Prognostic effect analysis of molecular subtype on young breast cancer patients

Objective： To make a prognostic effect analysis of molecular subtype on young breast cancer patients.Methods： Totally 187 cases of young breast cancer patients less than 40 years old treated in Obstetrics and Gynecology Hospital of Fudan University between June 2005 and June 2011 were included in our study. We described their clinical-pathological characteristics, disease-free survival（DFS） rate, and overall survival（OS） rate after a median follow-up period of 61 months. The factors associated with prognosis were also evaluated by univariate and multivariate analyses.Results： All patients were premenopausal, with an average age of 35.36±3.88 years old. The mean tumor size was 2.43±1.53 cm. Eighty-one cases had lymph node metastasis（43.3%）, 126 cases had lymphovascular invasion（67.4%）, and 125 cases had histological grade III（66.8%） disease. Twenty-seven cases（14.4%） were Luminal A subtype, 99 cases（52.9%） were Luminal B subtype, 29 cases（15.5%） were human epidermal growth factor receptor 2（HER-2） overexpression subtype, while 32 cases（17.1%） were triple negative breast cancer（TNBC） subtype according to 2013 St Gallen expert consensus. One hundred and thirty-five cases underwent mastectomy whereas 52 cases had breast-conserving surgery. One hundred and seventy-eight cases underwent adjuvant or neoadjuvant chemotherapy. Recurrence or metastasis occurred in 29 cases, 13 of which died. The 5-year DFS and OS rates were 84% and 92%. Multivariate analysis showed that nodal status（P=0.041） and molecular subtype（P=0.037） were both independent prognostic factors of DFS, while nodal status（P=0.037） and TNBC subtype（P=0.048） were both independent prognostic factors of OS. Conclusions： Molecular subtype is an independent prognostic factor of young breast cancer patients. TNBC has a high risk of relapse and death.

Changing patterns and survival improvements of young breast cancer in China and SEER database, 1999-2017

Objective: Breast cancer in young females was usually considered more aggressive and requires aggressive therapy. We investigated whether early detection and improved treatments changed the patterns of characteristics,management and outcomes of young breast cancer patients over time.Methods: Females under 40 years of age diagnosed with breast cancer during the periods 1999-2017 and1999-2015 were identified in the Fudan University Shanghai Cancer Center(FUSCC) and the population-based Surveillance, Epidemiology, and End Results(SEER) registry, respectively. Clinicopathologic characteristics and treatment information were collected. Patients diagnosed before 2013 were followed up.Results: The proportions of young breast cancer patients were 15.0% and 5.3% in the FUSCC and SEER cohorts, respectively. In the FUSCC cohort, there was a significant increase in the proportion of ductal carcinoma in situ(DCIS)(from 8.8% to 16.9%;P<0.0001) and it remained stable in SEER cohort. The proportion of T1-stage tumors increased dramatically in the FUSCC cohort(from 35.3% to 41.9%;P=0.008), whereas it decreased in SEER cohort(from 42.4% to 33.0%;P<0.0001). The percentage of estrogen receptor(ER)-positive cancers was consistently increased in both the invasive ductal carcinoma(IDC) and DCIS patients in the two cohorts. Breastconserving surgery and immediate implant reconstruction after mastectomy both exhibited increased use over time in the FUSCC cohort. Both the FUSCC and SEER cohorts showed a significantly better prognosis in the recent time period.Conclusions: With the increased early-stage and ER-positive diseases in young patients as well as better systemic treatment strategies, improved survival has been observed in recent years. There has been a substantial deescalation in surgical therapies in young breast cancer patients.

Histo-Phenotypic Aspects of Breast Cancer in Women under 40 Years Old, in Yaoundé

Introduction: Breast cancer is the most common cancer in women worldwide, with an increasing incidence. Although it is rare and no much studied in young women, it represents 7% of cases worldwide and often appears more aggressive with a poor prognosis compared to its counterpart in older women. The main objective of our study was to describe the histological and phenotypic aspects of breast cancer in women of age under 40. Methodology: We conducted a descriptive and analytical cross-sectional study, with retrospective collection of data over a period of 05 years. All women diagnosed with breast cancer were included and divided into 2 study groups: under 40 years old and over 40 years old. Data were analyzed using SPSS version 23.0 software, compared using the Chi square or Fisher exact test. A p value Results: We retained 196 files, either 89 for those under 40 and 107 for those over 40. Young patients with breast cancer had a higher stage, grade and tumor size. Lymph node involvement was more observed in women under 40 years (69.6% vs 53.2%). Older women were more likely to be hormone receptor positive (54.2% vs 38.2%);p = 0.018. HER-2 overexpression was higher in women younger than 40 years (39.32% vs 25.23%);p = 0.080 with a high Ki67 proliferation index (30.3% versus 2.8%);p 0.001. Triple-negative and Her-2 tumors were much more frequent in young women (48.3% vs. 36.4%;p = 0.063) and (17.97% vs. 10.3%;p = 0.125). Conclusion: Breast cancer in young women remains more aggressive and is dominated by triple negative and Her-2 phenotypes.

Provision of Fertility Preservation for Young Women with Early-Stage Breast Cancer

Breast cancer is the most common cancer in women worldwide, constituting 25% of all cancer diagnoses. Even though it is only affecting 4% - 6% of women under the age of 40, it remains the most common malignancy among younger patients. Advancement in the treatment and earlier detection gives excellent 5 years of survival. However, the standard treatment that comprises surgical-chemo radiation therapy or hormonal treatment often results in an increased incidence of treatment-induced infertility. Therefore, adding fertility preservation to primary cancer treatment may offer the best opportunity for future fertility. However, despite advancements in Assisted Reproductive Technology (ART), the uptake of fertility services in this group remains low. In this review, we highlighted the effect of all breast cancer treatments on women’s fertility, the effectiveness and safety of ART in breast cancer patients as well as the safety of pregnancy in breast cancer survivors. Our aim is to improve awareness of fertility preservation for breast cancer to ensure all women diagnosed with breast cancer have multidisciplinary approaches with early referral to fertility specialists to discuss regarding potential risks and benefits of fertility preservation to improve the uptake of fertility preservation among this group of patients.

Breast Cancers in Young Woman under 40 Years in Sub-Saharan Africa: Experience of the Gynecology Department of the University and Hospital Center of Treichville (Abidjan—Cote d’Ivoire)

Objective: To describe the epidemiological, clinical and therapeutic characteristics of women under 40 years followed for breast cancer. Method: This is a retrospective and cohort study with descriptive purpose conducted over 10 years on the management of breast cancer in 105 patients under 40 years in the Gynecology Service of the University and Hospital Center of Treichville. Results: The incidence of breast cancer in women under 40 years was 8.4%, and the majority of patients were over 35 years old (64.8%) and had a low socioeconomic level (61.7%). Some patients had classic risk factors for breast cancer: menarche before 12 years (48.6%), nulliparity (20%), family history of breast cancer (1.9%). The discovery of a breast abnormality was made by patients in 97.1% of the cases. Cancers were either isolated (92.4%) or associated with pregnancy (5.7%) or bilateral (1.9%). The majority of cancers were infiltrating ductal carcinomas (86.7%), of SBR II grade (69%). Patients generally benefited from a mastectomy with axillary dissection, framed by chemotherapy. The global survival at 10 years was 5%. Conclusion: This study allowed us to confirm that breast cancers in younger women were a reality in our country and posed us enormous difficulties in their management.

Patients with Early-Stage and Estrogen Receptor-Negative Breast Cancers: Young Age Does Link to Poor Outcomes

Purpose: This study aimed to evaluate whether young adult breast cancer patients have poor outcomes independent of established prognostic factors and analyze differences in prognosis between younger and older patients stratified by tumor subtype. Methods: Of 10,950 breast cancer patients treated at West China Hospital between 1998 and 2017, 741 younger patients (Results: We identified 11 parameters (all P P P P = 0.024] and HR for DFS = 1.301 [95% CI, 1.077 - 1.572;P = 0.006]). When stratified by tumor subtype, younger patients with T1, N0, tumor stage I, G3, estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and Ki67 ≥ 14% had a poor BCSS;in addition, patients with T1, N1, tumor stages I and II, G3, ER-negative, PR-negative, and triple-negative had a poorer DFS than older patients. Conclusion: Young age was an independent prognostic factor for BCSS and DFS in breast cancer patients. The increased risk of relapse was most pronounced in early-stage breast cancer, especially in patients with ER-negative disease.

Breast Cancer in Young Women about 87 Cases in the General Surgery Department CHU Gabriel Touré

Our objectives were to determine the frequency of breast cancer in young women, to determine the risk factors for breast cancer in young women, to detail the diagnostic process of the disease, to determine the different therapeutic strategies. This was a retrospective and descriptive study going from January 2005 to December 2021, a period of 17 years. The study involved 87 women with an average age of 33.2 years. Patients consulted 66 times or 75.9% for breast mass. The size of the tumor was greater than or equal to 5 cm in 62 patients;it was localized in the supero external quadrant 41 times or 47.1%. Molecular classification revealed the following results: Luminal A 21.4%;receptive (HER2) positive 28.6%, and triple negative 42.9%. Stage II was the most represented with 47.4%. Histology found infiltrating carcinoma of non-specific type in 76 patients. The treatment was mastectomy axillary dissection in 66 patients, quadrantectomy + axillary dissection in 6 cases (6.9%) associated with radiotherapy in 6 patients, chemotherapy was performed in 79 of our patients and hormone therapy in 10 patients. Conclusion: Breast cancer is frequent in our country. Patients generally consult us at a late stage. The possibility of determining certain receptors and carrying out certain non-surgical treatments on site would improve the prognosis.

中青年乳腺癌术后患者积极度及影响因素分析

目的了解中青年乳腺癌术后患者积极度现状并分析影响因素,为采取干预措施提高患者积极度提供参考。方法便利抽取208例乳腺癌术后患者为研究对象,采用一般资料调查表、患者积极度量表、社会影响量表(测评病耻感)、社会支持评定量表及乳腺癌幸存者自我效能感量表进行调查。结果中青年乳腺癌术后患者积极度得分为(58.10±9.45)分。多元线性回归分析显示,文化程度、是否保留乳房、病耻感、社会支持及自我效能感是中青年乳腺癌术后患者积极度的影响因素(均P<0.05)。结论中青年乳腺癌术后患者积极度处于中等水平,受多因素影响;可通过降低病耻感、增强社会支持及提高自我效能感,提高乳腺癌患者的自我管理积极度。

乳腺X线摄影及超声检查对不同病理类型及分子分型青年乳腺癌的诊断价值

目的 探讨乳腺X线摄影及超声检查对不同病理类型及分子分型青年女性乳腺癌的诊断价值。方法 选取我院经病理证实的青年女性乳腺癌患者87例,分析基本特征、病理类型、分子分型、影像学表现特点,对比乳腺X线摄影及超声检查的灵敏度及其联合灵敏度。结果 浸润性导管癌(invasive ductal carcinoma,IDC)为最常见病理类型(46.0%),最常见分子分型为Luminal B型(48.3%)。乳腺X线摄影中IDC常表现为不规则形,边缘模糊的肿块;IDC并导管原位癌(ductal carcinoma in situ,DCIS)以无定形、成簇或集群样分布的钙化为主;DICS以钙化或其他征象(结构扭曲或局灶性不对称)为主,钙化呈段样或弥漫性分布;其他类型癌主要表现为不规则或团块状,边缘清晰的肿块。Luminal B型以单纯钙化为主(35.7%);Luminal A型及三阴性型以肿块为主(分别为34.5%、42.9%);HER-2过表达型常表现为钙化(55.6%)。超声检查各病理类型及分子分型乳腺超声纵横比、病灶内部或(及)周围血流情况差异无统计学意义(P>0.05)。乳腺X线摄影的灵敏度为59.8%,超声检查的灵敏度为72.4%,二者结合的灵敏度为82.8%。结论 青年女性乳腺癌的个别影像学特征可用来预测肿瘤的某些病理类型。超声检查灵敏度高于乳腺X线摄影,超声检查联合乳腺X线摄影检查,可以提高灵敏度。

中青年乳腺癌患者术后心理反应的变化轨迹及影响因素研究

目的探讨中青年乳腺癌患者术后心理反应的异质性,并分析自我怜悯及感知伴侣回应对轨迹类别的预测作用。方法基于前瞻性研究设计,于2021年2月至2022年8月选取符合标准的247例中青年乳腺癌患者,采用一般资料调查表、乳腺癌患者心理反应量表、感知伴侣回应量表及自悯量表于术后化疗前、首次化疗后、化疗中期及化疗结束4个时间点进行随访调查,使用潜变量增长混合模型识别轨迹类型。结果中青年乳腺癌患者术后心理反应存在3种不同变化轨迹,命名为中等迟发下降组(61.13%)、低心理反应组(23.89%)和高危持续缓解组(14.98%);多分类logistic回归分析显示,心理反应轨迹类型的影响因素包括手术方式、自我怜悯及感知伴侣回应(均P<0.05)。结论中青年乳腺癌患者术后心理反应存在不同变化轨迹,手术方式、自我怜悯及感知伴侣回应能够预测患者的心理反应轨迹,应加强对中青年乳腺癌患者的心理反应干预,根据轨迹类型制定有效干预方案。

年轻乳腺癌病人二元应对、亲密关系与复发恐惧感的相关性研究

目的:调查年轻乳腺癌病人二元应对、亲密关系与复发恐惧感的现状,并采用结构方程模型对其路径进行分析。方法:采取便利抽样法选取2023年1月—6月在徐州医科大学附属医院放疗科就诊的190例年轻乳腺癌病人作为调查对象,使用乳腺癌病人一般情况调查表、二元应对量表、Locke-Wollance婚姻调适测定量表、复发恐惧量表对其进行问卷调查。结果:年轻乳腺癌病人二元应对总分为(114.82±16.89)分,亲密关系得分为(102.21±21.89)分,复发恐惧感得分为(36.24±4.12)分。年轻乳腺癌病人二元应对与亲密关系呈正相关(r=0.231,P<0.05),与复发恐惧感呈负相关(r=-0.358,P<0.05),亲密关系与复发恐惧感呈负相关(r=-0.296,P<0.05);结构方程模型拟合良好,二元应对和亲密关系直接影响病人复发恐惧感(β=-0.519,P<0.05;β=-0.425,P<0.05)。二元应对通过亲密关系间接影响病人复发恐惧感(β=-0.138,P<0.05)。结论:年轻乳腺癌病人二元应对、亲密关系处于中等水平,复发恐惧感较高。病人的二元支持应对与亲密关系、复发恐惧感之间存在密切相关性,亲密关系在二元应对与复发恐惧感间起中介作用。医护人员可制订针对性的二元应对干预措施,增进年轻乳腺癌病人与配偶间的亲密关系,以降低病人复发恐惧感。

全面综合性护理模式结合积极心理干预在中青年乳腺癌护理中的应用效果

目的分析全面综合性护理模式结合积极心理干预在中青年乳腺癌护理中的应用效果。方法研究选择我院2022年2月至2023年2月临床收治中青年乳腺癌患者42例为本次研究对象,采用数字抽签分组方式将42例患者划分为对照组(全面综合性护理)和观察组(全面综合性护理+积极心理干预),每组21例患者,对比分析两种不同护理模式下组间心理弹性量表(CD-RISC)、焦虑自评表(SAS)、抑郁自评量表(SDS)以及生活质量评定量表(SF-36)评分。结果护理后,观察组CD-RISC评分以及SF-36各项评分(躯体功能、行为功能、社会功能、情感健康)均高于对照组(均P<0.05);护理后,同对照组行SAS、SDS评分比较,观察组更低(均P<0.05)。结论全面综合性护理模式结合积极心理干预在中青年乳腺癌患者临床护理中的应用价值更高,患者经护理后心理状态更优,生活质量水平更高。

青年女性乳腺癌患者生育忧虑水平及影响因素的研究

目的:了解青年女性乳腺癌患者生育忧虑水平,并分析其影响因素。方法:选取本院2022年1月-2023年6月收治的青年女性乳腺癌患者为研究对象。采用一般资料调查表、癌症后生育忧虑量表、社会支持评定量表进行调查。采用单因素及多重线性回归模型分析影响青年女性乳腺癌患者生育忧虑水平的相关因素。结果:青年女性乳腺癌患者生育忧虑量表得分为(63.9±11.5)分,社会支持得分为(40.7±5.3)分,社会支持与生育忧虑呈负相关(r=-0.479,P<0.001)。多重线性回归分析显示,年龄(β=-0.105)、家庭经济收入(β=-0.196)、子女数量(β=-0.230)、疾病病程(β=0.118)、手术方式(β=0.184)、社会支持水平(β=-0.219)是青年女性乳腺癌患者生育忧虑的影响因素。结论:低龄、低收入、无子女、病程较长、术后乳房缺失的青年女性乳腺癌患者生育忧虑水平较高。增加社会支持,对患者生育忧虑具有保护作用。建议主动为患者提供生育咨询,制定个体化的治疗计划和生育保留方案,并鼓励患者主动寻求和利用社会支持缓解疾病压力,以降低生育忧虑。

PERMA积极心理干预对青年乳腺癌病人康复心理的影响

目的:探究PERMA积极心理干预对青年乳腺癌病人康复心理的影响。方法:选择医院2021年3月—2023年2月收治的110例青年乳腺癌病人为研究对象,按随机数字表法分为对照组、观察组,每组55例。对照组采取常规护理,观察组在对照组基础上增加PERMA积极心理干预,采用中文版癌症病人恐惧疾病进展简化量表、乳腺癌病人心理弹性量表分别评估病人的癌症复发恐惧及心理弹性水平。结果:观察组病人癌症复发恐惧评分低于对照组(P<0.05);观察组病人心理弹性评分高于对照组(P<0.05)。结论:PERMA积极心理干预应用于青年乳腺癌病人中能缓解病人癌症复发恐惧,有助于提升病人心理弹性水平。

年轻女性乳腺癌不同分子亚型的超声声像图特征分析

目的:探讨40岁以下年轻女性乳腺癌患者不同分子亚型的超声声像图特征。方法:回顾并分析2019年1月—2023年5月于南京中医药大学附属医院行乳腺超声检查并行乳腺癌切除术,且经手术后病理学检查证实为乳腺癌的年轻女性患者60例。按免疫组织化学检查结果分为Luminal A型、Luminal B型、三阴性型及人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)过表达型,分析不同亚型在肿块最大径、方位、纵横比、形态、边界、边缘毛刺征、内部回声、钙化灶、后方回声、血流分级、弹性评分方面的超声特点。结果:在60例乳腺癌患者中,Luminal A型较为常见(40.0%),HER2过表达型最少见(15.0%)。在不同分子亚型中,肿物的边缘毛刺征、钙化灶、后方回声差异有统计学意义(P<0.05),其中Luminal A型与Luminal B型多以边缘毛刺征(79.2%、55.3%)为主要表现,三阴性型多以后方回声增强或不变(91.7%)为主要表现,HER2过表达型多以钙化灶(88.9%)为主要表现。而在肿块最大径、方位、纵横比值、形态、边界、内部回声、血流分级、弹性评分中差异无统计学意义(P>0.05)。结论:年轻女性乳腺癌患者的超声声像图特征与其分子亚型存在一定相关性,可为术前预测乳腺癌分子亚型提供有价值的参考。

乳腺癌外科治疗十大热点

外科治疗是乳腺癌最主要的治疗手段,近年来随着乳腺癌的全身治疗的不断发展,乳腺癌的外科治疗理念也在发生变化,包括导管原位癌的外科治疗策略、前哨淋巴结微转移或宏转移的腋窝处理策略、新辅助治疗后的前哨淋巴结活检和保乳的安全性、新辅助治疗后手术时机的选择、年轻乳腺癌的外科治疗、Ⅳ期乳腺癌的手术治疗、植入物乳房重建的放疗时机等,面对这些问题,乳腺外科医生往往存在困惑,本文结合近年来乳腺癌外科治疗领域的最新进展及国内外指南,对困惑着乳腺外科医生的乳腺癌外科治疗十大热点问题进行总结,使乳腺癌的外科治疗更加规范化、个体化。

年轻乳腺癌患者生育决策过程中同辈支持需求质性研究

目的:探讨罹患乳腺癌后经历生育的年轻患者生育决策过程中对同辈支持的需求和体验,为年轻患者的生育管理提供科学的理论和实践依据。方法:采用质性研究中的现象学研究方法,对12例罹患乳腺癌后经历生育的年轻患者进行半结构式深入访谈,根据Colaizzi 7步分析法对原始资料进行整理分析。结果:提炼出5个主题,即资源共享的需求,情感支持的需求、信心和希望的需求、同辈支持的负性影响、同辈支持的建议。结论:年轻乳腺癌患者在生育决策过程中对同辈支持有着资源、情感、信心和希望的需求,但同辈支持也会产生负性的影响。因此,在临床实践中应不断完善支持方案,丰富同辈支持的形式,以患者需求为导向,优化精准配对,提高支持效率,同时不断完善系统、专业的培训,加强同辈支持督导,更好地促进年轻乳腺癌患者生育决策过程顺利进行。

乳腺外科中如何基于"生物-心理-社会模型"对年轻医生展开临床教学工作

当代乳腺癌的发病有年轻化趋势,应对年轻乳腺癌患者的诊疗难点和心理问题是乳腺外科医生需要掌握的重要内容.笔者挖掘了培养过程中的课堂、临床以及院外各个教学活动的细节,总结了基于"生物-心理-社会模型"培养新一代具有良好观察力、洞察力和共情力的优秀临床医生的经验.应用叙事医学模式,穿插真实病例,带教中鼓励医学生与年轻患者的沟通对话、独立制订治疗方案、病例讨论,全方位构建患者模型,建立以人为本的诊疗思维;鼓励学生加入患者的心理评估和宣教工作,为患者构建更安全、包容的社会环境.通过上述教学过程,可以使医学生获得更加深刻的学习体验.

综合性心理护理干预在年轻乳腺癌患者治疗期的应用

目的 分析综合性心理护理干预在年轻乳腺癌患者治疗期的应用效果。方法 选取2018年1月-2019年12月本院收治的60例年轻乳腺癌患者作为研究对象,随机分为对照和观察组,各30例。对照组给予常规护理模式,观察组给予综合性心理护理干预,比较两组护理效果。结果 两组护理前DT评分无明显差异(P>0.05);护理后,对照组DT评分高于观察组(P<0.05)。观察组护理总满意率高于对照组(P<0.05)。干预前,两组生活质量各指标均不存在大的差异(P>0.05);干预后,两组生活质量各指标均有所提升,但观察组提升幅度同对照组相较更大(P<0.05)。结论 针对年轻乳腺癌患者采用综合性心理护理干预措施可减轻其内心痛苦,使其积极接受治疗与护理,对促进护患关系改善也有重要价值,值得推广。

医务社会工作者联合同病患者介入干预对青年乳腺癌术后患者的影响

目的:探讨医务社会工作者联合同病患者介入干预对青年乳腺癌术后患者的影响。方法:以2018年1月1日~2020年8月31日收治的93例青年乳腺癌患者为研究对象,采用随机数字表法分为对照组47例和观察组46例;对照组给予常规护理干预,观察组在对照组基础上给予医务社会工作者联合同病患者介入干预。比较两组干预前后汉密顿焦虑量表(HAMA)、汉化癌症患者恐惧疾病进展简化量表(FoP-Q-SF)、数字评分法(NRS)、中文版疾病不确定感量表(MUIS)、应对方式问卷(CSQ)及世界卫生组织生活质量测定量表简表(WHOQOL-BREF)评分变化情况,并比较两组术后并发症发生率。结果:干预后,两组HAMA、FoP-Q-SF、NRS、MUIS、CSQ、WHOQOL-BREF评分均优于干预前(P<0.05),且观察组优于对照组(P<0.01,P<0.05);观察组术后并发症总发生率低于对照组(P<0.05)。结论:对青年乳腺癌术后患者给予医务社会工作者联合同病患者介入干预,可缓解患者负性情绪及术后疼痛程度,提高生活质量,降低其疾病不确定感及并发症发生率。