Primary Screening for Breast Diseases among 17618 Women in Wufeng Area, a Region with High Incidence of Cervical Cancer in China

In this study, the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated. From March to August, 2009, 17618 women, from Wufeng area of Hubei province, China, were recruited to screen breast diseases by using breast infrared diagnostic apparatus. Other diagnostic methods, such as B-mode ultrasound, X-ray mammography, needle biopsy and pathological examination were, if necessary, used to further confirm the diagnosis. The screening showed that 5990 of 17618 cases (34.00%) had breast diseases, 5843 (33.16%) had mammary gland hyperplasia, 48 (0.27%) had breast fibroadenoma, 11 (0.06%) had breast carcinoma, and 88 (0.50%) had other breast diseases. The peak morbidity of breast cancer was found in the women aged 50–60 ages. The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8, 0.157%) in comparison with that in the subjects younger than 50 years old (n=3, 0.024%) (u=2.327, P<0.05). It was shown that the occurrence of breast diseases was concentrated in women aged 20–40 years, while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40. Compared with the patients elder than or equal to 40 years old (n=3289, 27.46%), the morbidity rate of breast diseases was significantly increased in women less than 40 years old (2648 cases, 47.18%; P<0.001). However, there was no significant difference in the morbidity of breast diseases between the age group of 20–29 years and that of 30–39 years (P=0.453), and both of them were high. There was no significant association between the morbidity of breast diseases and cervical cancer. Since the morbidity of breast diseases was higher among young women, more attention should be paid to the screening of breast diseases among young women for early diagnosis.

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Fluorodeoxyglucose positron emission tomography/computed tomography(FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy(SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection(ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node(IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observationssuggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.

Epidemiological Pattern of Breast Diseases among Females in the South-Western Region, Saudi Arabia

Background: Breast diseases cover several conditions. The majority of breast diseases are noncancerous. Some of these lesions are clinically unremarkable, which needed minimal intervention. However, some symptoms may be of clinical value and attract the attention of both the patient and the attending physician, especially when they become persistent. The study aimed to assess the prevalence, pattern, types, and clinical profile of breast diseases among females in the South-western region, during the period from 2018-2020. Methods: A retrospective record-based descriptive approach was used through reviewing medical records of all cases with breast disease attended King Khalid Hospital during the period from January 2018 to January 2020. Data extracted throng pre-structured questionnaire. Results: The study included 211 cases whose ages ranged from 18 to 58 years old with a mean age of 28.9 ± 12.8 years. Breast mass was the most recorded complaint (95.1%) followed with breast pain (32%), skin changes. Benign findings based on the final pathology report were recorded for more than two thirds of the cases, with the most common finding were fibroadenoma. Excisional biopsy and modified radical mastectomy were the most reported surgical interventions. Conclusions: In conclusion, the study revealed that the majority of the cases had benign breast disease (BBD), where fibroadenoma was the most frequent.

Systemic oncological therapy in breast cancer patients on dialysis

The advancement of renal replacement therapy has significantly enhanced the survival rates of patients with end-stage renal disease(ESRD)over time.How-ever,this prolonged survival has also been associated with a higher likelihood of cancer diagnoses among these patients including breast cancer.Breast cancer treatment typically involves surgery,radiation,and systemic therapies,with ap-proaches tailored to cancer type,stage,and patient preferences.However,renal replacement therapy complicates systemic therapy due to altered drug clearance and the necessity for dialysis sessions.This review emphasizes the need for opti-mized dosing and administration strategies for systemic breast cancer treatments in dialysis patients,aiming to ensure both efficacy and safety.Additionally,ch-allenges in breast cancer screening and diagnosis in this population,including soft-tissue calcifications,are highlighted.

Can trastuzumab emtansine be replaced by additional chemotherapy plus targeted therapy for HER2-overexpressing breast cancer patients with residual disease after neoadjuvant chemotherapy?

Human epidermal growth factor receptor 2(HER2)-overexpressing breast cancer is an aggressive phenotype with a poor prognosis,and can easily metastasize and recur.Currently,chemotherapy plus HER2-targeted therapy is the standard systemic treatment for most of these patients.Given that neoadjuvant chemotherapy(NAC)has an efficacy equivalent to that of adjuvant chemotherapy and some additional benefits,many patients,especially those with more advanced tumors,prefer NAC and generally will not receive additional chemotherapy after surgery,irrespective of the pathological response.However,achieving pathological complete response to NAC is strongly correlated with prognosis,especially in triple-negative and HER2-overexpressing breast cancer.Therefore,postoperative treatment of these patients with residual diseases should be optimized to achieve favorable outcomes.The CREATE-X study has confirmed that additional chemotherapy can improve the outcomes of patients with HER2-negative residual disease after NAC.In addition,chemotherapy plays an indispensable role in the treatment of patients who receive surgery directly or who have recurrent lesions.Therefore,can additional chemotherapy improve prognosis of patients with HER2-overexpressing residual breast cancer?At present,no studies have compared the efficacy of additional chemotherapy plus trastuzumab with that of anti-HER2 therapy alone in residual cancer.The KATHERINE study revealed that trastuzumab emtansine(T-DM1)can reduce the risk of recurrence or death by 50%compared with trastuzumab in patients with HER2-positive residual invasive breast cancer after neoadjuvant therapy.T-DM1 is an antibody-drug conjugate of trastuzumab and the cytotoxic agent emtansine,and thus,to an extent,T-DM1 is equivalent to simultaneous application of chemotherapy and targeted therapy.However,high cost and low accessibility limit its use especially in low-and middle-income countries and regions.Hence,we proposed this perspective that additional chemotherapy plus trastuzumab should be given to HER2-overexpressing breast cancer patients with residual disease after NAC to improve their prognosis by discussing that the efficacy of additional chemotherapy plus trastuzumab is superior to that of anti-HER2 therapy alone and not inferior to T-DM1.Additional chemotherapy plus trastuzumab-based HER2-targeted therapy can be used as an alternative regimen to T-DM1 when T-DM1 is unavailable.However,further clinical research on the selection of chemotherapeutic agents is warranted.

Comparative Study of the Effect of Shugan Shuru Granule (疏肝舒乳颗粒) on Pathology and p53 Gene Expression in Patients with Hyperplastic Disease of Breast

Objective: To study the effect of Shugan Shuru Granule (疏肝舒乳颗粒,SSG) on the p53 gene expression in patients with hyperplastic disease of breast (HDB) to indirectly explore the mechanism of SSG’s effect on HDB on the molecular pathological level. Methods: Sixty-six patients with HDB were allocated in the treated group and the control group,with the former treated with SSG and the latter not. All patients underwent breast operation and their diseased mammary tissues were cut out, sectioned, and observed under microscopy with HE staining and immunohistochemical staining, with ABC method adopted to estimate the degree of hyperplasia and p53 gene expression. The severity of HDB was classified into normal, mild, moderate and severe grades (marked as 0 to Ⅲ), according to the degree of hyperplasia in the mammary gland. Results: Hyperplasia in the control group mostly belonged to grade Ⅰ-Ⅲ before treatment, showing overgrowth of gland and proliferation of glandular epithelial cells, which were high columnar shaped, more stratified, with papillary or substantive dysplasia. While in the treated group, most belonged to grade 0-Ⅰ after SSG treatment, with proliferated gland and dysplasia recovered to normal or disappeared. The positive rate of p53 gene expression in the treated group was 9.09%, and in the control group 39.39%, comparison between the two groups showing significant difference (P<0.01), the intensity in the former was significantly weaker than that in the latter.Conclusion: SSG could not only inhibit the proliferation of mammary duct epithelia and lobuli, but also inhibit the over-expression of P53. Therefore, it could be regarded as an effective remedy for treatment of HDB and prevention of mammary cancer genesis.

The significance of certain factors in the malignant degeneration of fibrocystic disease of breasts．

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A Novel Combined Approach for Metastatic Breast Cancer with Dural and Leptomeningeal Disease with an Impressive Clinical Outcome: A Case Study

Concurrent dural and leptomeningeal metastatic carcinomatosis are very rare and have a poor prognosis. Here we present a woman with advanced estrogen receptor (ER) positive and progesterone receptor (PR) positive breast cancer who presented with leptomeningeal disease. Patient underwent multi targeted epigenetic therapies applied in a protocol called MTET. She continued to respond to the interval treatment, which consisted only of the nutraceutical agents. Here we discuss her case in detail and we believe that such an example might be applied to other patients in this situation resulting clinical improvement and less toxicity.

Secondary Parkinson disease caused by breast cancer during pregnancy: A case report

BACKGROUND Paraneoplastic neurological syndrome manifesting as secondary Parkinson disease caused by breast cancer is extremely rare.CASE SUMMARY We report a 39-year-old primipara of 31 gestational weeks,who presented with worsening tremors,facial stiffness and speech disfluencies,and decreased limb strength.Thorough physical examinations and auxiliary tests suggested secondary Parkinson’s disease,but the pathogenesis was unknown.During the cesarean section at the 31 weeks plus 6 d,an exploration and liver biopsy revealed a metastatic,poorly differentiated adenocarcinoma.The positron emission tomography and immunohistochemical analysis confirmed a breast ductal carcinoma of stage IV.To our knowledge,only two reports have documented the association between the breast cancer and the Parkinson disease,and neither occurred in pregnant women.CONCLUSION Our case alerts the secondary Parkinson disease as the possible presentation of breast cancer,the most common malignancy during pregnancy.

STUDIES ON THE HISTOLOGICAL CLASSIFICATION OF PROLIFERATIVE DISEASE OF BREAST AND ITS RELATION WITH BREAST CARCINOMA

Objective: Proliferative disease of breast (PDB)always exists compositely, it is difficult to be classifiedduring pathologic diagnosis. For probe into therelationship between PDB and breast carcinoma in thecyto-biologic level, a new classification method wasstudied.Matcrials and methods: Specimen slices of 439 PDBin females and 176 breast carcinomas were studied incontrast. The degree of fibroplastic proliferation wastaken as the classifying index of the consecutive progressof PDB. Then the PDB cases were divided into three types:the lobular hyperplastic type (LHT), the fibroadenosistype (FAT) and the fibrosclerosis type (FST). Each typewas once again separated into simple and compoundgroups- A part of these slices were stained withmonoclonal immunohistochemical stain to demonstratethe hyperplastic activities of PDB cells as well as theencirclement of periductal myoepithelial cells and basemembrane.Results: PCNA express level was increasedsuccessively along with the progress of pathologic changesin all the three types of PDB. And especially, it was almostparallel with the cancerous express in FST. ASMAstaining showed afrophy and rupture of periductalmyoepithelial cells and base membrane in FST andserious untypical hyperplastic PDB cases.Conclusions: In FST and serious untypicalhyperplastic PDB cases, the ductal epithelial cellsproliferated vigorously, it is closely related with thegrowth of carcinomas. The imcomplete encirclement ofperiductal myoepithelial cells and base membrane arealso a sort of dangerous factor.

Determinants of Malignant Transformation in Fibrocystic Disease of Breast

Background: Fibrocystic disease of the breast in one of the commonest diseases in women above 30 years of age. The assumption of it being innocuous and benign is questionable with increased incidence of malignancies developing in these women. Introduction: Understanding the pathophysiology of fibrocystic disease is essential for identifying determinants of malignant change. Case Report: A case of carcinoma of breast developing in a longstanding and recurrent fibrocystic disease is reported. Discussion: The pathological changes including the influence of hormones on the natural history of the disease arediscussed to identify the determinants of malignant transformation. Conclusion: Breast cyst fluid, patterns of cellular lining of the cysts, multiplicity, recurrence and patterns of cellular morphology are important determinants of malignant change.

The Influence of Progesterone Gel Therapy in the Treatment of Fibrocystic Breast Disease

The effect of progesterone therapy on E2/P ratio changes during the luteal phase, and its consequences are on mastalgia and cyst, within a fibrocystic breast disease (FBD). Fifty women with FBD were included. Information for mastalgia and mastodynia were checked with a questionnaire. All women had (E2) and (P) concentration checked before and during the therapy on the 21st and 24th day of a cycle, ultrasound measured size and number of cysts before and during the therapy. T-test, X2-test, McNemar test, Wilcoxon test and Friedman test were used for statistics. There was a decrease E2/P relation during the therapy vs. before the treatment p < 0.01, as well as the decrease of E2 level on the 24th day during the therapy vs. same day of E2 level, before the therapy (p = 0.164). There was an increase of p level on the 24th day vs. on 24th day before the therapy (p < 0.001). During the therapy, it was found decrease in pain and tension (p < 0.001), and the number and size of the cysts (p < 0.001). Mastalgia and mastodynia significantly decreased during the local p gel therapy, and there was a significantly lower number and size of the cysts in patients with FBD.

Therapeutic molecules for multiple human diseases identified from pigeon pea(Cajanus cajan L.Millsp.)through GC–MS and molecular docking

Molecular mechanism behind the therapeutic potential of pigeon pea over the human diseases such as rheumatoid arthritis,breast cancer,type II diabetes,malaria,measles and sickle cell disease were revealed through docking of GC–MS identified phyto-compound ligands with candidate disease proteins.Of the 242 ligands,three dimensional structures of 47 compounds had to be drawn using ChemSketch and the remaining structures were retrieved from PubChem and docked with the active sites of candidate proteins.The molecules identified through docking were further subjected to ADMET analysis and promising drug candidates were identified for each disease.This paper presents a precise account of the chemoprofile of pigeon pea leaves,stems and seeds,interaction of these molecules with target proteins and suggests 26 highly potential molecules which are drug candidates for multiple human diseases.Pigeon pea seeds are especially proven as invaluable source for therapeutic molecules.

The Therapeutic Ways for Chronic Liver Diseases Accompanied by Diseases of the Endocrine and Mammary Glands

It is discovered by the authors of this article thatchronic hepatitis and hepatocirrhosis (hereinafterchronic hepatopathy for short) are often accompaniedby some diseases of endocrine and mammary glands.The authors have studied the pathogenesis andtreatment of the complications as presented in thefollowing.

A case report of breast Paget’s disease and related literature

Paget’s病是一种相对罕见的疾病,发生在乳头和乳晕区域,早期症状不典型。在这项研究中,我们报道了一例患有Paget’s病合并患乳腺癌的病例。术后病理标本中发现肿瘤无血管生成,其组织密度与周围腺体组织密度相似,无钙化点。通过广泛的文献综述,这种情况很少见。我们的研究可以为Paget's病合并乳腺癌情况病例的临床诊断和治疗提供经验。

2016-2021年湖南某三甲中医医院乳腺疾病患者流行病学分析

目的:分析2016-2021年湖南某三甲中医医院乳腺疾病患者流行病学特征。方法:选取2016-2021年湖南中医药大学第一附属医院乳腺科收治的22421例患者作为研究对象,统计22421例乳腺疾病患者时间分布特征、一般资料、年龄分布特点及疾病种类。结果:2016年乳腺疾病患者2223例(9.91%),2017年乳腺疾病患者3366例(15.01%),2018年乳腺疾病患者4284例(19.11%),2019年乳腺疾病患者4103例(18.30%),2020年乳腺疾病患者4041例(18.02%),2021年乳腺疾病患者4404例(19.64%),发病率呈增长趋势。22421例乳腺疾病患者多数已婚,医疗付费方以城镇职工医保为主,女性患者占99.59%(22329例),职业多为干部职员。22421例乳腺疾病患者年龄多为30~49岁,疾病种类多为乳腺癌、乳腺良性肿瘤,其中年龄15~39岁患者疾病种类以乳腺良性肿瘤为主,年龄40~79岁患者疾病种类以乳腺癌为主。结论:2016-2021年湖南某三甲中医医院乳腺疾病发病率呈逐年增长趋势,乳腺疾病好发于女性,患者多数已婚,年龄多为30~49岁,职业多为干部职员,医疗付费方式以城镇职工医保为主,疾病种类多为乳腺癌、乳腺良性肿瘤。建议>30岁女性定期进行乳腺疾病筛查,做到早筛查、早诊断、早治疗。同时相关部门需要加大乳腺疾病健康宣教力度,宣传适当运动、作息规律、情绪稳定的重要性。

乳腺腺体结构超声特征分级与乳腺疾病相关性的研究

目的回顾性分析乳腺腺体结构超声特征分级与乳腺疾病的关系,研究不同超声分级的乳腺腺体发生乳腺疾病的影响因素,探讨乳腺腺体超声结构特征分级在乳腺疾病诊断中的价值.方法收集2021年1月至2023年1月大庆龙南医院乳腺超声检查患者3000例,患者检查资料均进行乳腺影像报告和数据系统(DataSystem,BI-RADS)分类诊断,阳性病例均通过手术并得到病理证实.同时进行乳腺腺体超声结构特征分级,将乳腺腺体结构特征分为6级.分析乳腺腺体结构超声特征分级与阳性病例之间的相关性,分析不同乳腺腺体超声特征分级人群之间罹患乳腺疾病的特征差异.结果乳腺腺体结构超声特征6个分级人群中乳腺腺体超声分型对分级结果影响最大,雌激素相关饮食及药物、体质量指数BMI、年龄的影响依次降低,内分泌的影响最小.病理结果与分级结果的相关系数为0.716,差异有统计学意义(P=0.000).结论乳腺腺体结构超声特征分级能够有效地预示患者乳腺腺体患病几率,在临床诊断中具有明显的诊断价值,在乳腺检查中对乳腺腺体结构超声特征的分级评价可以很好的提示医生及患者重视乳腺患病的风险,具有较高的应用价值.

乳腺癌合并间质性肺疾病患者的临床特征及治疗情况

目的分析乳腺癌合并间质性肺疾病(ILD)患者的临床特征及治疗情况。方法收集76例乳腺癌患者的病历资料,分析其临床特征、检查结果、抗肿瘤药物的使用、ILD的发生及治疗情况。结果76例乳腺癌合并ILD患者中,9例患者无明显症状,其余67例均存在呼吸道等方面的症状;胸部CT检查均呈现不同程度的间质改变,其中52例患者表现为不同程度的低氧血症和呼吸衰竭;患者接受系统性化疗46例,靶向药物27例,恩美曲妥珠单抗2例,内分泌药物氟维司群1例;紫杉类药物ILD发生情况最多,靶向药物中依维莫司ILD发生情况最多,内分泌药物ILD发生情况最少;9例患者不良事件通用术语标准(CTCAE)分级为1级,59例CTCAE分级为2级,8例患者CTCAE分级为3级;所有患者经过治疗后ILD情况均明显好转。结论引起ILD的抗肿瘤药物主要以紫杉类及吉西他滨等细胞毒性药物和雷帕霉素靶蛋白(MTOR)抑制剂靶向药物为主。掌握ILD患者的临床特征及治疗方法,并有针对性地为乳腺癌合并ILD患者选择适宜的治疗方案,既可以增加药物疗效,也可以减少药物的不良反应,改善患者预后。

术前淋巴细胞与单核细胞比值在乳腺癌预后评估的探讨

目的探究外周血中淋巴细胞/单核细胞比值对乳腺癌患者中预后评估作用。方法收集2013年-2018年军区总医院接受手术切除的乳腺癌患者82例,分析淋巴细胞单核细胞比值与患者临床资料、预后评估的价值。结果(1)根据无疾病生存期,建立ROC曲线,根据约登指数取最佳敏感度及特异度,得出淋巴细胞单核细胞比值临界值为5.78。(2)按照LMR5.78分组,通过单因素方差分析得出术前高值LMR组与低值LMR组的临床资料中,年龄、绝经状态、TNM分期、雌激素受体、孕激素受体等均与LMR分组无统计学意义,DFS与LMR分组有统计学意义(P<0.05)。(3)生存函数分析,高LMR组乳腺癌患者的DFS明显延长,差异有统计学意义(P<0.05)。结论术前LMR≥5.78是乳腺癌预后有力的因素,术前LMR检测方便、低廉、结果稳定可作为乳腺癌患者预后的生物学标志物之一。

手足低温法预防盐酸多柔比星脂质体致手足综合征的效果

目的 从临床角度探究局部冷敷法在盐酸多柔比星脂质体(PLD)致相关手足综合征(HFS)中的应用效果。方法 采取非同期随机对照试验,选取2021年6月至2023年6月河北工程大学附属医院乳腺外科已治疗的乳腺癌患者为研究对象,以2021年6月至2022年5月化疗的乳腺癌患者为常规护理组(n=58),2022年6月至2023年6月化疗的乳腺癌患者为局部冷敷法组(n=55)。比较两组在4次PLD化疗阶段HFS的发生率、患者治疗依从性、诊疗满意度及患者就医体验感。结果 局部冷敷法组HFS发生率为23.6%(13/55),常规护理组为44.8%(26/58);局部冷敷法组HFS发生率低于常规护理组(χ^(2)=5.609,P=0.018)。局部冷敷法组HFS严重程度轻于对照组(P<0.05)。局部冷敷法组Ⅱ级及以上HFS发生率为10.9%、常规护理组为25.9%;局部冷敷法组Ⅱ级及以上HFS发生率低于常规护理组(P<0.05)。局部冷敷法组治疗依从性及满意度均高于常规护理组(P<0.05)。结论 局部冷敷法可有效预防和降低PLD化疗过程中HFS的发生率和严重程度、提高患者护理干预的依从性、患者满意度较高。