a designated BR referral pathway to help overcome these barriers.Methods: Semi-structured, in-depth interviews were conducted with ten women previously treated for breast cancer, 9 breast and reconstructive surgeons and 6 health professionals [n=25] who had identified problems with referrals for BR. Results: Referral-based barriers to BR discussion were identified at three different levels: from a public or private screening center to a General Practitioner (GP) or breast surgeon; from a GP to a breast surgeon; and from one breast surgeon (without BR skills) to another breast or plastic reconstructive surgeon (with BR skills). A lack of designated referral pathways has meant that clinically eligible women who are interested in considering immediate BR have been denied this opportunity.Conclusions: Streamlining referral processes, along with patient and clinician education, would help to ensure that women are at least seen by the most appropriate clinicians to discuss BR options and to maximise their opportunity for BR should they choose that option. Designated referral pathways could also be useful in ensuring that preference-sensitive treatment decisions are facilitated in settings with varying degrees of resources and in a range of clinical conditions.
 
The concordance of US and mammography results with pathology reports
Diagnostic statistics for US and mammography for breast malignancy considering pathology as the gold standard findings
Background: Ultrasonography and mammography are two radiologic approaches for screening breast cancer; however, the pathology report is required for the ultimate diagnosis of malignancy. This study aimed to assess the concordance of ultrasonography (US) and mammography with the pathology in breast cancer.Methods: A cross-sectional study was conducted to assess the breast US and the mammography findings based on the BI-RADS model in comparison with the definitive pathology reports in a single medical center. The sensitivity, the specificity, positive (PPV) and negative predictive value (NPV) and also the concordance between the US and the mammography data were analyzed.Results: In this study, 126 patients were included. The sensitivity, specificity, PPV, and NPV for the US were 69.8, 71.9, 75.6 and 81.3 and for mammography were 91.9, 76.6, 80.8 and, 94.6 percent, respectively. The ROC-curve for either the US or the mammography showed that the BI-RADS 4 was accompanied with the highest sensitivity and specificity for the screening of the malignant breast lesions regarding the final diagnosis. Although an overall higher correlation between mammography report and presence of a malignant lesion was observed, the total relative concordance between the results of US and mammography as screening tools proved to be statistically significant (P<0.01).Conclusion: Both the US and the mammography were sensitive and specific screening tools, particularly for the malignant breast lesions. Furthermore, when evidence of the BI-RADS?4 in either the mammography or the US was present, utilization of the other test could be ignored before biopsy.
 
Background: Breast cancer is considered a major health problem and the most common cancer among females in both developed and non-developed countries. Early diagnosis of breast cancer decreases morbidities and mortalities. This study attempts to explore the accuracy measures of a digital mammography unit in the diagnosis of breast cancer and compare the mammography results with the final histopathology results. Methods: The study was designed as a cross-sectional prospective hospital base in which mammography examination was used for patients. Then, U/S was performed as a complementary study. All the mammography and U/S reports were reviewed and compared with the histopathology results. Six indicators were used to measure the accuracy of the mammography system using their formulas. SPSS program was used to examine the correlation between imaging results and histopathological findings and to draw the area under the receiver operating characteristic curve (AUC). Confidence interval was considered at 95% and margin of error at 5%. Results: Sensitivity, Specificity, PPV, NPV, accuracy and the area under the ROC curve of mammography alone were 94.9%, 66.7%, 90%, 66.7%, 0.771 and increased to 100%, 76.9%, 90.3%, 100%, 92.7%, 0.917, respectively when Ultrasound was used as a complementary to mammography. A statistically significant moderate correlation was shown between the results of mammography alone and histopathology results (Spearman correlation= 0.527, P-value<0.01), and a statistically significant strong correlation between mammography combined with ultrasound, and histopathology results (Spearman correlation=0.882, P-value<0.01). Conclusion: Mammography is an important tool to detect breast cancer. Mammography when combined with Ultrasound yields a very significant improvement in sensitivity and specificity for diagnosing different breast lesions.
 
A schematic flow chart of the algorithms.
Comparison of accuracy rates among algorithms in the distribution of accuracy rates in validating classification data.
Comparison of accuracy rate of algorithms for optimization and search for parameters effective in cancer detection
Comparison of accuracy rates.
Background: Breast cancer (BC) is a prevalent disease and a major cause of mortality among women worldwide. A substantial number of BC patients experience metastasis which in turn leads to treatment failure and death. The survival rate has been significantly increased due to more rapid detection and substantial improvements in adjuvant therapies including newer chemotherapeutic and targeted agents, and better radiotherapy techniques.Methods: In this study, we cross-compared the application of advanced artificial intelligence algorithms such as Logistic Regression, K-Nearest Neighbors, Discrete Cosine Transform, Random Forest Classifier, Support Vector Machines, Multilayer Perceptron, and Ensemble to diagnose BC metastasis. We further combined MLP with genetic algorithm (GA) as a hybrid method of intelligent analysis. The core data we used for comparison belonged to the images of both benign and malignant tumors collected from Wisconsin Breast Cancer dataset from the UCI repository.Results: The application of several different algorithms to the collection of BC data indicated that these algorithms have comparable accuracy rate in detecting and predicting cancer. However, our hybrid algorithm showed superior accuracy, sensitivity and specificity compared to the individual algorithms. Two methods of comparison (Cross-Validation and Holdout) were applied to this study which produced consistent results.Conclusion: Our findings indicate that our MLP-GA hybrid algorithm can speed up diagnosis with higher accuracy rate than the individual patterns of algorithm.
 
Background: Several studies reported the role platelet activation, platelet volume (MPV) and other Indices in breast cancer but the data is inconsistent and/or diverse. The aim of this study was to systematically evaluate the role of platelet activation and platelet volume indices in women with BC as predictors for cancer progression and poor prognosis. Methods: Patients were recruited from our local oncology center between 2019 to 2020 following ethics approval. 80 patients with locally invasive BC, 20 metastatic and 100 controls were recruited. ADP-induced platelet activation was assessed by light-transmission aggregometry. Platelet P-selectin (CD62P) expression with and without ADP stimulation was assessed by flow cytometry. A comprehensive analysis of platelet count and platelet volume indices (PVIs) (MPV, PDW, MPV/P and PDW/P) was conducted. Data were analyzed in relation to tumor pathology, hormone receptors (ER, PR, HER-2) and proliferation index Ki-67. Regression analyses were conducted for the prediction of poor prognosis, tumor aggression and metastatic potential. Results: We found a significant increase in platelet aggregation (MA), CD62P expression, CD62P+ADP, MPV, PDW, MPV/P and PDW/P in the metastatic group compared to the locally invasive group. Univariate regression analysis showed significance for ADP, MA, CD62P+ADP, MPV and PDW/P. Conclusion: MPV/P and PDW/P can be used as simple low-cost predictors for cancer progression and poor prognosis. We conclude platelet activation and specific platelet indices can help predict prognosis in females with BC.
 
Background: External compression, thrombosis, or stenosis of the superior vena cava can lead to superior vena cava syndrome, a diagnosis that should be considered swiftly in patients presenting with classic symptoms such as facial and neck swelling, plethora, and distended neck veins. Case Presentation: We report a case of acute port-a-cath associated superior vena cava thrombosis in a longstanding, previously uncomplicated vascular access device in a patient with stable ER+/PR+/HER2+ metastatic breast cancer. After initial treatment, there was limited clinical improvement with subcutaneous low molecular weight heparin (LMWH). Following multidisciplinary team discussion, catheter-directed thrombolysis was performed, which resulted in complete symptom resolution. Conclusion: The recognition of signs and symptoms is crucial in diagnosing acute superior vena cava syndrome, particularly in patients with a malignancy history or a central venous access device in situ. The thrombotic complications of port-a-cath symptoms can occur at any time and management should be guided by multidisciplinary discussion. In appropriately selected patients, catheter-directed thrombolysis can be successful and can lead to rapid symptom resolution.
 
37 year old female patient diagnosed with left breast cancer by US and mammography with extremely dense breast on mammography (ACR d), preoperative MRI was done and revealed a) Speculated outline malignant featuring left breast mass at about 6 o'clock. b) Multiple enhancing foci seen surrounding the mass with ductal enhancement denoting multicentricity. c) Suspicious non-mass enhancement at the upper inner quadrant of right breast. Histopathological examination proved multicentric invasive ductal carcinoma of the left breast and invasive ductal carcinoma of the right breast.
Female patient, aged 57 years old, diagnosed as right breast cancer by US and mammography, and preoperative breast MRI revealed malignant featuring unifocal mass at the lower outer quadrant of right breast, no other enhancing lesions of right breast, normal left breast. Histopathological evaluation proved invasive ductal carcinoma of the right breast.
Characterictics data of the participants(n=84)
MRI findings of the participants (n=84)
Background: Breast MRI has demonstrated excellent sensitivity in determining the extent of breast cancer and occult malignancy. This study aimed to evaluate the added value of breast MRI compared to mammography and ultrasonography in surgical decision.Methods: A cross-sectional study was conducted on 84 female patients with newly diagnosed breast cancer by ultrasonography and mammography where conservative breast surgery was initially considered, and then bilateral breast MRI was performed and the multidisciplinary decision was revised. The data was analyzed to determine the additional value of breast MRI in treatment planning.Results: Eighty-four patients were included of whom 44 (52.4%) patients had additional findings on MRI. The treatment plan was changed after the second ultrasonography and histopathology in 44 patients (52.4%) with a remarkable increase in the rate of modified radical mastectomy after MRI. Conclusion: Preoperative breast MRI has great value in defining the surgical decision in patients with early breast cancer.
 
Population characteristics.
Characterization of the preoperative biopsy.
Surgical treatment and tumor characteristics.
Adjuvant therapy and outcomes
Background: Adenoid cystic carcinoma of the breast (ACCB) is a rare breast malignancy. Despite often being a triple negative tumor, it has a favorable prognosis, with low rates of recurrence and progression. The ideal treatment of ACCB is debatable; thus, the aim of this study was to characterize a population diagnosed with ACCB and to evaluate the treatment outcomes. Methods: We performed a single-center retrospective analysis of patients with a histological diagnosis of ACCB treated at our dedicated Oncological Center between 1987 and 2020. The patients were identified in collaboration with the Anatomical Pathology Department, which also reviewed the surgical pathology reports. Results: Thirteen women with a median age of 68 years old were diagnosed with ACCB. The most frequent clinical diagnosis was a breast nodule (n=5); the preoperative image was suggestive of malignancy in nine patients, with seven being diagnosed with a ACCB in the preoperative biopsy. Regarding treatment, nine patients underwent conservative surgery, but three required re-excision. Sentinel lymph node biopsy (SLNB) was performed in seven patients, none revealing metastases; one patient had stage III ACCB and was initially treated with a modified radical mastectomy (MRM); the remaining were stage I (n=7) and II (n=5). Adjuvant radiotherapy was performed in eight patients, and two were initially proposed for chemotherapy but were considered unfit. With a median follow-up of 123 months (16-407), one case of local recurrence and two cases of distant metastasis were identified, one of whom died of disease. Conclusion: ACCB is a rare tumor with a good prognosis; however, as demonstrated, it can present an aggressive behavior. Conservative surgery and adjuvant radiotherapy are the indicated treatment and SLNB may be omitted in grade 1 tumors.
 
Background: NCCN guidelines recommend surgical excision for patients with atypical ductal hyperplasia (ADH) on percutaneous biopsy. Improved imaging and biopsy techniques have lower contemporary upgrade rates, challenging standard practice. We sought to identify low-risk features of ADH to define patients who may benefit from active monitoring over surgical excision.Methods: A retrospective analysis identified 87 stereotactic biopsies diagnosing ADH undergoing surgical excision at a single institution from 01/2008 to 10/2015. Imaging was reviewed for lesion size and residual calcifications. Biopsy slides were reviewed for ADH features. Categorical variables were analyzed using Chi-square and Fisher’s exact tests; continuous variables with T- and Wilcoxon tests. Logistic regression model was used to determine the association between the number of low-risk features present and odds of upgrade.Results: Upgrade was identified in 13 cases (14.9%; 11 ductal carcinoma in situ and 2 invasive breast cancer). Low-risk imaging features included imaging size <1cm (P=0.004) and >50% removed by biopsy (P=0.03). The only significant low-risk pathologic feature was the lack of micropapillary features (P=0.10). Focal ADH (1-2 foci, P=0.12) was felt to be clinically significant. Those with the lowest risk of upgrade (0%) had all 4 low-risk features (n=17, 20%). When comparing biopsies that differed by one low-risk feature, the biopsy with one less low-risk feature present had 129% increase in odds of upgrade (exact OR=2.29, 95% CI 1.35, 4.15, P=0.001). Conclusion: Overall upgrade rate was low in this contemporary cohort. Patients at lowest risk for upgrade had all 4 low-risk features and could be safely offered active monitoring over surgical excision.
 
Background: Health literacy (HL) is an individual’s ability to interpret and effectively utilize health information. Low HL has been associated with poorer treatment adherence. The effect of HL on treatment adherence is important to understand when survival is closely tied with treatment, such as in breast cancer (BC). The aim of our review was to examine the influence of HL on treatment adherence in BC patients. Methods: A scoping review was conducted according to the Joanna Briggs Institute methodological framework. A comprehensive search was performed using 5 electronic databases to map the available literature. Studies were included that assessed BC patients’ HL with a validated instrument and associated this with treatment adherence. Results: Our review initially yielded 1404 studies. Of these, 9 studies (n=2468) met our inclusion criteria. Five studies (n=1478, 60%) found no association between HL and treatment adherence. Of the 3 studies (n=1175) focused on breast surgery decision-making, 2 studies (n=915, 77.8%) reported a positive association between HL and the decision to partake in reconstruction. In contrast, 3 (n=936) of 5 (n=1147) studies examining adjuvant therapy demonstrated that treatment decisions were not affected by HL. Conclusion: Although it is difficult to determine the relationship between HL and treatment adherence from the contrasting results of the available literature, HL may have a greater impact on surgical decision-making as compared to the receipt of adjuvant therapy. Additional research is required to better characterize the effects of HL on treatment adherence, including surgical decision-making.
 
Patient characteristics
Removed nodes and biopsy method
Background: The optimal number of sentinel lymph nodes (SLNs) to be removed is controversial based on the false negative rate and prognosis. We investigated factors related to the number of SLNs and the possibility of optimizing the number of SLNs. Methods: We retrospectively reviewed 167 cases in which 0.3 or 0.5 ml of ferucarbotran was sub-dermally injected without massage from July 2016 to November 2018. Sentinel lymph node biopsy (SNB) was conducted using both radioisotope (RI) and superparamagnetic iron oxide (SPIO). The removed nodes with a value of ?0.5 ?T on a magnetometer were considered to be SLNs (SPIO nodes). The total SPIO node count in each case was calculated. Results: There was a significant correlation between the number of SPIO nodes and total count of SPIO nodes (rs=0.821, p
 
Use of adjuvant chemotherapy per year of treatment in patients with hormone-sensitive, HER-2 negative, and 1-3 node positive tumors
5 year distant recurrence-free interval curve in 66 patients treated during 2004-10 and in 170 patients treated during 2011-18
Events in the 236 patients
Background: There is a tendency to decrease the intensity of breast cancer treatments, e.g. omitting adjuvant chemotherapy in endocrine-sensitive and HER-2 negative patients. The purpose of this study was to analyse changes in the frequency of the indication of adjuvant chemotherapy and the differences in survival over time for this subtype of breast cancer, with 1–3 positive nodes. Methods: The study was based on descriptive, observational, retrospective, single-institution research between 2004–10 and 2011–18, on endocrine-sensitive, HER-2 negative breast cancer, stage pN1 (1–3 nodes). The analytical tests carried out for a comparison of the frequency of chemotherapy use the chi-square test with Fisher's exact test. Survival data in both periods are presented. Results: A total of 236 patients were included, 66 for the period 2004–10, and 170 for 2011–18. More patients were treated with hormone therapy alone in 2011–18: hormone therapy alone 10/66 (15.20%) for 2004–10, and 83/169 (49.10%) for 2011–18; chemotherapy-hormone therapy 56/66 (84.80%) for 2004–10, and 86/169 (50.90%) for 2011–18 (P = 0.0001). For 2004–10, the 5-year overall survival probability was 100%. For 2011–18 it was 98.20% (95% CI 95.65–100). For 2004-10, 5-year disease free survival (DFS) was 96.9% (95% CI 92.7–101). For 2011–18 it was 87.7% (95% CI 81.8–93.5) (P=0,040). For 2004–10 the 5 year distant relapse free interval was 96.9% (95% CI 92.5–101.2). For 2011–18 it was 93% (95% CI 88.1–97.9) (P=0.312). Conclusion: A decrease in the indication of adjuvant chemotherapy according to the clinical risk is confirmed in endocrine-sensitive, HER-2 negative breast cancer, with 1-3 positive nodes, over the period 2011–18 compared to 2004–10. Based on the results, 5-year DFS is slightly worse in the 2011–18 period.
 
Background: Triple negative breast cancer (TNBC) is the most aggressive and worst prognosis group among breast cancer molecular subtypes. Determining the prognostic factors and parameters affecting survival in the TNBC group were aimed with this retrospective study. Methods: The patients were divided into two groups as TNBC and non-TNBC. Clinicopathological and treatment parameters of both groups were compared. Survival rates were evaluated using Kaplan Meirer method. Results: 110(11.1%) of 992 patients were triple negative. 2, 5 and 10-year overall survival (OS) was 91.8%, 75.8%, 64% and 98.5%, 91.3% and 76.2%, respectively in the TNBC and non-TNBC groups. Disease-free survival (DFS) was median 29.7 months in the TNBC group and 52.37 months in the non-TNBC group. The TNBC group has more grade 2-3 tumors (95.8% vs 87.8%, p=0.019), higher ki-67 value (72.7% vs 44.9%, p<0.001), more metastasis presence (28.2% vs 16.2%, p=0.002) and more exitus (28.2% vs 14.5%, p<0.001) than the non-TNBC group. It was not statistically significant as well as local recurrence was higher in the TNBC group. Brain metastasis was observed more frequently in the TNBC group. In the TNBC group, being ≥70 years of age (p=0.05), having T3-4 disease (p=0.040), presence of PNI (p=0.022), presence of metastasis (p<0.001), presence of brain metastasis (p=0.049) had a negative effect on OS in univariate analysis. Conclusion: Shorter OS and DFS were found in the TNBC group similar to previous studies. Since hormonal treatment cannot be used in this group, individualization of treatments gains importance by knowing the prognostic factors.
 
Background: Autoimmune/inflammatory syndrome (ASIA) constitutes a set of related immune mediated diseases that share a common clinical picture and a history of a previous exposure to an adjuvant agent. From a clinical standpoint, patients present with none specific manifestations such as myalgia, arthralgia, chronic fatigue and dry mouth as well as neurological manifestations such as cognitive disturbances, memory loss and neurologic disabilities. .Case presentation: A previously healthy 25-year-old patient who underwent breast augmentation 3 years ago, with an asymptomatic rupture of the silicone breast implant, presented with three major criteria of ASIA, and improved after bilateral implant removal. She also had pleuritis and pericarditis, rarely described in such disease. A literature review on complications related to breast implants, their questionable relationship to the onset of autoimmune pathologies, and basic aspects of the diagnosis and management of ASIA was carried out. Conclusion: The silicone presented in breast implants should be considered as an adjuvant, with the potential to cause chronic stimulation to the immune system. This can lead to systemic manifestations that can be severe in patients genetically predisposed and potentially not reversible even after surgical removal of the implants. When facing patients with breast implants and systemic clinical symptoms, lymph node disorders, neurological manifestations, or serositis as in the case presented, without other defined etiology, the possibility of ASIA should be considered in the differential diagnosis.
 
Results of Confirmatory Factor Analysis of the Adult Hope Scale (AHS)
Relationship between AHS with the socio-demographic of sample (N=177)
Model Fit Index (N=177)
Pearson's correlation between AHS with DASS-21(n=177)
Background: Cancer has experienced an alarming growth in the last two decades and is considered a pressing health problem of modern life. This study investigated the validity of Snyder's Adult Hope Scale (AHS) in Iranian women with breast cancer. Methods: 177 Iranian women with breast cancer were randomly selected for the present descriptive cross-sectional study. Participants completed a demographic questionnaire and the Persian version of Snyder's Adult Hope Scale (AHS), the DASS-21. The psychometric properties of the AHS were examined using confirmatory factor analysis (CFA) and discriminant validity using analysis of the DASS-21. Results: The results of CFA showed that the two-factor provided an excellent fit to the data. All items of the loadings delivered a significant factor.These results are acceptable because the factor loadings of all items were significant, and the factor load of all items other than item 1 is higher than 0.5, indicating the model's optimal fit. There was a significant negative relationship between AHS and DASS-21 scores for anxiety (r=-0.49), depression (r=-0.51), and stress (r=-0.47), indicating acceptable divergent validity. Conclusion: Snyder's Adult Hope Scale (AHS) can be used as a valid and appropriate tool in clinical and educational settings to assess the hope of women with breast cancer and prepare treatment and prevention programs.
 
Background: The participation of patients in treatment and nursing decision-making has been advocated by many medical staff. This is not only to attach importance to the wishes of patients, but also to the needs of social development. The purpose of this research was to investigate the attitudes of Chinese breast cancer medical staff towards the implementation of breast cancer decision-making aids.Methods: A cross-sectional study was conducted among 420 doctors and nurses in the Department of Breast Surgery. We used a questionnaire designed by investigators. Data was collected from February 2021 to September 2021. IBM SPSS Version 22 was used to analyze the collected data.Results: Overall, 420 valid questionnaires were returned from 220 doctors and 200 nurses. Response rate was 85.19%. The results showed that 77.14% of the medical staff supported the promotion of breast cancer decision-making aids, and 85.71%(360/420)agreed that patients should be the main participants in high-quality clinical decision-making. Also, 95.24%(400/420)believed that patients should know the reasons for making treatment decisions, and agreed that the positive effects of patient decision-making aids were positively correlated with high education (r education=0.317, P=0.001). There were statistically significant differences in the attitudes of medical staff with different working years (X2=9.432, P=0.024), educational background (X2=42.918, P<0.001) and shared decision education (X2=11.932, P=0.008) on whether to promote decision-making aids. Conclusion: At this stage, breast medical staff have a positive attitude towards using breast cancer decision aids for joint decision-making.
 
Breast cancer-related lymphedema (BCRL) is a devastating potential complication of axillary lymphadenectomy and radiotherapy. Several effective surgical treatment measures now exist, including lymphaticovenicular anastomosis (LVA), vascularized lymph node transplant (VLNT), and vascularized lymph vessel transplant (VLVT) for fluid-predominant disease, and liposuction and radical excision for solid-predominant disease. Super-microsurgical LVA is of particular interest, owing to its minimally invasive nature and highly favorable outcomes in the hands of experienced supermicrosurgeons. As LVA techniques are refined and improved, interest is rising in utilizing it to prevent the manifestation of disease in the first place. Lymphatic microsurgical preventive healing approach (LYMPHA), also known as immediate lymphatic reconstruction (ILR), is the most widely used approach. It involves performing axillary LVA immediately following axillary lymphadenectomy. While preliminary results are favorable, the high-pressure proximal axillary venous branches used in ILR and the site’s vulnerability to damage from radiotherapy endanger the long-term patency of these anastomoses. Moreover, a theoretical oncologic concern exists regarding creating a direct conduit for the remaining malignant cells in the axilla into the circulation. Finally, coordinating ILR with axillary lymphadenectomy creates significant logistical challenges. Delayed, distally-based LVA (DD-LVA) has emerged as an alternative method that avoids these issues. This article presents an overview of the development of preemptive lymphatic reconstruction, and the senior author’s approach to the novel technique of DD-LVA.
 
Clinicopathological characteristics of TNBC patients
Correlations between AR expression and tumor location, margin, recurrence, histology, survival parameters
Association between AR expression and tumor size, lymph node involvement, grade and Ki67 parameters
Background: Triple negative breast cancer (TNBC) is a heterogeneous disease group with a higher recurrence risk and poorer prognosis. In this study, we aimed to investigate the frequency and prognostic value of androgen receptor (AR) expression in tissues of TNBC patients.Methods: In this study a total of 60 TNBC patients treated between 2011 - 2016 in Shahid Sadoughi and Mortaz Hospital were included and their medical records were analyze. The available paraffin blocks were assessed immunohistochemically to determine AR expression. Tumors with ?10% nuclear staining were considered AR-positive, while the ones with <10% staining were considered AR-negative. The association between AR expression, and clinical-pathologic characteristics and prognosis in TNBC was analyzed. Results: The result showed that AR expression in TBNC correlated with high risk of recurrence but no significant correlation with the age, grade, tumor size, lymph node status, type of diagnosis, tumor location, and Ki-67 level was observed. Positive immunoreactivity for AR was observed in 19 out of 60 (11%) specimens. No correlation was observed between the AR expression and the age, grade, tumor size, lymph node status, type of diagnosis, tumor location, and Ki-67 level. The AR-positive patients exhibited high risk of recurrence (P=0.016) and death (P=0.015) in comparison with the AR-negative patients. Concusions: AR may not be a suitable biomarker and treatment target for the Iranian Yazd patients with TNBC.
 
Background: Triple-negative breast cancer (TNBC) accounts for 15 to 20% of all breast cancers. These patients do not benefit from hormone therapy and other targeted treatments of breast cancer. Recently, researchers proposed the use of androgen receptor (AR)-targeted therapies in this subset of patients. The rate of AR expression in TNBC patients varies from 0 to 53%. AR positivity is associated with a better outcome for breast cancer patients. The purpose of this study was to evaluate AR status in TNBC patients and its association with other demographic and pathologic features.Methods: This cross-sectional study was conducted in the Cancer Institute of Iran, affiliated with Tehran University of Medical Sciences, in 2015. Archived formalin-fixed, paraffin-embedded breast tumor blocks were evaluated to determine the AR status of the tumors. Demographic and pathologic characteristics of the patients were retrieved from the department of pathology database. Data were analyzed with SPSS 18.0.Results: Seventy-seven TNBC patients with the mean age of 45.3 ± 11.5 were assessed. Twenty-six patients (34%) showed AR expression, and 51 patients (56%) did not have AR expression. There was no significant correlation between AR status and age, tumor size, histopathologic type of tumor, or lymph node involvement. However, AR positivity had a statistically significant association with a lower tumor grade and lymphovascular invasion (P = 0.029 and P = 0.01, respectively).Conclusion: TNBC patients with AR expression tend to have lower tumor grades and higher rates of lymphovascular invasion.
 
Background: There are various factors affecting the effectiveness of the treatment of breast cancer patients. Although the disease pathology, along with surgery and other therapeutic modalities, plays the principal role in patient outcomes, anesthesia still plays an important role in the success of treatment. This study was designed to show the effects of anesthetic plans on risk classification and assessment in breast cancer surgeries. Methods: Two hundred sixty patients receiving different types of breast cancer surgery for therapeutic and reconstructive purposes were enrolled in this study. They were divided into three groups according to the anesthesia risk assessment. Group 1 consisted of low-risk patients (ASA I) who received small surgeries such as lumpectomy. Patients with intermediate risk of anesthesia (ASA II) or those who underwent breast cancer and axillary surgery with overnight admission (ASA I or II) were considered as group 2. Group 3 comprised the patients with higher risk for anesthesia (ASA class III) regardless of the surgery type or those in any ASA class who were about to undergo advanced and prolonged surgeries such as breast reconstruction with free or pedicle flaps. Results: Two hundred sixty-eight surgical interventions were done in 260 patients. There were 106, 107, and 47 patients in groups 1, 2, and 3, respectively. In group 1, five patients out of 106 were admitted in the hospital for 24 hours after surgery and the remaining 101 patients were discharged from the hospital in a few hours after the operation when they were fully conscious and could tolerate the diet completely. All 107 patients in group 2 were admitted in the hospital for a few days after the operation, though the vast majority of them (98 patients) discharged from the hospital the day after surgery. In the last group, 6 out of 47 patients showed the signs of surgical complications such as partial flap ischemia in the postoperative period, mostly after TRAM or DIEP flap breast reconstruction surgery. Conclusion: The findings of this study support the idea that breast surgeries can be done in an ambulatory situation with no considerable risk. In contrast, all medical and anesthetic considerations should be taken into account in more complex surgeries, especially when they are applied in high-risk patients.
 
A. Effect of DA on the Sub G0 phase of the cell cycle. Treatment with DA induces a dose dependent increase in the number of cells at the Sub G0 (apoptotic) phase. Data is presented as mean± SD, n=3 per treatment group. DA 15µg/ml (P=0.014). DA 30µg/ml (P=0.001). DA, Dipsacus asperoides; SD, standard deviation. B. Effect of DA on Caspase 3/7 activity. Treatment with DA induces a dose dependent increase in the caspase activity. Data are presented as mean±SD, n=3 per treatment group. DA 15µg/ml (P=0.001). DA 30µg/ml (P=0.005). DA, Dipsacus asperoides; SD, standard deviation.
Source of antibodies
Background: Triple negative breast cancer (TNBC) lacks expressions of estrogen receptor-α (ER-α), progesterone receptor (PR) and amplified human epidermal growth factor receptor-2 (HER-2). Current treatment for TNBC includes anthracyclin, taxol and cisplatin-based conventional chemotherapy and survival pathway PARP, PI3K, AKT and mTOR selective targeted therapy. These treatments exhibit dose-limiting systemic toxicity and presence of drug resistant cancer stem cells, which highlight the need for identification of efficacious testable alternatives that are not toxic to non-tumorigenic cells. Dipsacus asperoides (DA) is a Chinese nutritional herb and its root represents a common ingredient in Chinese herbal formulations used in women for estrogen related health issues, osteoporosis and breast diseases. This study aims to investigate the growth inhibitory effects of DA, and to detect mechanisms for its efficacy. Methods: Human mammary carcinoma derived triple negative MDA-MB-231 cell line represented the TNBC model. Non-fractionated aqueous extract from DA represented the test agent. Anchorage dependent growth, anchorage independent (AI) colony formation and cell cycle progression quantified growth inhibition. Western blot-based analysis for inhibition of RAS, PI3K and AKT and RB signaling identified mechanistic leads. Results: Treatment with DA induced a dose dependent cytostatic growth arrest (IC50:15 µg/ml; IC90: 30 µg/ml), reduced AI growth and inhibited cell cycle progression via G2/M arrest. DA affected the RAS, PI3K, AKT and RB signaling pathways, and functioned as a natural inhibitor of cyclin dependent kinase 4/6. Cellular apoptosis paralleled increase in pro-apoptotic Caspase 3/7 activity. Conclusion: These results demonstrate that DA inhibited growth, affected cell cycle progression, induced apoptosis and inhibited cancer cell survival pathways. This study validates a mechanism-based approach to identifying testable substitutes for secondary prevention/therapy of TNBC.
 
Background: Considering the role of psychological components in the life of patients with cancer, the present study was conducted to investigate the relationship between mental, existential, and religious well-being and death anxiety in women with breast cancer. Methods: In this descriptive, correlational study, the statistical population included all women with breast cancer referred to Shahid Rahimi Hospital in Khorramabad in 2017. A sample of 100 patients was selected through convenience sampling and data were collected using Templer’s Death Anxiety Scale, the Warwick-Edinburgh Mental Well-being Scale, and the Spiritual Well-being Scale. For the purpose of data analysis, mean, standard deviation, Pearson’s correlation coefficient and multiple regression were applied using SPSS 22. Results: The study findings indicated a significant, negative correlation between mental well-being, existential well-being, and religious well-being and death anxiety in patients with breast cancer (? = 0.05). Conclusion: According to the results of this study, mental, existential, and religious well-being are important contributors to mental health and quality of life of patients with cancer. Therefore, enhancing these components in cancer patients can be introduced as a complementary treatment along with medical treatments in order to improve psychological problems in clinical settings.
 
Demographic variables of the participants.
Mean, standard deviation (SD), and Pearson correlation coefficients of the study variables
Background: Understanding the disease symptoms is among the important psychological and behavioral variables in cancer treatment, which is based on the acquisition of information from different sources and patient's beliefs and can affect the mental health and capability of the individual in compliance with the disease. The present study aimed to investigate the relationship of coping strategies with death anxiety through the mediation of disease perception in patients with breast cancer in Abadan city in 2020. Methods: The study was a descriptive correlation performed by path analysis. The statistical population included all patients with breast cancer in Abadan city and 200 of which were selected as the sample of the study using convenience sampling. The research instruments included the Death Anxiety Scale (DAS), the Ways of Coping Questionnaire (WCQ), and the Brief Illness Perception Questionnaire (Brief IPQ). The proposed model was evaluated using path analysis with AMOS software. Results: The results showed that there was a significant association between problem-focused strategy and disease perception (P= 0.002), problem-focused strategy and death anxiety (P= 0.001), emotion-focused strategy and disease perception (P= 0.001), disease perception and death anxiety (P= 0.001). There was no significant association between problem-focused strategy and death anxiety. The results of path analysis indicated that disease perception played a mediating role in the association between the emotion- and problem-focused strategies with death anxiety (P= 0.01). Conclusion: According to the results of the study, the proposed model had a good fit and is an important step in identifying the factors affecting the death anxiety of patients with breast cancer.
 
Background: Women with breast cancer suffer high levels of stress due to their disease-induced emotional, cognitive, behavioral and physical problems which increase their metacognitive beliefs, death anxiety, and rumination, disrupt the treatment process, and exert a negative impact. The present study aimed to investigate the effectiveness of positive thinking training on perceived stress, metacognitive beliefs, and death anxiety in women with breast cancer in Ahvaz in 2019. Methods: This was a quasi-experimental study with pretest-posttest control group design. Statistical population consisted of all women with breast cancer visiting Shafa Health Center of Ahvaz in 2019, among whom 30 women were selected as the sample using convenience sampling. Cancer patients were randomly divided into intervention (n=15) and control (n=15) groups. The research instruments included the Perceived Stress Scale, the Metacognitions Questionnaire (MCQ-30), and the Scale of Death Anxiety (SDA). Univariate and multivariate analysis of covariance were used to analyze data. Results: Results suggested that positive thinking training reduced perceived stress, metacognitive beliefs and death anxiety in women with breast cancer in the intervention group compared with those in the control group (P<0.001). Conclusion: According to the results of the study, positive thinking training was effective in reducing perceived stress, metacognitive beliefs, and death anxiety in women with breast cancer.
 
Top-cited authors
Ahmad Kaviani
  • Archives of Breast Cancer
Sanaz Zand
  • Kaviani Breast Cancer Institute
Mojgan Karbakhsh
  • Tehran University of Medical Sciences
S. Mahdi Tabatabaei
  • Islamic Azad University Borujerd Branch
Mahdi Nasiri
  • Segal Biotechnology Co., Iran.