Triple Negative Breast Cancer Treatment: Use of Platinum and Platinum Analogs

Triple negative breast cancer (TNBC) is characterized by a high sensitivity to antiblastic drugs and a high pathological complete remission rate after neoadjuvant therapy. In patients showing complete remission, the probability of developing metastatic disease would seem to be reduced. Nonetheless, this cancer has a high percentage of relapse. Anthracyclines, taxanes and platinum compounds are the most effective drugs for the treatment of TNBC. There is substantial evidence to support the efficacy of platinum-based chemotherapy, probably attributable to the mechanism of action of such drugs, which react with the DNA repair system. PARP inhibitors would also seem to be very interesting. Despite promising results, TNBC remains a disease with a poor prognosis due to the lack of targeted therapy. The discovery of new targets and new agents is thus a high priority issue for this type of breast cancer. In this respect, lipoplatin has been identified as a potentially interesting treatment option to evaluate in both neoadjuvant and advanced settings.

Hyperthermia for Breast Cancer Treatment Using Slotted Circular Patch Antenna

The primary intent of this paper is to investigate the potential of using a slotted circular patch antenna at 2.45 GHz for breast tumor hyperthermia treatment. A cancer treatment model consisting of a microstrip patch antenna and breast phantom comprising tumor is designed and simulated in CST Studio Suite 2018. The radiation properties of the proposed antenna attain 3 dB beam width of 74.1°and 70.5°for the E-Plane and the H-plane, respectively. The breast phantom is exposed to the designed antenna radiation for 10 minutes, leading to raise the breast phantom temperature by 8.5°C and 11.4°C once the antenna pumped power is 1.5 and 2 watt, respectively. By considering 10 minutes as an exposure time, the breast temperature as a function of the applied antenna power is studied and compared with previous published results.

Breast Cancer in a Supernumerary Breast at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital: About a Case

Accessory or ectopic breast tissue is an anomaly in the development of the breast. It is a rare condition that occurs along the embryological mammary line. In less than 1% of all breast cancers, supernumerary breast cancer is reported, with the axillary location being the most common in 60% to 90% of cases. Cancerous degeneration of this supernumerary breast tissue can pose a dual diagnostic and therapeutic problem. We report the case of locally advanced adenocarcinoma in a right supernumerary breast. This is a 75-year-old, grand-multiparous, postmenopausal, and known hypertensive patient on treatment. Family history was remarkable for brain cancer in her sister and oesophageal cancer in her mother. She consulted for a mass in the right axillary cavity on supernumerary breast evolving for a year. Clinical examination revealed a large, fixed, budding and haemorrhagic-ulcerated mass of the right axilla, with long axis measuring about 15 cm. There was as wella supernumerary breast on the left, but without particularity. A soft tissue ultrasound showed a large hypoechoicmass in the right axillary region of 116 mm with areas of central necrobiosis. Morphologically, the breasts were normal. A breast MRI revealed a subcutaneous mass in the right axillary cavity with skin ulceration and satellite lymphadenopathy. The extension assessment revealed liver metastases, and a biopsy of the mass revealed a breast adenocarcinoma. The case was the subject of a multidisciplinary consultation meeting following which a wide excision of the mass was indicated. The histo-pathology analysis results of the surgical specimen were in favour of a triple negative papillary adenocarcinoma. After a post-operative multidisciplinary consultation meeting, adjuvant chemotherapy was indicated. The development of supernumerary breasts depends on hormones, just like normal breasts. Breast cancer in accessory breast tissue is quite rare with the incidence being 6%. The most common pathology is invasive carcinoma (50% - 75%). It is usually located in the armpit (60% - 70%) although it can be present in other less common locations such as the inframammary region (5% - 10%) and rarely the thighs, perineum, groin and the vulva. Since accessory axillary breast tissue is not considered during breast screening examination, it is necessary for clinicians to be aware of this entity and associated pathologies. Their preventive excision in women at high risk can also be considered.

Conservative Treatment of Breast Cancer and Oncoplasty at the Teaching Hospital Mother and Child of Jeanne Ebori Foundation in Libreville (Gabon)

Introduction: Breast cancer is currently the most common malignant tumour in women worldwide. Objective: To evaluate conservative treatment of breast cancer and oncoplasty at the teaching hospital Mother and Child of Jeanne Ebori Foundation (CHUMEFJE). Patients and methods: This is an observational, descriptive study, which took place from August 2019 to December 2021 at CHUMEFJE. Data were collected using patients’ medical records, and operative and pathological anatomy reports. Results: Conservative treatment and oncoplasty were performed in 12 (34.2%) patients. Of these patients, 8 (66.7%) benefited from an external technique and 2 (16.7%) from a pamectomy. Post-operative complications were dominated by lymphocele in 5 (41.6%) patients. Ten (83.3%) patients were satisfied with the post-operative aesthetic result. At the time of updating the records, 1 (8.3%) patient had died and 11 (91.7%) were alive. Conclusion: Conservative treatment and oncoplasty are giving satisfactory results at the CHUMEFJE in Libreville.

Breast Cancer Hyperthermia Treatment Based on Slotted Patch Antenna at 2.45 GHz

The present work proposed a simple model for breast cancer hyperthermia treatment at 2.45 GHz. The proposed model involves nine-element antennas alongside a numerical breast comprising multiple tumors. Using a coupled EM-Thermal simulation in the CST suite, the simulated results for a single antenna showed a reflection coefficient (S11) better than -47 dB and demonstrated a bandwidth of 78 MHz. The specific absorption rate (SAR) as a function of input powers was examined inside the breast tissues, where it exhibited a promising performance higher than 3 W/kg at the tumor volume when the applied power was at a reasonable level of 1.5 W whereas it was well attained under the recommend IEEE level of 1.6 W/kg through the surrounded health tissues. Taking into consideration nine-element antennas covering the breast containing two different located tumors, the maximum temperature as a function of treatment time was presented at which a resulting temperature of 43°C was obtainable within 10 minutes, favored for hyperthermia purposes. Considering the maximum power level of 1.5 W, the potential use of applying three-element antennas, simultaneously with 0.5 W, could be achieved.

Current Status of Diagnosis And Treatment of Primary Breast Cancerin Beijing,2008

Objective：To investigate the status of diagnosis and treatment of primary breast cancer in Beijing,2008.Methods：All the patients who were diagnosed as primary breast cancer in Beijing in 2008 were enrolled in this study.Information of these patients,including the features of tumors,clinical diagnosis and treatment was collected,and filled in the well-designed questionnaire forms by trained surveyors.The missing data were partly complemented through telephone interviews.Results：A total of 3473 Beijing citizens were diagnosed as primary breast cancer（25 patients with synchronal bilateral breast cancer） in Beijing,2008.Of them 82.09% were symptomatic.19.02% and 34.11% were diagnosed using fine needle aspiration biopsy（FNAB） and core needle biopsy（CNB）,respectively.15.92% received sentinel lymph node biopsy（SLNB） and 24.27% received breast conserving surgery（BCS）.Among 476 cases with Her-2 positive,only 96 received anti-Her-2 therapy.We found that the standardization level varied in hospitals of different grades,with higher level in Grade-III hospitals.Of note,some breast cancer patients received non-standard primary tumor therapy：65.63% of the patients with ductal carcinoma in situ（DCIS） received axillary lymph node dissection and 36.88% received chemotherapy;25.89% of the patients underwent breast conserving surgery without margin status;12.10% of the patients received chemotherapy less than 4 cycles.Conclusion：Although most breast cancer patients received basic medical care,the mode of diagnosis and treatment should be improved and should be standardized in the future in Beijing.

Impact of CYP2D*6 in the adjuvant treatment of breast cancer patients with tamoxifen

Biotransformation of tamoxifen to the potent antiestrogen endoxifen is performed by cytochrome P450(CYP) enzymes, in particular the CYP2D6 isoform. CYP2D6*4 is one of the most frequent alleles associated with loss of enzymatic activity. The incidence of CYP2D6*4 among Caucasians is estimated up to 27%, while it is present in up to 90% of all poor metabolizers within the Caucasian population. The hypothesis under question is whether the presence of one or two non-functioning(null) alleles predicts an inferior outcome in postmenopausal women with breast cancer receiving adjuvant treatment with tamoxifen. The numerous existing studies investigating the association of CYP2D6 with treatment failure in breast cancer are inconsistent and give rather conflicting results. Currently, routine CYP2D6 testing among women with breast cancer is not recommended and the significance of CYP2D6 phenotype in decision making regarding the administration of tamoxifen is unclear. The present study summarizes current literature regarding clinical studies on CYP2D6*4, par-ticularly in terms of response to tamoxifen therapy and breast cancer outcome.

Review of treatment assessment using DCE-MRI in breast cancer radiation therapy

As a noninvasive functional imaging technique, dynamic contrast-enhanced magnetic resonance imaging(DCEMRI) is being used in oncology to measure properties of tumor microvascular structure and permeability. Studies have shown that parameters derived from certain pharmacokinetic models can be used as imaging biomarkers for tumor treatment response. The use of DCE-MRI for quantitative and objective assessment of radiation therapy has been explored in a variety of methods and tumor types. However, due to the complexity in imaging technology and divergent outcomes from different pharmacokinetic approaches, the method of using DCE-MRI in treatment assessment has yet to be standardized, especially for breast cancer. This article reviews the basic principles of breast DCE-MRI and recent studies using DCE-MRI in treatment assessment. Technical and clinical considerations are emphasized with specific attention to assessment of radiation treatment response.

Toremifene in the treatment of breast cancer

Although more widespread screening and routine adjuvant therapy has improved the outcome for breast cancer patients in recent years, there remains considerable scope for improving the efficacy, safety and tolerability of adjuvant therapy in the early stage disease and the treatment of advanced disease. Toremifene is a selective estrogen receptor modifier(SERM) that has been widely used for decades in hormone receptor positive breast cancer both in early and late stage disease. Its efficacy has been well established in nine prospective randomized phase Ⅲ trials compared to tamoxifen involving more than 5500 patients, as well as in several large uncontrolled and non-randomized studies. Although most studies show therapeutic equivalence between the two SERMs, some show an advantage for toremifene. Several meta-analyses have also confirmed that the efficacy of toremifene is at least as good as that of tamoxifen. In terms of safety and tolerability toremifene is broadly similar to tamoxifen although there is some evidence that toremifene is less likely to cause uterine neoplasms, serious vascular events andit has a more positive effect on serum lipids than does tamoxifen. Toremifene is therefore effective and safe in the treatment of breast cancer. It provides not only a useful therapeutic alternative to tamoxifen, but may bring specific benefits.

Sentinel lymph node metastasis after neoadjuvant treatment in breast cancer:Any size matters?

One of the advantages of neoadjuvant chemotherapy(NAC) treatments is its ability to convert patients who need a mastectomy in breast conservative surgery. NAC has also increased the conversion of node positive patients into node negative in around 40% allowing the use of sentinel node biopsy(SLN) in this setting. Timing of SLN biopsy after NAC has been a subject of debate. In patients with clinically node negative before NAC,rates of success and false negative rates of SLN after NAC are similar to those in the adjuvant setting,so SLN after NAC in previous negative axilla has been incorporated in the staging of the axilla. More controversial is its use in patients with positive axillary nodes before NAC who convert to node negative after NAC. Several randomized studies have reported the identification rates and the false negative rates of the SLN after NAC,concordant in the importance of surgical technique. As there is an agreement in the abandon of the immunohistochemistry(IHC) for SLN in the adjuvant setting as SLN IHC detected metastasis appear to have no impact on overall survival,in patients with SLN after NAC the inclusion of isolated tumor cell(ITC) as positive nodes lowers the false negative rates of the technique,suggesting the importance of assessing the SLN by IHC after NAC and considering it as residual disease. Longer follow up is needed to determine the prognostic implications of ITC in the SLN after NAC.

Green tea compounds in breast cancer prevention and treatment

Breast cancer is the most common cancer among women. In recent years, many in vitro and in vivo studies indicate that green tea possesses anti-cancer effects. The epidemiological studies, however, have produced inconclusive results in humans. Likewise, results from animal models about the preventive or therapeutic effects of green tea components are inconclusive. The mechanisms by which green tea intake may influence the risk of breast cancer in humans remain elusive. Here, we review recent studies of green tea polyphenols and their applications in the prevention and treatment of breast cancer. Furthermore, we discuss the effect of green tea components on breast cancer by reviewing epidemiological studies, animal model studies and clinical trials. At last, we discuss the mechanisms by which green tea components suppress the develop-ment and recurrence of breast cancer. A better understanding of the mechanisms will improve the utilization of green tea in breast cancer prevention and therapy and pave the way to novel prevention and treatment strategies for breast cancer.

Efficacy, patterns of use and cost of Pertuzumab in the treatment of HER2+ metastatic breast cancer in Singapore: The National Cancer Centre Singapore experience

BACKGROUND Pertuzumab is a humanized anti-human epidermal growth factor receptor 2(HER2)monoclonal antibody found in a Phase III clinical trial to significantly improve median survival in HER2 positive metastatic breast cancer(MBC)when used in combination with a taxane and Trastuzumab,and its clinical efficacy has transformed the therapeutic landscape of HER2-positive breast cancer.There are currently few reports on the pattern of use and value of Pertuzumab in real world settings.Our study describes the clinical efficacy and treatment costs of Pertuzumab in HER2-positive MBC treated in a tertiary cancer centre in Singapore in a predominantly Asian population.AIM To investigate the clinical efficacy and treatment costs of Pertuzumab in HER2-positive MBC in an Asian population in Singapore.METHODS A retrospective study of 304 HER2-positive MBC patients seen at National Cancer Centre Singapore between 2011-2017 was conducted.Demographic and clinical data were extracted from electronic medical records.Clinical characteristics and billing data of patients who received Pertuzumab were compared with those who did not.RESULTS Thirty-one(62.0%)of the fifty(16.4%)patients who received Pertuzumab as firstline therapy.With a median follow-up of 21.5 mo,there was a statistically significant difference in the median overall survival between Pertuzumab and non-Pertuzumab groups[51.5(95%CI:35.8–60.0)vs 32.9(95%CI:28.1–37.5)mo;P=0.0128].Two(4.88%)patients in the Pertuzumab group experienced grade 3(G3)cardiotoxicity.The median treatment cost incurred for total chemotherapy for the Pertuzumab group was 130456 Singapore Dollars compared to 34523 Singapore Dollars for the non-Pertuzumab group.The median percentage of total chemotherapy costs per patient in the Pertuzumab group spent on Pertuzumab was 50.3%.CONCLUSION This study shows that Pertuzumab use in the treatment of metastatic breast cancer is associated with a significantly better survival and a low incidence of serious cardiotoxicity.However,the proportionate cost of Pertuzumab therapy remains high and further cost-effectiveness studies should be conducted.

Evaluation of 3D-CRT and VMAT Radiotherapy Plans for Left Breast Cancer with Regional Lymph Nodes Irradiation

Introduction: Radiation therapy after breast surgery is an integral part of the treatment of early breast cancer. The goal of radiation therapy is to achieve the best possible coverage of the planning target volume (PTV), while reducing the dose to organs at risk (OARs) which are normal tissues whose sensitivity to irradiation could cause damage that can lead to modification of the treatment plan. In the last decade, radiation oncologist started to use the Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for irradiating the breast, in order to achieve better dose distribution and target dose to the PTV and OAR. The aim of this study is to compare 2 external radiotherapy techniques (VMAT vs 3D) for patients with node-positive left breast cancer. Patients and Methods: We randomly selected 10 cases of postoperative radiotherapy for breast cancer in our hospital. The patients are all female, the average age was 45.4 years old, and the primary lesions are left breast. The ANOVA test was used to compare the mean difference between subgroups, and the p value Results: Dose volume histogram (DVH) was used to analyze each evaluation dose of clinical target volume (CTV) and organs at risk (OARs). Compared to 3DCRT plans, VMAT provided more uniform coverage to the breast and regional lymph nodes. The max point dose for tVMAT was lower on average (106.4% for VMAT versus 109% for 3DCRT). OAR sparing was improved with tVMAT, with a lower average V17Gy for the left lung (27.91% for VMAT versus 30.04% for 3DCRT, p and lower for V28Gy (13.75% for VMAT versus 22.34% for 3DCRT, p = 0.01). We also found a lower V35Gy for the heart on VMAT plan (p = 0.02). On the contrary, dose of contralateral breast was lower in 3DCRT than VMAT (0.59 Gy vs 3.65 Gy, p = 0.00). Conclusion: The both types of plans can meet the clinical dosimetry demands of postoperative radiotherapy for left breast cancer. The VMAT plan has a better conformity, but 3CDRT can provide a lower dose to the contralateral organs (breast and lung) to avoid the risk of secondary cancers.

Familial versus Sporadic Breast Cancer: Different Treatments for Similar Tumors?

Objective: It is unclear if and to what extent family history of breast/ovarian cancer or BRCA1/2-mutation carriership influences breast cancer treatment strategy. We investigated whether treatment differed between patients from BRCA1/2 families and those unselected for family history. Methods: We included 478 BRCA1/2-related patients referred for genetic testing before or after diagnosis. Two references were used: 13,498 population-based and 6896 hospital-based patients. Surgical treatment and adjuvant chemotherapy use was analyzed using logistic regression models, stratified by tumor size, nodal status, age at and period of diagnosis, and estrogen receptor status (ER). Results: BRCA1/2 cases aged 35 - 52 years at diagnosis and/or with tumors < 2 cm were more likely to have undergone a modified radical mastectomy (Odd Ratios (OR) ranging from 2.8 to 5.1) compared to the references. This effect was most pronounced in patients treated after 1995 (OR 5.7 to 10.3). Compared to the reference groups, chemotherapy was more often administered to BRCA1 and ER-negative BRCA1/2-cases irrespective of age and nodal status (OR 1.9 to 24.3). Conclusion: After 1995 treatment of BRCA1/2-associated patients consisted notably of more mastectomies and adjuvant chemotherapy than their population-based counterparts with the same tumor characteristics. There is a need to be aware of such differences in daily practice and interpretation of survival studies on BRCA1/2 mutation carriers.

Successful Treatment of Recurrent Triple-Negative Breast Cancer with Combination of Targeted Therapies

We present an interesting case of a 56-year-old female diagnosed with invasive high-grade triple-negative breast cancer, who developed diffuse liver metastases following lumpectomy and combination chemotherapy with docetaxel, doxorubicin and cyclophosphamide, re-excision and radiation therapy. Restaging CT and PET scans revealed massive involvement of the liver. She was treated with a combination of gene targeted and cytotoxic chemotherapy including capecitabine, erlotinib, bevacizumab and phenylbutyrate. She tested weakly positive for HER-2 despite prior negative FISH, which prompted us to add trastuzumab to her regimen. Baseline CT revealed five liver tumors—the sum of the products of the two largest perpendicular diameters was 110 cm2. Follow-up CT after three months of treatment revealed 62% decrease in total tumor load. More than 50% decrease in tumor size persisted on two follow-up CT scans, confirming partial response. She developed progressive disease after 15 months of treatment. A group of 16 women, including this patient, diagnosed with triple negative breast cancer with distant metastases were treated by our team with a combination of gene targeted therapy and chemotherapy. Six percent of patients obtained partial response, 25% minor response, 31% stable disease, and 38% progressive disease. The median duration of treatment in patients who relapsed after the second-, third- and fourth- to seventh-lines of chemotherapy was 59 weeks, 22 weeks and 17 weeks, respectively. Comparison of results obtained with cytotoxic chemotherapy revealed that MDT in the second- and third-lines was only nine and four weeks, respectively. In conclusion, this case report indicates that it is possible to obtain durable objective response of recurrent TNBC with a combination of gene targeted agents.

Under-Treatment and Poorer Survival Outcomes in Elderly Breast Cancer Patients in Singapore: A Comparison with Younger Patients in a Tertiary Institution

Introduction: The numbers of elderly patients with breast cancers are increasing with an ageing population, yet clinical research on these patients is still lacking. This study aims to examine the differences between elderly patients and their younger counterparts, with a view to optimize management plans for the former. Methods: Patients ≥ 40 years old with histologically proven breast cancer between 1991 and 2008 were identified from our database, and grouped according to age for analyses: old elderly (≥75 years), young elderly (65 to 74 years) and young (40 to 64 years). Clinicopathologic characteristics, treatment and survival rates were compared across the 3 groups. Results: There were 103 (11.53%) old elderly, 147 (16.5%) young elderly and 643 (72.0%) young patients. The 2 elderly groups presented at later stages, received less adjuvant or palliative chemotherapy (P < 0.001), and less adjuvant radiotherapy (P < 0.001), compared to the younger patients. Both breast cancer specific survival (CSS) and overall survival (OS) in the old elderly (CSS: 64.7% (95% confidence interval [CI]: 53.4% - 73.8%), OS: 46.4% (95% CI: 35.6% - 56.4%)) and young elderly group (CSS: 82.4% (95% CI: 74.4% - 88.0%) OS: 78.6% (95% CI: 70.4% - 84.8%)) were lower than the young patient group (CSS: 84.9% (95% CI: 81.6% - 87.7%), OS: 83.4% (95% CI: 80.0% - 86.3%)) at 5 years. Conclusion: Our findings showed that clinicopathologic characteristics of elderly breast cancer patients differed from their younger counterparts. Poorer survival outcomes among our elderly patients may be the result of their under-treatment.

Consultation, Diagnosis and Treatment Delays for Breast Cancer among Patients Followed up at the YaoundéGeneral Hospital, Cameroon

Introduction: Breast cancer is often diagnosed at an advanced stage in Cameroon. The objective was to analyse consultation, diagnosis and treatment delays for breast cancer among patients followed up at the Yaoundé General Hospital (YGH) in Cameroon. Materials and Methods: This was a cross-sectional study carried out from the files of patients followed up for breast cancer at the YGH from January 1, 2014 to April 30, 2018. A total of 183 patients were included. We measured time elapsed between the awareness of first signs of disease and the initial consultation (consultation delays), time lapse between the initial consultation and pathological diagnosis of breast cancer (diagnosis delays), interval between pathological diagnosis and treatment onset (treatment delays), time elapsed between the initial consultation and management (health system delays) and time elapsed from awareness of first signs of disease to treatment onset (overall delays). Results: The delays (median, IIQ) were: (5.1 months;IIQ: 1.7 - 12.4), (25 days;IIQ: 10 - 67), (27 days;IIQ: 13 - 63), (2.2 months;IIQ: 1.2 - 5.8) and (9.9 months;IIQ: 4.4 - 17.6) respectively for consultation, diagnosis, treatment, health system and overall delays. The risks associated with a delay in initial consultation of greater than 3 months were (OR;95% CI): unschooled patients (2.01;1.66 - 2.40);monthly income below the minimum wage (2.70;1.81 - 5.96);unemployment (2.14;1.02 - 3.24) and absence of a family history of cancer (2.44;1.66 - 6.10). The main reasons for a late first consultation were: ignorance (60.2%), financial challenges (17.6%) and a preference for alternative treatment (11.1%). Conclusion: The consultation, diagnosis and treatment delays for breast cancer are very often long in our setting than those reported in developed countries. Both patients’ and institutional factors are demonstrated. There is a need to increase public awareness on the value of early diagnosis of breast cancer. Also, health system should be improved to enable early diagnosis and treatment of this affection.

A Novel Treatment Optimization System and Top Gene Identification via Machine Learning with Application on Breast Cancer

Traditional treatment selection of cancers mainly relies on clinical observations and doctor’s judgment, but most outcomes can hardly be predicted. Through Genomics Topology, we use 272 breast cancer patients’ clinical and gene information as an example to propose a treatment optimization and top gene identification system. This study faces certain challenges such as collinearity and the Curse of Dimensionality within data, so by the idea of Analysis of Variance (ANOVA), Principal Component Analysis (PCA) is implemented to resolve this issue. Several genes, for example, SLC40A1 and ACADSB, are found to be both statistically significant and biological-studies supported;the model developed can precisely predict breast cancer mortality, recurrence time, and survival time, with an average MSE of 3.697, accuracy rate of 88.97%, and F1 score of 0.911. The result and methodology used in this study provide a channel for people to further look into the more precise prediction of other cancer outcomes through machine learning and assist in the discovery of targetable pathways for next-generation cancer treatment methods.

Body mass index trends and quality of life from breast cancer diagnosis through seven years’ survivorship

BACKGROUNDWeight gain is a potential negative outcome of breast-cancer treatment,occurringin 50%-to-96%of breast-cancer patients,although the amount of weight gain isinconsistently reported in the literature.Research has also shown a relationshipbetween overweight/obesity and breast-cancer mortality.Correspondingly,weight management is a self-care approach known to benefit quality of life(QOL).These research questions and analysis add to existing literature byexamining participants’body mass index(BMI)trend and its relationship withQOL indicators over seven years.AIMTo examine:(1)BMI trends among breast cancer survivors;and(2)The trends’relationship to QOL indicators over seven years.METHODSDuring the Breast Cancer and Lymphedema Project,378 patients’weight andheight were recorded by nurses prior to or just after beginning breast cancertreatment and repeated at quarterly-to-semiannual intervals over seven years.Additionally,participants annually completed the 36-Item Short Form HealthSurvey(SF-36),a valid and reliable tool assessing QOL and health concepts,including physical function,pain,and emotional well-being.BMI trends,changein BMI,and change in SF-36 subscales over seven years were calculated using arandom-intercept repeated-measures regression.Patients were placed into BMIcategories at each time point:Normal,Overweight and Obese.As patients’weights changed,they were categorized accordingly.RESULTSDuring the seven-year study and while controlling for age and residence,participants gained an average of 0.3534 kg/m^2(P=0.0009).This amountremained fairly consistent across BMI categories with those in the normal-weight category(n=134)gaining 0.4546 kg/m^2(P=0.0003);Overweight(n=190)gaining 0.2985 kg/m^2(P=0.0123);and obese(n=199)gaining 0.3147 kg/m^2,(P=0.0649).Age(under or over 55)and region(metro/micro vs small/rural)weresignificantly associated with BMI increase in both the normal and obesecategories.There were statistically significant(P<0.0100)changes in five of theeight SF-36 domains;however,the directions of change were different andsomewhat divergent from that hypothesized.Controlling for age and region,these five were statistically significant,so there were no change or differencesbetween the micropolitan/metropolitan and small town/rural groups.CONCLUSIONAlthough only modest increases in mean BMI were observed,mean BMI changewas associated with selected QOL indicators,suggesting the continued need forself-care emphasis during breast cancer survivorship.

Risk factors and natural history of breast cancer in younger Chinese women

AIM: To investigate the age differences in the risk factors, clinicopathological characteristics and patterns of treatment of female breast cancer patients. METHODS: Seven thousand one hundred and fiftytwo women with primary breast cancer from the Hong Kong Breast Cancer Registry were recruited after receiving patients' consent, they were asked to complete standardized questionnaires which captured their sociodemographic characteristics and risk factors associated with breast cancer development. Among them, clinicopathological data and patterns of treatment were further collected from medical records of 5523 patients with invasive breast cancers. Patients were divided into two groups according to the age at diagnosis: younger(< 40 years old) vs older patients(≥ 40 years old) for subsequent analyses.RESULTS: Analysis on the sociodemographic characteristics and exposure to risk factors were performed on 7152 women with primary breast cancer and the results revealed that younger patients were more likely to have unhealthy lifestyles; these include a lack of exercise(85.4% vs 73.2%, P < 0.001), having high stress in life(46.1% vs 35.5%, P < 0.001), having dairy/meat-rich diets(20.2% vs 12.9%, P < 0.001),having alcohol drinking habit(7.7% vs 5.2%, P = 0.002). Younger patients were also more likely to have hormone-related risk factors including nulliparity(43.3% vs 17.8%, P < 0.001) and an early age at menarche(20.7% vs 13.2%, P < 0.001). Analyses on clinicopathological characteristics and patterns of treatment were performed on 5523 women diagnosed with invasive breast cancer. The invasive tumours in younger patients showed more aggressive pathological features such as having a higher percentage of grade 3 histology(45.7% vs 36.5%, P < 0.001), having a higher proportion of tumours with lymphovascular invasion(39.6% vs 33.2%, P = 0.003), and having multifocal disease(15.7% vs 10.3%, P < 0.001); they received different patterns of treatment than their older counterparts.CONCLUSION: Younger patients in Hong Kong are more likely to encounter risk factors associated with breast cancer development and have more aggressive tumours than their older counterparts.