Comparative Study between Lidocaine 2% and Dexamethasone Local Wound Infiltration Effect on Postoperative Pain Post Mastectomy: A Randomized Controlled Study

Objective: To compare the efficacy and safety of Lidocaine 2% versus Dexamethasone injected locally in mastectomy wound as pain relieving agents. Materials & Methods: A randomized single-blinded study in which 50 patients candidate for Mastectomy were included. Participants were equally randomized into two groups;Group A, in which patients received 10 ml Lidocaine 2% and Group B, in which patients received 16 mL Dexamethasone. In both groups, the drugs were given via local infiltration in the subcutaneous layer of the Mastectomy wound immediately after skin closure. Pain control was assessed post-operatively in the first 24 hours using the visual analogue scale (VAS) in addition the need for additional analgesia was recorded. Results: There was a statistically significant lower VAS score in group A (Lidocaine group) when compared to those in group B (Dexamethasone group) 1 h, 6 h, 12 h postoperatively with no significance 24 h postoperatively (36% vs 64% 1 h, 28% vs 64% 6 h, 30% vs 72% 12 h and, 80% vs 60% 24 h). This statistical significance was evident throughout the post-operative hours (1 h, 6 h, 12 h). Though local Lidocaine caused marked improvement of pain in bigger number of patients in group A than group B, yet it showed no statistical significance 24 h post-mastectomy. Furthermore, the number of participants that needed additional doses of analgesia lower in group A (48% vs 56%) in comparison to group B, but still showed no statistical significance. Conclusion: Local injection of Lidocaine 2% in Mastectomy wounds, has an upper hand in reducing the post-operative pain and showed a lesser need for post-operative analgesia when compared to local Dexamethasone injection.

Association of Metastasis and Axillary Lymph Node Tuberculosis in Breast Cancer: Clinical Case and Review of the Literature

The coexistence of tuberculosis with axillary lymph node metastases in breast carcinoma is rare. Axillary lymph node metastasis is the most important factor in the staging of breast carcinoma, and the number of axillary lymph nodes metastasizing changes the stage. Since tuberculosis also produces lymph node enlargement, this can mimic or complicate the staging of a malignant disease. Dual organ pathology can lead to interpretation difficulties and inappropriate treatment of tuberculosis as well as breast carcinoma. Additionally, fine needle aspiration cytology (FNAC) of such cases can be misleading if only one of the diseases is detected. We report two cases of infiltrating carcinoma of the nonspecific type of the breast in two women aged 35 and 55 where tuberculosis was found in the axillary lymph nodes in addition to metastases. As the present case led to the fortuitous discovery of tuberculosis with tumor metastasis, it reinforces the possibility of a coexisting lesion in the minds of pathologists, especially in areas endemic to tuberculosis.

Breast Cancer: Knowledge, Attitudes on Risk Factors and Means of Screening by Medical Students from Lomé, Togo

Background: Breast cancer is the leading cause of cancer-related death in women around the world. The objective of this study was to assess knowledge and attitudes about breast cancer screening among students in the Faculty of Health Sciences at the University of Lomé. Methods: This was a prospective descriptive transversal study conducted among students enrolled in the Faculty of Health Sciences (FSS) of the University of Lomé (UL) in the 2019 school year account 2020. The purpose of this study was to assess the knowledge and attitudes of medical students about breast cancer screening. Results: In total, the questionnaire was completed by 934 students, for a response rate of 57.1%. The most frequently mentioned risk factors were the presence of a family history of breast cancer (n = 799, 85.55%) and the use of oral or injectable contraceptives (n = 606, 64.88%). There is a statistically significant link between the participants’ knowledge of the self-examination and clinical examination of the breasts and certain socio-demographic characteristics, namely age (OR = 0.2, 95% CI [0.11 - 0.75], p-value < 0.0001), the level of study (OR = 1.5, 95% CI [0.55 - 2.46], p-value = 0.0054), the follow-up of a course on breast cancer (OR = 2.63, 95% CI [0.32 - 4.33], p-value = 0.009) and the effectiveness of an internship in a gynecology-obstetrics department (OR = 0.77, 95% CI [0.49 - 2.56], p-value < 0.0001). Similarly, there is a statistically significant link between participants’ knowledge of mammography and certain socio-demographic characteristics, namely age (OR = 0.75, 95% CI [0.50 - 0.84], p-value = 0.0005), the level of study (OR = 1.92, 95% CI [1.11 - 3.46], p-value < 0.0001), the follow-up of a course or training on breast cancer (OR = 2.44, 95% CI [0.08 - 3.91], p-value < 0.0001) and the effectiveness of an internship in a gynecology-obstetrics department (OR = 0.62, 95% CI [0.33 - 0.85], p-value < 0.0001). Conclusion: Knowledge and attitudes related to breast cancer screening have been found to be generally satisfactory to medical students. Active measures are needed to develop educational programs for health personnel, which could enable them to disseminate knowledge and positively influence patient attitudes.

Women’s Performance of Breast Cancer Screening (Breast Self-Examination, Clinical Breast Exam and Mammography)

Background: Breast cancer is the most common malignancy among women in Saudi Arabia. Despite the availability of early detection methods to diagnose breast cancer, a huge number of women are still unaware about these methods. This study was conducted to identify the attitude of women in Medina toward breast cancer screening methods, including breast self-examination (BSE), clinical breast examination (CBE) and mammography. Methods and Materials: A cross-sectional survey has been conducted on 124 women aged from 39 and older, who attended Taibah Medical Center for cancer screening either by doctor’s recommendation, family or friends advice, or by herself. Face to face questionnaire was used to collect data. All data were analyzed by statistical analysis system software. Results: The results showed only 35.5%, 27.4% and 37.8% of participants reported that they practiced BSE, CBE and annual mammography, respectively. Only 27.3% of women practiced BSE once per month, and 8.8% visited doctor annually for CBE. Both educational level (p = 0.004) and family history (p = 0.01) were significantly related to BSE. 57.7% of the participants who had positive family history practiced BSE, and 56.0% of the participants who practiced BSE were highly educated. Lacking awareness about BSE is the most important barrier in not practicing BSE, while not having a breast lump was the reason for not undergoing either clinical breast examination (38.7%) or periodic mammography (54.9%). Conclusion: This study emphasized the need for massive health education program to increase awareness, and improve the attitude of women toward breast cancer screening methods.

Expression of Multidrug Resistance ATP-Binding Cassette(ABC)Transporters in Canine Mammary Tumors

Mammary neoplasms are the most common tumors in female dogs. They are usually treated using solely surgical mastectomy—which is recognized as unsatisfactory in many cases. Given this, the benefits of chemotherapy in dogs with mammary cancer need to be further explored. Some drugs that can be used for treating canines with mammary tumors may be substrates of uptake and/or efflux transporters such as the ATP-binding cassette (ABC) transporters. Unfortunately, very little is known regarding the pathobiology of such proteins in canine tumors, including mammary cancer. Accordingly, this study was designed to characterize the expression of ABC transporters P-glycoprotein, MRP1, and MRP2 and their relation with clinicopathologic factors in order to allow a better understanding of their influence in canine mammary cancer. P-glycoprotein was expressed in tumors from 55.8% of patients, while MRP1 and MRP2 were expressed in 37.2% and 39.5% of tumors, respectively. P-glycoprotein expression showed to be related with regional lymph node spread (P = 0.0038), as well as with tumor grade (P = 0.0353) and with a shorter survival (P = 0.0245). MRP1 revealed a strong association with a higher histological grade (P < 0.0001) and overall survival (P = 0.0002). Additionally, MRP1 was determined as prognostic indicator independent of lymph node status using Cox proportional-hazards regression multivariate analysis (P = 0.0216). No relations between MRP2 and clinicopathologic features were observed. We have found that P-glycoprotein and MRP1 are expressed in highly aggressive canine mammary tumors and are related with poor prognosis. Our results suggest that they may play a significant role in the course of canine mammary cancer progression and be promising candidate markers for a validation study on therapy outcome.

Benefits and Limitations of Volumetric Modulated Arc Therapy in Treating Bilateral Breast Cancer with Regional Lymph Nodes

Purpose: The study was performed comparing dosimetric characteristics of volumetric modulated arc therapy (VMAT) and field-in-field (FiF) techniques on a patient with synchronous bilateral breast carcinoma. Methods: The patients with bilateral breast cancer treatment were included in this study. A total dose of 40.05 Gy in 15 fractions was prescribed to the Planning Target Volume (PTV) of the whole bilateral breast cancer with the supraclavicular and infraclavicular nodes, with a complementary boost of 10 Gy in 4 fractions to the surgical bed (PTVboost). For both radiotherapy techniques, several VxGy parameters were analyzed for the PTVs, together with the Conformity index (CI), the Homogeneity index (HI) and the critical organs at risk (OARs), lungs and heart. Results: The patient was treated by the VMAT technique and the daily treatment time was less than 20 minutes with daily CBCT imaging. In the VMAT plan, the PTV 95% dose covered 38.89 ± 0.81 Gy, compared to 37.26 ± 1.02 Gy in the FiF technique. The VMAT plan improved the dose homogeneity index and lower dose in lung towards high dose region. Conclusion: The study demonstrates the viability of the VMAT technique in the treatment of bilateral breast cancer. The introduced single isocentric VMAT technique is fast to deliver and it increases the dose homogeneity of the target volume with some limitations. The treatment was well tolerated, without interruption of the treatment courses caused by treatment-related toxicities.

Genetic Variation of <i>hTERT</i>, Leukocyte Telomere Length and the Risk of Breast Cancer: A Case-Control Study in Egyptian Females

Background: hTERT is a key player in telomere biology and its activity is directly related to cell senescence and development of many health-related problems including cancer. Although previous studies investigated this association, the results greatly vary among populations. This study aimed to investigate the association of hTERT gene SNPs and the risk of breast cancer (BC) in Egyptian females and their impact on telomere length (TL). Methods: 218 BC patients and 178 age-matched healthy females were genotyped for hTERT variants rs2736098G > A, rs2735940C > T using PCR-RFLP and for MNS16A tandem repeat using PCR to determine their association with breast cancer risk. Telomere length was measured using qPCR. Results: hTERT rs2736098G > A results indicated that both AG and GG genotypes and G allele were associated with an increased risk of BC. The rs2735940 TT genotype was significantly associated with BC risk, however, the MNS16A tandem repeat region polymorphism didn’t show any correlation with the risk of developing BC. TL showed a significant reduction in BC patients with age 40 years compared with controls. However, it didn’t show a significant difference above the age of 40 years. Conclusions: hTERT rs2736098 and rs27365940, not MNS16A may be associated with an increased risk of developing BC in Egyptian females. Also, telomere length can be a promising screening marker of BC especially in young population.

Up to Date Management of DCIS and Future Directions

Ductal carcinoma in situ (DCIS) is a non-invasive malignancy confined within the basement membrane of the breast ductal system. There is a lot of disparity in the natural history of DCIS with an estimated incidence of progression to invasive ductal carcinoma between 20% to 53% over ten or more years after initial diagnosis. The surgical and adjuvant management of DCIS has advanced significantly in the last couple of decades. Nonetheless, surgeons, medical oncologists, and radiation oncologists, along with their patients, still depend on conventional clinical and pathologic risk factors to make management decisions. Irrespective of the management strategy, long-term survival is excellent. The debate around DCIS relates to preventing either under-treatment or over-treatment. In this paper, we will review the incidence and management options of DCIS. Additionally, we will focus on several current disputes related to the management of DCIS, including breast conserving surgery, the role of radiation in breast conservation surgery, sentinel node biopsy in DCIS, hormonal therapy, various risk stratification schemes, and the option of active surveillance for low-risk DCIS.

Decreasing Birth Rate Determining Worldwide Incidence and Regional Variation of Female Breast Cancer

Purpose: Urbanization, obesity and ageing associated with lifestyle changes (Westernized diet patterns, pollution, physical inactivity) have been proposed as the major contributing factors for the global rise in breast cancer (BCa) and have been the variables used to predict the future breast cancer rate. At the same time, socio-economic level, instead of birth rate, has been proposed for explanation of dramatic regional variations of breast cancer incidence. We sought to determine which factor plays the determining role in predicting worldwide breast cancer incidence rates and regional variations. Methods: Bivariate correlation was conducted to examine the relationships between country-specific estimates of birth rate, BCa incidence, urbanization, overweight, ageing and GDP. Partial correlation was performed to identify the correlation between BCa incidence with each independent variable while we controlled the other four variables. Multiple linear regression was used to identify the most significant predictors of BCa incidence. Post hoc Scheff and independent T-Test analysis were performed to compare mean differences in BCa incidence rates and residuals of BCa standardised on birth rate in the WHO regions, and UN developed and developing regions respectively. Results: Worldwide, BCa incidence rate tends to increase while birth rate decreases and urbanization, overweight, ageing and GDP increase. However, birth rate was the only variable that had a significant correlation with BCa incidence when controlled for the other four variables. Birth rate was the only significant predictor of BCa incidence in regression analysis. Multiple mean differences of BCa incidence between regions were significant, but all disappeared when the contributing effect of birth rate on BCa incidence rate was removed. Conclusions: Birth rate plays a determining role in worldwide BCa incidence rate and regional variations. Current BCa projection methods may estimate future rates of BCa poorly if they fail to incorporate the impact of birth rate.

Awareness about Early Detection Methods, Symptoms and Risk Factors towards Breast and Cervical Cancer among the Female Students of Mawlana Bhashani Science and Technology University (MBSTU), Santosh, Tangail, Bangladesh

The study was conducted to ensure knowledge, attitude, awareness about breast and cervical cancer among the female students of Mawlana Bhashani Science and Technology University. This study was carried out from July to September, 2015 among the participants of university female halls, different female hostels and different faculty of the university by using a validated questionnaire which was developed for this study. A total 250 female students, at the age of (18 - 26) years were participated. Collected information was analyzed using SPSS, Graph-pad Prism and MS Excel. The results showed that about 87.6% participants were undergraduate. Most of them come from village (45.6%) and city (36.0%). About 90% were Muslims and the socioeconomic level of most of the participants was middle (90.4%). In case of food intake patterns, it was observed that 35.6% participants eat chips, soft drinks, popcorn everyday;40.4% eat meat regularly;24% eat sugar everyday;27.6% eat fruits and vegetables every day. Among them, 55.6% girls maintained daily 1 hour physical activity;37.2% did exercise rarely;34.8% participants rarely do strenuous exercise. About 84.4% respondents have not any family history of cancer;6% participants have sister or mother having breast tumor and 7.2% have at least more than one close relative who have cancer. Among the participants, only 0.8% drank alcohol;1.2% have addiction of smoking cigarette;15.6% girls wear tight bra;3.6% have benign breast disease and 2.8% participants have attended in breast or cervical cancer screening programs. The moderate numbers of girls have breast cancer screening practice. Among them, only 28.8% participants have ever heard about BSE (Breast self-examination) and 40.4% have not any knowledge about breast cancer treatment. About 50.8% respondents don’t have any knowledge about cervical cancer treatment. The village people are the most risky group. About 17.02% girls recognized weakened immune system as a risk factor of cervical cancer. It can be concluded that, knowledge of participants regarding breast and cervical cancer is poor. Targeted education should be implemented to improve the knowledge of respondents about early detection methods and symptoms of breast and cervical cancer.

The Unmet Needs of African American Women with Breast Cancer

Breast cancer is the most common cancer in women and treatment includes various combinations of surgery, chemotherapy, and/or hormone therapy. The multimodal treatment of breast cancer improves survival outcomes, but it also contributes to a prolonged period of medical intervention with associated physical and emotional consequences. However, we know less about the specific clinical experiences of African American (AA) women during treatment for breast cancer and in survivorship. The studies that have addressed the issue of breast cancer in AA women have focused primarily on early detection and epidemiological variables such a screening, mortality and staging at diagnosis. In our study, in-depth semi-structured phone interviews were conducted to explore the clinical experiences, concerns and needs of AA women who had survived breast cancer. The AA women reported that their physicians did not provide adequate disease and treatment information;did not discuss clinical trials with them;and did not offer access to support services.

Is Breast Background Parenchymal Enhancement on MRI Related to BI-RADS Score and Follow-Up Rate?

Objective: We investigated the correlations between background parenchymal enhancement (BPE) and MRI interpretations with respect to short-interval follow-ups and biopsy rates. Methods: All accessible MRI examinations from 128 women during a limited time period in 2016 were evaluated. A blinded radiologist visually categorized BPE as minimal, mild, moderate, or marked. A BI-RADS category was also assigned. We used descriptive statistics to report the findings and chi-square and Fisher’s exact tests to compare categories. Results: Prevalence of minimal, mild, moderate, and marked BPE was 14.1%, 43.0%, 32.0%, and 10.9%, respectively. The short-interval follow-up rates were 22.2%, 27.3%, 26.8%, and 7.1% in women with minimal, mild, moderate, and marked BPE, respectively. BPE was not associated with the short-interval follow-up rate (p-value = 0.477). Biopsy rates were 22.2%, 27.3%, 22.0%, and 57.1% in women with minimal, mild, moderate, and marked BPE, respectively. Although there was no significant relationship between biopsy rates and BPE levels (p-value = 0.095) in the total population, these two factors were significantly associated in premenopausal women (p-value = 0.023) and in women of 30 - 39 years (p-value = 0.001). Conclusion: Higher BPE does not correlate with short-interval follow-up rates, but appears to be related to biopsy rate, thus causing false-positives and unnecessary biopsy recommendations, particularly in younger, premenopausal women.

Statins and Breast Cancer: An Overview of the Current Situation

Statins [(3-hydroxy-3-methylglutaryl-coenzyme A reductase, HMG-CoA reductase, abbreviated HMGCR) inhibitors] inhibit cholesterol synthesis and are commonly used in the treatment and prevention of cardiovascular diseases. Preclinical and clinical studies have shown that the drug can be effective in several cancers including breast cancer which is the second most frequent cancer in the world and the commonest one among women. In breast cancer cell lines statins reduce proliferation, increase apoptosis, decrease invasion and sensitize them to radiation. Clinical trials in breast cancer patients have shown positive outcome in terms of decreased recurrence rate, decreased mortality and positive role as neoadjuvant agent. They may have a particular role in treatment-resistant cases like triple-negative or inflammatory breast cancer which have a poorer prognosis. There is also evidence of their potential use in metastatic bone disease from breast cancer. When statins inhibit 3-hydroxy-3-methylgutaryl CoA reductase which is the rate-limiting enzyme of the mevalonate pathway, the levels of mevalonate as well as its downstream products are decreased. Hence cancer growth is inhibited by reduced prenylation of CAAX proteins, N-Glycosylation of growth factor receptors and synthesis of membrane and steroid among others. Also statins are relatively cheap and can contribute to decrease the high cost of cancer treatment. However studies till now have not shown any association with decreased breast cancer incidence. In addition there are doubts regarding safety of statins when used over a prolonged period of time. Although statins are relatively safe with myotoxicity and hepatotoxicity being their major side effects, evidence regarding issues like drug interactions with anti-cancer drugs is lacking.

The Role of Serum Trace Elements and Oxidative Stress in Egyptian Breast Cancer Patients

Background: Oxidative stress is considered to be involved in the pathophysiology of all cancers. Studies indicated that the levels of oxidative stress markers increased in breast cancer. Trace metals are essential to normal human homeostasis. When present in an abnormal expression, they contribute in many pathological processes. Some trace metals are claimed to be carcinogenic and capable of inducing a toxic effect through the formation of free radicles and acting as cofactors in the oxidative damage of biological macromolecules and DNA. Objective: Our aim was to investigate the serum levels of some trace elements (Copper, Zinc and Cadmium), the total oxidative and anti-oxidative capacity (TOC and TAC) in patients with breast cancer in comparison to patients with benign breast tumours. Patients and Methods: The present study included 65 females. The participates were divided into 2 main groups: control group which consisted of 20 apparently healthy female;the patient groups which divided into 3 groups: group B included 15 patients with benign breast tumours, group N consisted of 15 newly diagnosed breast cancer patients and group M included 15 patients with metastatic breast cancer. Results: The mean serum levels of Copper, Zinc, and Cadmium were significantly higher in the three patients groups (B, N and M) than the control group. Similarly, serum uric acid (UA) and (TAC) levels showed significant higher level in both breast cancer groups as compared to the benign group. However TOC levels showed only significantly higher level in metastatic group. Conclusions: The present study suggested elevated TAC, UA and TOC in breast cancer patients. The increased levels of trace elements could lead to formation of free radicals or other reactive oxygen species. The serum profile of these trace metals may be helpful in predicting prognosis of breast cancer.

A Cross Sectional Study of the Knowledge and Practice of Self-Breast Examination among Market Women at the Makola Shopping Mall, Accra, Ghana

Background: Breast cancer is one of the most common cancers in women worldwide. With an estimated incidence of 1,676,633 with 521,817 deaths in the year 2012, the figure is expected to hit the 82.5 millionth mark by 2015. Breast cancer screening is reported to be extremely low in most low-middle income countries like Ghana. This study was to determine the knowledge and practices of self-breast examination among market women at Makola Shopping Mall in Accra, Ghana. Methods: The study was conducted at the Makola Shopping Mall in Accra among women above the age of 20 years who owned a store and sell at the mall. Data were collected using mixed method involving in-depth interviews and questionnaire survey. Random samples of 170 participants were selected from a population of 400 for the quantitative survey. A total of eight in-depth interviews were conducted to generate qualitative data to complement the survey data. Results: Majority (60%) of the respondents were between the ages of 20 - 40 years. There’s a high literacy rate among the participants. Though awareness of self-breast examination was very high (93%), only 27% practiced self-breast examination in line with the recommended one week period after menses due to lack of knowledge of the basic skills to do self-breast examination. Conclusion: In view of the lack of knowledge resulting in non-performance of self-breast examination, continuous education on breast cancer screening should be given to the women to enable them acquire the skills of performing self-breast examination to promote early detection of the disease.

Breast Cancer Survival in Cameroon: Analysis of a Cohort of 404 Patients at the YaoundéGeneral Hospital

This study aimed to estimate the survival rate of breast cancer in a group of patients followed up at the Yaoundé General Hospital in Cameroon. A retrospective review of records of patients managed for breast cancer between 1995 and 2007 was carried out at the Yaoundé General Hospital. Survival analysis was carried out with survival defined as the time between the date of unequivocal diagnosis of cancer and the date of last follow-up or death. Survival curves were plotted in R.3.1.1 software. Mean age of the patients was 47.5 ± 12.36 years. Most of the patients (67.9%) presented with advanced breast cancer disease (stage III and IV). Overall patient survival rate was 30% at 5 years and 13.2% at 10 years. Median overall survival time was 2 (1.9 - 3) years. There was a correlation between survival and the stage of disease. The highest survival rates were recorded in stages I and II while the lowest rates were recorded in stage IV. There was no statistically significant difference in survival among the age groups (p = 0.15). Overall survival rates of breast cancer are 30% at 5 years and 13.2% at 10 years among Cameroonian patients and are lower compared with 90% and 82% respectively at 5 years and 10 years in some developed countries.

Breast Cancer in Western Iraq: Clinicopathological Single Institution Study

Background: Breast cancer is the most frequent malignancy of women worldwide;In Iraq, it ranks first among cancers diagnosed in women, but studies on breast cancer among women in Western Iraq are limited. Breast cancer rate in Arabic countries is lower than that in West nations and more common in younger age. The aim of this study is to estimate age of presentation, stage, grade, type and side of tumor and their comparison with other Iraqi regions as well as with some Arabic and West countries. Materials and Methods: This is a descriptive study conducted between 1st of February 2011 to 30th of January 2015 in Western Iraq. 292 cases of breast cancer were enrolled in this study, including 206 cases of mastectomy and 86 cases of lumpectomy. Results: Average age at diagnosis: 47.16 (SD: 12.15), median age at diagnosis: 45 with mode of: 40. Cases with age <50 y: 68.15%. Regarding tumor stages, only 2.39% were presented in pT0 & pT1 categories, and only 2.92% of 206 mastectomy cases were presented in stage 0 & stage I, 12.7% of cases were of grade I. Regarding the types: invasive ductal carcinoma, not otherwise specified type: 88%, medullary type: 6.8%, mucinous type: 2.1% & invasive lobular type: 3.1%. Left side (179)/Right side (113) = 1.58, and the bilaterality was 2.7%. Conclusion: Breast cancer rate among females in Western Iraq is low, but it is relatively higher in younger age group in comparison to other studies and mostly presented beyond early stage with a higher grade.

Adenoma of the Nipple, Mimicking Paget’s Disease of the Breast: Report of a Case

Nipple adenoma is a rare benign condition that simulates malignancy. A 37-year-old woman presented with unilateral bloody nipple discharge for 1-year duration followed by severe nipple erosion. As biopsy revealed nipple adenoma and therefore, complete local excision was done. The final histopathology showed florid papillomatosis which was adequately excised. Nipple adenoma although rare entity this should be included in the differential diagnosis of any nipple erosion such as carcinoma and Paget’s disease of the breast specially when associated with bloody discharge in premenopausal women.

Increased Cellular Invasion and Proliferation via Estrogen Receptor after 17-<i>β</i>-Estradiol Treatment in Breast Cancer Cells Using Stable Isotopic Labeling with Amino Acids in Cell Culture (SILAC)

17-β-estradiol (estrogen) is a steroid hormone important to human development;however, high levels of this molecule are associated with increased risk of breast cancer primarily due to estrogen’s ability to bind and activate the estrogen receptor (ER) and initiate gene transcription. Currently, estrogen mechanisms of action are classified as genomic and non-genomic and occur in an ER-dependent and ER-independent manner. In this study, we examine estrogen signaling pathways, by measuring changes in protein expression as a function of time of exposure to estrogen in both ER-positive (MCF-7) and ER-negative (MDA-MB-231) cell lines. Using a robust experimental design utilizing isotopic labeling, two-dimensional LC-MS, and bioinformatics analysis, we report genomic and non-genomic ER regulated estrogen responsive proteins. We find a little over 200 proteins differentially expressed after estrogen treatment. Cell proliferation, transcription, actin filament capping and cell to cell signaling are significantly enriched in the MCF-7 cell line alone. Translational elongation and proteolysis are enriched in both cell lines. Subsets of the proteins presented in this study are for the first time directly associated with estrogen signaling in mammary carcinoma cells. We find that estrogen affected the expression of proteins involved in numerous processes that are related to tumorigenesis such as increased cellular division and invasion in an ER-dependent manner. Moreover, we identified negative regulation of apoptosis as a non-genomic process of estrogen. This study complements gene expression studies and highlights the need for both genomic and proteomic analyses in unraveling the complex mechanisms by which estrogen affects progression of breast cancer.

Breast Conserving Surgery: Has the Standard of Care Enhanced Outcomes for Patients?

Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publication of the Randomized Controlled Trials (RCTs) of Breast Conserving Surgery versus mastectomy in early breast cancer, the adoption of BCS for breast cancer patients’ surgical management has been comprehensive. A computerized bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes. The growth pattern and biopsy of Ductal Carcinoma In Situ (DCIS) differ from invasive cancer, impacting margins. It is essential to understand how the Society of Surgical Oncology (SSO) DCIS margin guideline has influenced practice. Early breast cancer surgical management should be unique to each patient, driven by evidence-based medicine, and focused on specific clinical, histological, and molecular characteristics of the tumor. Conclusion: The current management for early breast cancer should be tailored and evidence-based to each patient based on the clinical, histological and molecular characteristics of the tumor. Presumably, the standard of care in BCS has enhanced the outcomes for this patient population. This review made by peers will help surgeons to stay up to date with the current literature and help them manage breast cancer while improving multiple clinical parameters such as Disease-Free Survival (DFS), Recurrence-Free Survival (RFS) and most importantly Overall Survival (OS).