Clinical Application of Preliminary Breast Cancer Screening for Dense Breasts Using Real-Time AI-Powered Ultrasound with Deep-Learning Computer Vision

Objective:We propose a solution that is backed by cloud computing,combines a series of AI neural networks of computer vision;is capable of detecting,highlighting,and locating breast lesions from a live ultrasound video feed,provides BI-RADS categorizations;and has reliable sensitivity and specificity.Multiple deep-learning models were trained on more than 300,000 breast ultrasound images to achieve object detection and regions of interest classification.The main objective of this study was to determine whether the performance of our Al-powered solution was comparable to that of ultrasound radiologists.Methods:The noninferiority evaluation was conducted by comparing the examination results of the same screening women between our AI-powered solution and ultrasound radiologists with over 10 years of experience.The study lasted for one and a half years and was carried out in the Duanzhou District Women and Children's Hospital,Zhaoqing,China.1,133 females between 20 and 70 years old were selected through convenience sampling.Results:The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value were 93.03%,94.90%,90.71%,92.68%,and 93.48%,respectively.The area under the curve(AUC)for all positives was 0.91569 and the AUC for all negatives was 0.90461.The comparison indicated that the overall performance of the AI system was comparable to that of ultrasound radiologists.Conclusion:This innovative AI-powered ultrasound solution is cost-effective and user-friendly,and could be applied to massive breast cancer screening.

Survey on the Consciousness of Japanese Women Regarding Dense Breasts on Mammography

Patients with dense breasts on mammography have a higher risk of developing breast cancer and missing a tumor mass than those with non-dense breasts. Whether examinees who have dense breasts should be notified is currently under consideration in Japan;however, there is concern about the low level of understanding regarding dense breasts. A questionnaire survey on the degree of comprehension regarding dense breasts was conducted among 409 general women of >20 years of age in Hachinohe city in October 2017 and 2018. The results showed that the degree of comprehension was extremely low, as only 35 people (8.5%) responded with, “I know the meaning”;however, 32 of them (91.5%) stated that they would like to be notified in they had dense breasts. In addition, the degree of comprehension regarding dense breasts was significantly greater among those who had a breast cancer screening history (OR = 6.4;95% CI = 2.0 - 19.8;P = 0.001) and a self-examination history than among those with no such history (OR = 2.5;95% CI = 1.1 - 5.8;P = 0.03). However, the degree of comprehension did not differ between participants of years of age or between participants with and without a breast cancer sufferer among their close blood relatives. The present findings to reflect a low understanding of dense breasts on mammography screening and suggest that the degree of comprehension is influenced by the presence or absence of a consultation history and a self-examination history.

On Cultural Default and Compensation in Big Breasts and Wide Hips From the Perspective of Cultural Schema Theory

Cultural schema theory proposes that when we interact with members of the same culture in certain situations, or talk about certain information with them many times, cultural schemas are created and stored in our brain, which can promote coherence between the original and target language text, thus solving the cultural default caused by the cultural differences. It is vital to make cultural compensation to different cultural schemas and to coordinate the cultural contradiction. This thesis focuses on the translation methods and strategies in Big Breasts and Wide Hips from the perspective of the cultural schema theory, which exemplifies how cultural default and compensation functions in this novel.

A Culture Approach to the English Translation of Chinese Literature——A Case Study of Big Breasts and Wide Hips

Literary translation has become the most significant pathway for Chinese literature to enter the world literature scene and compete for international recognitions. In order to present a exhaustive analysis and exploration of the strategies of culture translation, it selects one of Mo Yan's classic work Big Breasts and Wide Hips and its English version translated by American scholar Goldblatt as the case study. It will mainly discuss about the cultural transmission through literary translation and the cultivation of talented translators in order to expand Chinese culture's international influence through improving literary translation.

Using shape contexts method for registration of contra lateral breasts in thermal images

AIM: To achieve symmetric boundaries for left and right breasts boundaries in thermal images by registration. METHODS: The proposed method for registration consists of two steps. In the first step, shape context, an approach as presented by Belongie and Malik was applied for registration of two breast boundaries. The shape context is an approach to measure shape similarity. Two sets of finite sample points from shape contours of two breasts are then presented. Consequently, the correspondences between the two shapes are found. By finding correspondences, the sample point which has the most similar shape context is obtained. RESULTS: In this study, a line up transformation which maps one shape onto the other has been estimated in order to complete shape. The used of a thin plate spline permitted good estimation of a plane transformation which has capability to map unselective points from one shape onto the other. The obtained aligningtransformation of boundaries points has been applied successfully to map the two breasts interior points. Some of advantages for using shape context method in this work are as follows:(1) no special land marks or key points are needed;(2) it is tolerant to all common shape deformation; and(3) although it is uncomplicated and straightforward to use, it gives remarkably powerful descriptor for point sets significantly upgrading point set registration. Results are very promising. The proposed algorithm was implemented for 32 cases. Boundary registration is done perfectly for 28 cases.CONCLUSION: We used shape contexts method that is simple and easy to implement to achieve symmetric boundaries for left and right breasts boundaries in thermal images.

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

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A Long Term Review of Surgically Treated Enlarged Breasts

Introduction: Breast hypertrophy (excessive enlargement of breast), a condition though rare, is well pronounced in some females. Surgery either by reduction mammaplasty or sub-cutaneous mastectomy is often employed in treatment of this condition. Aim: This study seeks to find out the long term level of satisfaction of the surgery on these persons after about 10 - 12 years after treatment. Materials and Methods: From January 1994 to December 2000, the Komfo Anokye Teaching Hospital (KATH) carried out surgeries on 43 females who presented with several degrees of breast hypertrophy. Patients were asked to answer questionnaires on their condition pre-operatively and post-operatively during the long term review process. Results: Thirty-four (79.1%) patients out of the 43 were available for the review with the patients stating there was much (100%) improvement in terms of the pain they felt in the neck, upper and lower back regions. There was no re-occurrence of the condition in any of the patients;29 (85.3%) stated they were satisfied and that their new breast size(s) was/were excellent for them. Conclusion: The pre-operative complications experienced by these patients were resolved hence this surgical procedure was good and the quality of life of these persons had been improved.

Cultural models of female breasts and breast cancer among Korean women

Although a great many qualitative descriptions of the experience of having breast cancer exist, they overwhelmingly represent experiences of women in Western cultures and are based on assumptions that stem from Western individualism. This study explores and describes cultural models shared by a group of non-Western women, South Koreans, in reference to female breasts and breast cancer. The hermeneutic phenomenology-grounded qualitative study was conducted with 40 Korean women, between 23 and 81 years of age, half of whom were breast cancer survivors. The analysis elicited two cultural models, both characterized in terms of physical relationships to others (as opposed to the woman’s individual or independent view of her body): a breast-feeding mother to a child and an attractive wife to a husband. Female breasts are interpreted as a medium that connects women to roles as mothers and wives. Breast cancer can lead women to detach from their previous relational and role-oriented identities. Cultural traditions, cultural concepts, and culture-related health beliefs in Korea are interwoven deeply in the women’s stories about breasts, as a gendered organ, and its disease. The findings suggest that understanding indigenous cultural models should precede any supportive breast cancer care for women from non-Western cultural backgrounds.

Circular RNAs in breast cancer diagnosis,treatment and prognosis

Breast cancer has surpassed lung cancer to become the most common malignancy worldwide.The incidence rate and mortality rate of breast cancer continue to rise,which leads to a great burden on public health.Circular RNAs(circRNAs),a new class of noncoding RNAs(ncRNAs),have been recognized as important oncogenes or suppressors in regulating cancer initiation and progression.In breast cancer,circRNAs have significant roles in tumorigenesis,recurrence and multidrug resistance that are mediated by various mechanisms.Therefore,circRNAs may serve as promising targets of therapeutic strategies for breast cancer management.This study reviews the most recent studies about the biosynthesis and characteristics of circRNAs in diagnosis,treatment and prognosis evaluation,as well as the value of circRNAs in clinical applications as biomarkers or therapeutic targets in breast cancer.Understanding the mechanisms by which circRNAs function could help transform basic research into clinical applications and facilitate the development of novel circRNA-based therapeutic strategies for breast cancer treatment.

Microwave-induced thermoacoustic elastic imaging:A simulation study

Microwave-induced thermoacoustic imaging(MTI)has the advantages of high resolution,high contrast,non-ionization,and non-invasive.Recently,MTI was used in the¯eld of breast cancer screening.In this paper,based on the¯nite element method(FEM)and COMSOL Multiphysics software,a three-dimensional breast cancer model suitable for exploring the MTI process is proposed to investigate the in°uence of Young's modulus(YM)of breast cancer tissue on MTI.It is found that the process of electromagnetic heating and initial pressure generation of the entire breast tissue is earlier in time than the thermal expansion process.Besides,compared with normal breast tissue,tumor tissue has a greater temperature rise,displacement,and pressure rise.In particular,YM of the tumor is related to the speed of thermal expansion.In particular,the larger the YM of the tumor is,the higher the heating and contraction frequency is,and the greater the maximum pressure is.Di®erent Young's moduli correspond to di®erent thermoacoustic signal spectra.In MTI,this study can be used to judge di®erent degrees of breast cancer based on elastic imaging.In addition,this study is helpful in exploring the possibility of microwave-induced thermoacoustic elastic imaging(MTAE).

RARRES2 regulates lipid metabolic reprogramming to mediate the development of brain metastasis in triple negative breast cancer

Background Triple negative breast cancer(TNBC),the most aggressive subtype of breast cancer,is characterized by a high incidence of brain metastasis(BrM)and a poor prognosis.As the most lethal form of breast cancer,BrM remains a major clinical challenge due to its rising incidence and lack of effective treatment strategies.Recent evidence suggested a potential role of lipid metabolic reprogramming in breast cancer brain metastasis(BCBrM),but the underlying mechanisms are far from being fully elucidated.Methods Through analysis of BCBrM transcriptome data from mice and patients,and immunohistochemical validation on patient tissues,we identified and verified the specific down-regulation of retinoic acid receptor responder 2(RARRES2),a multifunctional adipokine and chemokine,in BrM of TNBC.We investigated the effect of aberrant RARRES2 expression of BrM in both in vitro and in vivo studies.Key signaling pathway components were evaluated using multi-omics approaches.Lipidomics were performed to elucidate the regulation of lipid metabolic reprogramming of RARRES2.Results We found that downregulation of RARRES2 is specifically associated with BCBrM,and that RARRES2 deficiency promoted BCBrM through lipid metabolic reprogramming.Mechanistically,reduced expression of RARRES2 in brain metastatic potential TNBC cells resulted in increased levels of glycerophospholipid and decreased levels of triacylglycerols by regulating phosphatase and tensin homologue(PTEN)-mammalian target of rapamycin(mTOR)-sterol regulatory element-binding protein 1(SREBP1)signaling pathway to facilitate the survival of breast cancer cells in the unique brain microenvironment.Conclusions Our work uncovers an essential role of RARRES2 in linking lipid metabolic reprogramming and the development of BrM.RARRES2-dependent metabolic functions may serve as potential biomarkers or therapeutic targets for BCBrM.

Diagnostic challenges and individualized treatment of cervical adenocarcinoma metastases to the breast:A case report

BACKGROUND Cervical cancer is a rare primary tumor resulting in metastases to the breast with few cases reported in literature.Breast metastases are associated with poor prognosis.The following case highlights the diagnostic challenges associated with metastatic cervical cancer to the breast along with individualized treatment.CASE SUMMARY A 44-year-old G7P5025 with no significant past medical or surgical history presented with heavy vaginal to an outside emergency department where an exam and a pelvic magnetic resonance imaging showed a 4.5 cm heterogenous lobulated cervical mass involving upper two thirds of vagina,parametria and lymph node metastases.Cervical biopsies confirmed high grade adenocarcinoma with mucinous features.A positron emission tomography/computed tomography(PET/CT)did not show evidence of metastatic disease.She received concurrent cisplatin with external beam radiation therapy.Follow up PET/CT scan three months later showed no suspicious fluorodeoxyglucose uptake in the cervix and no evidence of metastatic disease.Patient was lost to follow up for six months.She was re-imaged on re-presentation and found to have widely metastatic disease including breast disease.Breast biopsy confirmed programmed death-ligand 1 positive metastatic cervical cancer.The patient received six cycles of carboplatin and paclitaxel with pembrolizumab.Restaging imaging demonstrated response.Patient continued on pembrolizumab with disease control.CONCLUSION Metastatic cervical cancer to the breast is uncommon with nonspecific clinical findings that can make diagnosis challenging.Clinical history and immunohistochemical evaluation of breast lesion,and comparison to primary tumor can support diagnosis of metastatic cervical cancer to the breast.Overall,the prognosis is poor,but immunotherapy can be considered in select patients and may result in good disease response.

Metochalcone induces senescence-associated secretory phenotype via JAK2/STAT3 pathway in breast cancer

Breast and lung cancers are the leading causes of mortality and most frequently diagnosed cancers in women and men,respectively,worldwide.Although the antitumor activity of chalcones has been extensively studied,the molecular mechanisms of isoliquiritigenin analog 2',4',4-trihydroxychalcone(metochalcone;TEC)against carcinomas remain less well understood.In this study,we found that TEC inhibited cell proliferation of breast cancer BT549 cells and lung cancer A549 cells in a concentration-dependent manner.TEC induced cell cycle arrest in the S-phase,cell migration inhibition in vitro,and reduced tumor growth in vivo.Moreover,transcriptomic analysis revealed that TEC modulated the activity of the JAK2/STAT3 and P53 pathways.TEC triggered the senescence-associated secretory phenotype(SASP)by repressing the JAK2/STAT3 axis.The mechanism of metochalcone against breast cancer depended on the induction of SASP via deactivation of the JAK2/STAT3 pathway,highlighting the potential of chalcone in senescence-inducing therapy against carcinomas.

Reversal of tamoxifen resistance by artemisinin in ER+breast cancer:bioinformatics analysis and experimental validation

Breast cancer is the leading cause of cancer-related deaths in women worldwide,with Hormone Receptor(HR)+being the predominant subtype.Tamoxifen(TAM)serves as the primary treatment for HR+breast cancer.However,drug resistance often leads to recurrence,underscoring the need to develop new therapies to enhance patient quality of life and reduce recurrence rates.Artemisinin(ART)has demonstrated efficacy in inhibiting the growth of drug-resistant cells,positioning art as a viable option for counteracting endocrine resistance.This study explored the interaction between artemisinin and tamoxifen through a combined approach of bioinformatics analysis and experimental validation.Five characterized genes(ar,cdkn1a,erbb2,esr1,hsp90aa1)and seven drug-disease crossover genes(cyp2e1,rorc,mapk10,glp1r,egfr,pgr,mgll)were identified using WGCNA crossover analysis.Subsequent functional enrichment analyses were conducted.Our findings confirm a significant correlation between key cluster gene expression and immune cell infiltration in tamoxifen-resistant and-sensitized patients.scRNA-seq analysis revealed high expression of key cluster genes in epithelial cells,suggesting artemisinin’s specific impact on tumor cells in estrogen receptor(ER)-positive BC tissues.Molecular target docking and in vitro experiments with artemisinin on LCC9 cells demonstrated a reversal effect in reducing migratory and drug resistance of drug-resistant cells by modulating relevant drug resistance genes.These results indicate that artemisinin could potentially reverse tamoxifen resistance in ER-positive breast cancer.

Tumor deposits in axillary adipose tissue in patients with breast cancer:Do they matter?

Tumor deposits(TDs)are defined as discrete,irregular clusters of tumor cells lying in the soft tissue adjacent to but separate from the primary tumor,and are usually found in the lymphatic drainage area of the primary tumor.By definition,no residual lymph node structure should be identified in these tumor masses.At present,TDs are mainly reported in colorectal cancer,with a few reports in gastric cancer.There are very few reports on breast cancer(BC).For TDs,current dominant theories suggest that these are the result of lymph node metastasis of the tumor with complete destruction of the lymph nodes by the tumor tissue.Even some pathologists classify a TD as two lymph node metastases for calculation.Some pathologists also believe that TDs belong to the category of disseminated metastasis.Therefore,regardless of the origin,TDs are an indicator of poor prognosis.Moreover,for BC,sentinel lymph node biopsy is generally used at present.Whether radical axillary lymph node dissection should be adopted for BC with TDs in axillary lymph nodes is still inconclusive.The present commentary of this clinical issue has certain guiding significance.It is aimed to increase the awareness of the scientific community towards this under-recognized problem in BC pathology.

Ferroptosis biomarkers predict tumor mutation burden's impact on prognosis in HER2-positive breast cancer

BACKGROUND Ferroptosis has recently been associated with multiple degenerative diseases.Ferroptosis induction in cancer cells is a feasible method for treating neoplastic diseases.However,the association of iron proliferation-related genes with prognosis in HER2+breast cancer(BC)patients is unclear.AIM To identify and evaluate fresh ferroptosis-related biomarkers for HER2+BC.METHODS First,we obtained the mRNA expression profiles and clinical information of HER2+BC patients from the TCGA and METABRIC public databases.A four gene prediction model comprising PROM2,SLC7A11,FANCD2,and FH was subsequently developed in the TCGA cohort and confirmed in the METABRIC cohort.Patients were stratified into high-risk and low-risk groups based on their median risk score,an independent predictor of overall survival(OS).Based on these findings,immune infiltration,mutations,and medication sensitivity were analyzed in various risk groupings.Additionally,we assessed patient prognosis by combining the tumor mutation burden(TMB)with risk score.Finally,we evaluated the expression of critical genes by analyzing single-cell RNA sequencing(scRNA-seq)data from malignant vs normal epithelial cells.RESULTS We found that the higher the risk score was,the worse the prognosis was(P<0.05).We also found that the immune cell infiltration,mutation,and drug sensitivity were different between the different risk groups.The highrisk subgroup was associated with lower immune scores and high TMB.Moreover,we found that the combination of the TMB and risk score could stratify patients into three groups with distinct prognoses.HRisk-HTMB patients had the worst prognosis,whereas LRisk-LTMB patients had the best prognosis(P<0.0001).Analysis of the scRNAseq data showed that PROM2,SLC7A11,and FANCD2 were significantly differentially expressed,whereas FH was not,suggesting that these genes are expressed mainly in cancer epithelial cells(P<0.01).CONCLUSION Our model helps guide the prognosis of HER2+breast cancer patients,and its combination with the TMB can aid in more accurate assessment of patient prognosis and provide new ideas for further diagnosis and treatment.

Hypoxia-mediated programmed cell death is involved in the formation of wooden breast in broilers

Background Wooden breast(WB)myopathy is a common myopathy found in commercial broiler chickens worldwide.Histological examination has revealed that WB myopathy is accompanied by damage to the pectoralis major(PM)muscle.However,the underlying mechanisms responsible for the formation of WB in broilers have not been fully elucidated.This study aimed to investigate the potential role of hypoxia-mediated programmed cell death(PCD)in the formation of WB myopathy.Results Histological examination and biochemical analysis were performed on the PM muscle of the control(CON)and WB groups.A significantly increased thickness of the breast muscle in the top,middle,and bottom portions(P<0.01)was found along with pathological structure damage of myofibers in the WB group.The number of capillaries per fiber in PM muscle,and the levels of p O_(2) and s O_(2) in the blood,were significantly decreased(P<0.01),while the levels of p CO_(2) and TCO_(2) in the blood were significantly increased(P<0.05),suggesting hypoxic conditions in the PM muscle of the WB group.We further evaluated the PCD-related pathways including autophagy,apoptosis,and necroptosis to understand the consequence response to enhanced hypoxic conditions in the PM muscle of birds with WB.The ratio of LC3 II to LC3 I,and the autophagy-related factors HIF-1α,BNIP3,Beclin1,AMPKα,and ULK1 at the m RNA and protein levels,were all significantly upregulated(P<0.05),showing that autophagy occurred in the PM muscle of the WB group.The apoptotic index,as well as the expressions of Bax,Cytc,caspase 9,and caspase 3,were significantly increased(P<0.05),whereas Bcl-2 was significantly decreased(P<0.05)in the WB-affected PM muscle,indicating the occurrence of apoptosis mediated by the mitochondrial pathway.Additionally,the expressions of necroptosis-related factors RIP1,RIP3,and MLKL,as well as NF-κB and the pro-inflammatory cytokines TNF-α,IL-1β,and IL-6,were all significantly enhanced(P<0.05)in the WB-affected PM muscle.Conclusions The WB myopathy reduces blood supply and induces hypoxia in the PM muscle,which is closely related to the occurrence of PCD including apoptosis,autophagy,and necroptosis within myofibers,and finally leads to abnormal muscle damage and the development of WB in broilers.

Normalized glandular dose coefficients for digital breast tomosynthesis using detailed Chinese breast models

The rise in breast cancer diagnoses among Chinese women has necessitated the use of X-ray breast screening,which carries a radiation risk.This study aimed to provide a dosimetry protocol for the Chinese female population to replace the traditional standard that utilizes simplified breast models,for the accurate estimation of the mean glandular dose of a patient undergoing digital breast tomosynthesis(DBT).The first set of detailed Chinese female breast models and representative breast parameters was constructed.Considering backscatter radiation and computational efficiency,we improved the combination of these models and the Chinese reference adult female whole-body voxel phantom.Image acquisition for four commercial DBT systems that are widely employed in China was simulated using the Monte Carlo method to obtain the normalized glandular dose coefficients of DBT(D_(gN)^(DBT))and the glandular depth dose(D_(g)^(dep)(z))for different breast characteristics and X-ray spectra.We calculated a series of D_(gN)^(DBT) values for breasts with different percentage mass glandularities(5%,25%,50%,75%,and 100%)and compressed breast thicknesses(2,3,4,5,6,and 7 cm)at various tube potentials(25,28,30,32,35,and 49 kV)and target/filter combinations(W/Rh,W/Al,Mo/Mo,Rh/Rh,and Rh/Ag).The parameter dependence of the breast characteristics and beam conditions on D_(gN)^(DBT) in detailed breast models was investigated.The D_(gN)^(DBT) results were 14.6-51.0%lower than those of the traditional dosimetry standard in China.The difference in D_(gN)^(DBT) was mainly due to a decrease in the depth of the main energy deposition area caused by the glandular distribution along the depth direction.The results obtained in this study may be used to improve breast dosimetry in China and provide more detailed information on risk assessment during DBT.

Sequential neoadjuvant chemotherapy using pegylated liposomal doxorubicin and cyclophosphamide followed by taxanes with complete trastuzumab and pertuzumab treatment for HER2-positive breast cancer: A phase Ⅱ single-arm study

Objective: Despite cardiotoxicity overlap, the trastuzumab/pertuzumab and anthracycline combination remains crucial due to significant benefits. Pegylated liposomal doxorubicin(PLD), a less cardiotoxic anthracycline, was evaluated for efficacy and cardiac safety when combined with cyclophosphamide and followed by taxanes with trastuzumab/pertuzumab in human epidermal growth factor receptor-2(HER2)-positive early breast cancer(BC).Methods: In this multicenter, phase II study, patients with confirmed HER2-positive early BC received four cycles of PLD(30-35 mg/m^(2)) and cyclophosphamide(600 mg/m^(2)), followed by four cycles of taxanes(docetaxel,90-100 mg/m^(2) or nab-paclitaxel, 260 mg/m^(2)), concomitant with eight cycles of trastuzumab(8 mg/kg loading dose,then 6 mg/kg) and pertuzumab(840 mg loading dose, then 420 mg) every 3 weeks. The primary endpoint was total pathological complete response(tp CR, yp T0/is yp N0). Secondary endpoints included breast p CR(bp CR),objective response rate(ORR), disease control rate, rate of breast-conserving surgery(BCS), and safety(with a focus on cardiotoxicity).Results: Between May 27, 2020 and May 11, 2022, 78 patients were treated with surgery, 42(53.8%) of whom had BCS. After neoadjuvant therapy, 47 [60.3%, 95% confidence interval(95% CI), 48.5%-71.2%] patients achieved tp CR, and 49(62.8%) achieved bp CR. ORRs were 76.9%(95% CI, 66.0%-85.7%) and 93.6%(95% CI,85.7%-97.9%) after 4-cycle and 8-cycle neoadjuvant therapy, respectively. Nine(11.5%) patients experienced asymptomatic left ventricular ejection fraction(LVEF) reductions of ≥10% from baseline, all with a minimum value of >55%. No treatment-related abnormal cardiac function changes were observed in mean N-terminal pro-BNP(NT-pro BNP), troponin I, or high-sensitivity troponin.Conclusions: This dual HER2-blockade with sequential polychemotherapy showed promising activity with rapid tumor regression in HER2-positive BC. Importantly, this regimen showed an acceptable safety profile,especially a low risk of cardiac events, suggesting it as an attractive treatment approach with a favorable risk-benefit balance.

Associations between health-related fitness and patient-reported symptoms in newly diagnosed breast cancer patients

Background:Newly diagnosed breast cancer patients experience symptoms that may affect their quality of life,treatment outcomes,and survival.Preventing and managing breast cancer-related symptoms soon after diagnosis is essential.The purpose of this study was to investigate the associations between health-related fitness(HRF)and patient-reported symptoms in newly diagnosed breast cancer patients.Methods:This study utilized baseline data from the Alberta Moving Beyond Breast Cancer Cohort Study that were collected within 90 days of diagnosis.HRF measures included peak cardiopulmonary fitness(peak volume of oxygen consumption(VO_(2peak))),maximal muscular strength and endurance,flexibility,and body composition.Symptom measures included depression,sleep quality,and fatigue.Adjusted multivariable logistic regression was performed for analyses.Results:Of 1458 participants,51.5%reported poor sleep quality,26.5%reported significant fatigue,and 10.4%reported moderate depression.In multivariable-adjusted models,lower relative VO_(2peak)was independently associated with a greater likelihood of all symptom measures,including moderate depression(p<0.001),poor sleep quality(p=0.009),significant fatigue(p=0.008),any symptom(p<0.001),and multiple symptoms(p<0.001).VO_(2peak)demonstrated threshold associations with all symptom measures such that all 3 lower quartiles exhibited similar elevated risk compared to the highest quartile.The strength of the threshold associations varied by the symptom measure with odds ratios ranging from-1.5 for poor sleep quality to-3.0 for moderate depression and multiple symptoms.Moreover,lower relative upper body muscular endurance was also independently associated with fatigue in a dose-response manner(p=0.001),and higher body weight was independently associated with poor sleep quality in an inverted U pattern(p=0.021).Conclusion:Relative VO_(2peak)appears to be a critical HRF component associated with multiple patient-reported symptoms in newly diagnosed breast cancer patients.Other HRF parameters may also be important for specific symptoms.Exercise interventions targeting different HRF components may help newly diagnosed breast cancer patients manage specific symptoms and improve outcomes.