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Journal of Clinical Oncology : Official... Jul 2013To determine whether there is a benefit to adjuvant radiation therapy after breast-conserving surgery and tamoxifen in women age ≥ 70 years with early-stage breast... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To determine whether there is a benefit to adjuvant radiation therapy after breast-conserving surgery and tamoxifen in women age ≥ 70 years with early-stage breast cancer.
PATIENTS AND METHODS
Between July 1994 and February 1999, 636 women (age ≥ 70 years) who had clinical stage I (T1N0M0 according to TNM classification) estrogen receptor (ER) -positive breast carcinoma treated by lumpectomy were randomly assigned to receive tamoxifen plus radiation therapy (TamRT; 317 women) or tamoxifen alone (Tam; 319 women). Primary end points were time to local or regional recurrence, frequency of mastectomy, breast cancer-specific survival, time to distant metastasis, and overall survival (OS).
RESULTS
Median follow-up for treated patients is now 12.6 years. At 10 years, 98% of patients receiving TamRT (95% CI, 96% to 99%) compared with 90% of those receiving Tam (95% CI, 85% to 93%) were free from local and regional recurrences. There were no significant differences in time to mastectomy, time to distant metastasis, breast cancer-specific survival, or OS between the two groups. Ten-year OS was 67% (95% CI, 62% to 72%) and 66% (95% CI, 61% to 71%) in the TamRT and Tam groups, respectively.
CONCLUSION
With long-term follow-up, the previously observed small improvement in locoregional recurrence with the addition of radiation therapy remains. However, this does not translate into an advantage in OS, distant disease-free survival, or breast preservation. Depending on the value placed on local recurrence, Tam remains a reasonable option for women age ≥ 70 years with ER-positive early-stage breast cancer.
Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Biomarkers, Tumor; Breast Neoplasms; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Mastectomy, Segmental; Neoplasm Recurrence, Local; Neoplasm Staging; Odds Ratio; Radiotherapy, Adjuvant; Receptors, Estrogen; Tamoxifen; Time Factors; Treatment Outcome
PubMed: 23690420
DOI: 10.1200/JCO.2012.45.2615 -
Archives of Pathology & Laboratory... Nov 2017Primary neuroendocrine tumors of the breast are a rare and underrecognized subtype of mammary carcinoma. Neuroendocrine tumors of the breast occur predominately in... (Review)
Review
Primary neuroendocrine tumors of the breast are a rare and underrecognized subtype of mammary carcinoma. Neuroendocrine tumors of the breast occur predominately in postmenopausal women. The tumors are subclassified into well-differentiated and poorly differentiated neuroendocrine tumors, and invasive breast carcinoma with neuroendocrine features. Well-differentiated tumors show architectural similarity to carcinoids of other sites but lack characteristic neuroendocrine nuclei. Poorly differentiated neuroendocrine tumors are morphologically identical to small cell carcinoma of the lung. Neuroendocrine differentiation, seen in up to 30% of invasive breast carcinomas, is most commonly associated with mucinous and solid papillary carcinomas. The diagnosis of neuroendocrine differentiation requires expression of the neuroendocrine markers synaptophysin or chromogranin. The main differential diagnosis is a metastatic neuroendocrine tumor from an extramammary site. Neuroendocrine tumors of the breast are treated similarly to other invasive breast carcinomas. Although no consensus has been reached on the prognosis, most studies suggest a poor outcome.
Topics: Biomarkers, Tumor; Breast Neoplasms; Breast Neoplasms, Male; Carcinoma, Neuroendocrine; Cell Differentiation; Chromogranin A; Diagnosis, Differential; Female; Humans; Male; Neoplasm Grading; Neoplasm Staging; Prognosis; Synaptophysin
PubMed: 29072945
DOI: 10.5858/arpa.2016-0364-RS -
Annals of Oncology : Official Journal... Sep 2015
Topics: Female; Humans; Breast Neoplasms; Neoplasm Staging
PubMed: 26314782
DOI: 10.1093/annonc/mdv298 -
Cancer Control : Journal of the Moffitt... 2021Breast cancer (BC) is the most common cancer in women and men combined, and it is the second cause of cancer deaths in women after lung cancer. In Lebanon, the same... (Review)
Review
Breast cancer (BC) is the most common cancer in women and men combined, and it is the second cause of cancer deaths in women after lung cancer. In Lebanon, the same epidemiological profile applies where BC is the leading cancer among Lebanese females, representing 38.2% of all cancer cases. As per the Center for Disease Control, there was a decline in BC mortality rate from 2003 to 2012 reflecting the adoption of national mammographic screening as the gold standard for BC detection by Western countries. The aim of this review study is to summarize current recommendations for BC screening and the available modalities for detecting BC in different countries, particularly in Lebanon. It also aims at exploring the impact of screening campaigns on BC early stage diagnosis in Lebanon. Despite the considerable debates whether screening mammograms provides more harm than benefits, screening awareness should be stressed since its benefits far outweigh its risks. In fact, the majority of BC mortality cases in Western countries are non-preventable by the use of screening mammograms alone. As such, Lebanon adopted a public focus on education and awareness campaigns encouraging early BC screening. Several studies showed the impact of early detection that is reflected by an increase in early stage disease and a decrease in more aggressive stages. Further studies should shed the light on the effect of awareness campaigns on early breast cancer diagnosis and clinical down staging at a national scope; therefore, having readily available data on pre- and post-adoption of screening campaigns is crucial for analyzing trends in mortality of breast cancer origin and reduction in advanced stages diseases. There is still room for future studies evaluating post-campaigns knowledge, attitudes, and practices of women having participated, emphasizing on the barriers refraining Lebanese women to contribute in BC screening campaigns.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Humans; Lebanon; Mammography; Mass Screening; Morbidity; Survival Rate
PubMed: 34538124
DOI: 10.1177/10732748211039443 -
Integrative Cancer Therapies Jan 2014Many women use black cohosh as a natural treatment for menopausal symptoms. However, controversy exists around safety in breast cancer, because of its purported... (Review)
Review
BACKGROUND
Many women use black cohosh as a natural treatment for menopausal symptoms. However, controversy exists around safety in breast cancer, because of its purported estrogenic activity. We conducted a systematic review of black cohosh use in women with or at risk of breast cancer.
METHODS
We searched MEDLINE, Embase, the Cochrane Library, and AMED from inception to July 2012 and October 2012 for human interventional or observational data pertaining to the safety and efficacy of black cohosh in patients with or at risk of breast cancer, including an assessment of the effect of black cohosh on estrogen responsive tissues.
RESULTS
Of 450 records, we included 26 articles: 14 randomized controlled trials, 7 uncontrolled trials, and 5 observational studies.The evidence on efficacy for ho t flashes is divided, with some benefits seen when compared with baseline, but not when compared with placebo. Two observational studies found no association between black cohosh and risk of breast cancer, whereas 2 studies reported significant reductions in risk of primary breast cancer among postmenopausal women (adjusted odds ratio = 0.47, 95% confidence interval = 0.27-0.82), and risk of recurrence (adjusted hazard ratio = 0.75, 95% confidence interval = 0.63-0.89). Seventeen trials showed no significant impact on circulating hormone levels or proliferation in estrogen responsive tissues.
CONCLUSIONS
Current evidence does not support an association between black cohosh and increased risk of breast cancer. There is a lack of evidence supporting the efficacy of black cohosh for reduction of hot flashes in breast cancer patients. Given conflicting but promising results, and apparent safety, further research is warranted.
Topics: Breast Neoplasms; Cimicifuga; Female; Hot Flashes; Humans; Incidence; Phytotherapy; Plant Preparations; Recurrence; Risk Factors; Treatment Outcome
PubMed: 23439657
DOI: 10.1177/1534735413477191 -
Breast (Edinburgh, Scotland) Jun 2011Breast sarcomas are rare neoplasms of the breast that need to be clearly distinguished from the very common breast carcinomas and treated in a multidisciplinary manner... (Review)
Review
Breast sarcomas are rare neoplasms of the breast that need to be clearly distinguished from the very common breast carcinomas and treated in a multidisciplinary manner modelled after treatment paradigms in other sarcoma locations. An increasing need to differentiate sarcoma sub-types based on molecular characteristics that will also be depicted in differential treatment sensitivities and development of specifically targeted therapies are equally valid in sarcomas in general and in breast sarcomas in particular. Of special interest in breast are sarcomas developing after breast irradiation for a previous breast carcinoma, a scenario that is increasingly common, given the increasing trends of breast conservation in the surgical treatment of breast carcinoma that necessitates the adjuvant use of radiotherapy.
Topics: Breast Neoplasms; Female; Humans; Neoplasm Staging; Neoplasms, Radiation-Induced; Prognosis; Sarcoma
PubMed: 21398126
DOI: 10.1016/j.breast.2011.02.016 -
Integrative Cancer Therapies May 2014Flax is a food and dietary supplement commonly used for menopausal symptoms. Flax is known for its lignan, α-linolenic acid, and fiber content, components that may... (Review)
Review
BACKGROUND
Flax is a food and dietary supplement commonly used for menopausal symptoms. Flax is known for its lignan, α-linolenic acid, and fiber content, components that may possess phytogestrogenic, anti-inflammatory, and hormone modulating effects, respectively. We conducted a systematic review of flax for efficacy in improving menopausal symptoms in women living with breast cancer and for potential impact on risk of breast cancer incidence or recurrence.
METHODS
We searched MEDLINE, Embase, the Cochrane Library, and AMED from inception to January 2013 for human interventional or observational data pertaining to flax and breast cancer.
RESULTS
Of 1892 records, we included a total of 10 studies: 2 randomized controlled trials, 2 uncontrolled trials, 1 biomarker study, and 5 observational studies. Nonsignificant (NS) decreases in hot flash symptomatology were seen with flax ingestion (7.5 g/d). Flax (25 g/d) increased tumor apoptotic index (P< .05) and decreased HER2 expression (P< .05) and cell proliferation (Ki-67 index; NS) among newly diagnosed breast cancer patients when compared with placebo. Uncontrolled and biomarker studies suggest beneficial effects on hot flashes, cell proliferation, atypical cytomorphology, and mammographic density, as well as possible anti-angiogenic activity at doses of 25 g ground flax or 50 mg secoisolariciresinol diglycoside daily. Observational data suggests associations between flax and decreased risk of primary breast cancer (adjusted odds ratio [AOR] = 0.82; 95% confidence interval [CI] = 0.69-0.97), better mental health (AOR = 1.76; 95% CI = 1.05-2.94), and lower mortality (multivariate hazard ratio = 0.69; 95% CI = 0.50-0.95) among breast cancer patients.
CONCLUSIONS
Current evidence suggests that flax may be associated with decreased risk of breast cancer. Flax demonstrates antiproliferative effects in breast tissue of women at risk of breast cancer and may protect against primary breast cancer. Mortality risk may also be reduced among those living with breast cancer.
Topics: Breast Density; Breast Neoplasms; Butylene Glycols; Cell Proliferation; Dietary Supplements; Female; Flax; Glucosides; Hot Flashes; Humans; Menopause
PubMed: 24013641
DOI: 10.1177/1534735413502076 -
Medicine Aug 2021This study aimed to explore clinical significance of core needle biopsy (CNB) in pathological diagnosis of breast neoplasm.Seventy one breast neoplasm samples were...
This study aimed to explore clinical significance of core needle biopsy (CNB) in pathological diagnosis of breast neoplasm.Seventy one breast neoplasm samples were obtained from Tongzhou Maternal and Child Health Hospital of Beijing between the years of 2006 and 2014. Forty five specimens were obtained via CNB and cases offering 26 of them received neoadjuvant chemotherapy. Pathology, histology, and immunohistochemistry results were compared between CNB specimens and excisional biopsy.Upward and downward tendencies could be observed in CNB specimens and excisional biopsy, respectively, in all items. Tumor proportion of CNB tissues was (33 + 2)/45 = 77.78%, when ductal carcinoma in situ detected by both CNB and excisional biopsy was 31/45 = 68.89%, with a consistency of (31 + 3)/45 = 75.56%. Tumor thrombus detected by both CNB and excisional biopsy was 2/45 = 4.44%. Among cases receiving neoadjuvant chemotherapy, CNB and excisional biopsy, in mitotic figure, cytological scoring and histological grading, showed a total change rate of >50% (50%-75%), while changes in duct and cellular heteromorphism were not distinct. Cases showing changes were up to 73.08%, with 8/26 = 30.77% for rise and 11/26 = 42.31% for descent.CNB could be used for preoperative diagnosis of breast neoplasm, and help to determine proper treatment regimen, thus elevating the rate of breast conserving. However, this method still has several limitations, particularly in immunohistochemical tests of human epidermal receptor protein-2. Neoadjuvant chemotherapy may influence the accuracy of CNB diagnosis.
Topics: Adult; Aged; Biopsy, Large-Core Needle; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging
PubMed: 34449464
DOI: 10.1097/MD.0000000000026970 -
Chinese Clinical Oncology Jun 2018The estrogen receptor (ER) has been targeted for breast cancer treatment for over a century, but many challenges persist. ER-positivity identifies the largest breast... (Review)
Review
The estrogen receptor (ER) has been targeted for breast cancer treatment for over a century, but many challenges persist. ER-positivity identifies the largest breast cancer subgroup, and ER-directed therapies prolong survival and improve symptoms in the advanced setting with a very favorable side effect profile. Treatment strategies have included decreasing estrogen synthesis and modulating or degrading the ER. However, ER+ breast cancer once diagnosed in the advanced setting still represents an incurable condition. Many efforts are ongoing to circumvent resistance mechanisms with a few strategies already incorporated into clinical practice such as the combination of endocrine agents with drugs that interfere with other signaling pathways and cell-cycle progression. Important questions remain as how best to select each available strategy, how to sequence them and ultimately how to extend benefits to the largest number of patients in need.
Topics: Antineoplastic Agents, Hormonal; Breast Neoplasms; Female; Humans; Neoplasm Metastasis; Receptor, ErbB-2; Receptors, Estrogen
PubMed: 30056727
DOI: 10.21037/cco.2018.06.06 -
Seminars in Cancer Biology Dec 2015Clinical oncology is advancing toward a more personalized treatment orientation, making the need to understand the biology of metastasis increasingly acute. Dissecting... (Review)
Review
Clinical oncology is advancing toward a more personalized treatment orientation, making the need to understand the biology of metastasis increasingly acute. Dissecting the complex molecular, genetic and clinical phenotypes underlying the processes involved in the development of metastatic disease, which remains the principal cause of cancer-related deaths, could lead to the identification of more effective prognostication and targeted approaches to prevent and treat metastases. The past decade has witnessed significant progress in the field of cancer metastasis research. Clinical and technological milestones have been reached which have tremendously enriched our understanding of the complex pathways undertaken by primary tumors to progress into lethal metastases and how some of these processes might be amenable to therapy. The aim of this review article is to highlight the recent advances toward unraveling the clinical and molecular complexity of breast cancer metastases. We focus on genes mediating breast cancer metastases and organ-specific tropism, and discuss gene signatures for prediction of metastatic disease. The challenges of translating this information into clinically applicable tools for improving the prognostication of the metastatic potential of a primary breast tumor, as well as for therapeutic interventions against latent and active metastatic disease are addressed.
Topics: Animals; Biomarkers, Tumor; Breast Neoplasms; Disease Progression; Female; Gene Expression Regulation, Neoplastic; Genetic Association Studies; Humans; Models, Biological; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Organ Specificity; Prognosis
PubMed: 26319607
DOI: 10.1016/j.semcancer.2015.08.009