ObjectiveBy comparing the epidemiological characteristics of the incidence and death of female breast cancer in China and the United States, the differences in prevention and screening strategies between China and the United States were analyzed to explore the prevention and control measures of female breast cancer in China. MethodsBased on the relevant data released by the Global Burden of Disease in 2020, the National Cancer Center of China, and the China Health Statistical Yearbook, the new cases and deaths of breast cancer in Chinese and American women in 2023 were estimated respectively, and the incidence, mortality and time trend of breast cancer in Chinese and American women were analyzed. ResultsIn China, 376 789 new cases of female breast cancer and 116 791 deaths were expected in 2023. In the United States, approximately 297 790 women were expected to be newly diagnosed with breast cancer in 2023, representing approximately 15.2% of new cancer cases. About 43 170 women died from breast cancer, accounting for about 7.1% of all cancer deaths. The incidence of breast cancer in women in the United States during the period 1975–2020 gradually increased and then stabilized; In contrast, the incidence of breast cancer among Chinese women increased year by year during the period 1990–2020. In recent years, the incidence and mortality rates of breast cancer in Chinese women had increased more than those in the United States, and there was a large difference between urban and rural areas in China. ConclusionsBoth China and the United States face a large burden of female breast cancer, and the characteristics of female breast cancer in China are similar to those in the United States. To reduce the burden of breast cancer in Chinese women, further efforts should be made in various aspects, such as strengthening breast cancer education, raising public health awareness, improving diet structure, cultivating healthy lifestyle, increasing screening efforts, and improving medical level.
ObjectiveTo understand current research progress of microRNA (miRNA) in pathogenesis of triple-negative breast cancer (TNBC), and to provide reference for understanding pathogenesis and treatment of TNBC.MethodTheresearch progress of relationship of TNBC and miRNA was reviewed by reading relevant literatures at home and abroad in recent years.ResultsThe miRNAs were involved in a variety of biological processes, including the cell proliferation, apoptosis, autophagy, differentiation, metastasis, etc., and played an important role in the cancer initiation and metastasis. Therefore, researchers had attempted to treat and prevent the TNBC by targeting miRNAs. At present, there had been a large number of reports that the miRNAs played a key role in TNBC, which were classified as the anti-oncogene and oncogene, and was associated with metastasis and prognosis of TNBC.ConclusionmiRNA is very important in pathogenesis of TNBC. Mechanism of studying miRNA is necessary for treatment and prevention of TNBC.
Objective To explore therapeutic effect of endocrine therapy in breast cancer patients with negative hormone receptor (HR–) of primary lesion and positive HR (HR+) of metastatic axillary lymph node lesion. Methods Sixty-seven cases of breast cancer with HR– of primary lesion and HR+ of metastatic axillary lymph node lesion from January 2011 to January 2016 were selected. All the patients were randomly divided into endocrine therapy group (33 cases) and control group (34 cases). The patients were given the oral drug of tamoxifen on the basis of conventional chemotherapy in the endocrine therapy group after the surgery, 10 mg/time, twice daily, 5 years; while the patients in the control group were not given the oral drug of tamoxifen but the other therapy same as the endocrine therapy group. The survivals were compared in both groups. Results There were no significant differences in the age, menstrual condition, tumor diameter, preoperative TNM stage, and so on between the endocrine therapy group and the control group (P>0.05). All the patients were followed up for 12–60 months with a 48.5 months of median time. There were no significant differences in the rates of the local recurrence and metastasis, or death rate due to the recurrence and metastasis in both groups (P>0.05). The progression-free survival and overall survival in the endocrine therapy group were significantly higher than those in the control group (P<0.05). The 5-year cumulative progression-free survival and overall survival in the endocrine therapy group were significantly better than those in the control group (P<0.05). Conclusion Pay attention to molecular classification of primary lesion and metastatic axillary lymph node lesion in patients with breast cancer, and endocrine therapy might be able to improve survival rate of breast cancer patients with primary lesion HR– and metastatic axillary lymph node lesion HR+.
Objective To describe the role of breast palpation imaging (PI) in breast cancer screening. Method We searched the latest research and previous literatures of PI in the diagnosis of breast cancers, and made an review after reading the articles. Results PI had better diagnostic efficiency than clinical breast examination (CBE) in breast cancer screening. PI combined with mammography (MG) and/or breast ultrasound (BUS) could further improve the diagnostic efficiency. Conclusion PI has important value in breast cancer screening, and is an important supplement to existing breast cancer screening methods.
ObjectiveTo analyze the factors influencing axillary pathological complete response (pCR) after neoadjuvant therapy (NAT) and to provide the possibility of exempting axillary surgery for patients with better pathological efficacy of primary breast lesions after NAT. MethodsAccording to the inclusion and exclusion criteria, the patients with breast cancer admitted to the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from January 1, 2020 to June 30, 2022 were retrospectively analyzed. All patients were diagnosed with ipsilateral axillary lymph node metastasis of breast cancer and the NAT cycle was completed according to standards. All patients underwent axillary lymph node dissection (ALND) after NAT. The therapeutic effect of primary breast lesions was evaluated by Miller-Payne (MP) grading system. The axillary pCR was judged according to whether there was residual positive axillary lymph nodes after ALND. The unvariate and multivariate logistic regressions were used to analyze the risk factors affecting the axillary pCR. At the same time, the possibility of exempting axillary surgery after NAT in the MP grade 5 or in whom without ductal carcinoma in situ (DCIS) was evaluated. The ALND was considered to exempt when the negative predictive value was 90% or more and false negative <10% or almost same. ResultsA total of 111 eligible patients with breast cancer were gathered in the study, 64 of whom with axillary pCR. There were 43 patients of MP grade 5 without DCIS after NAT, 41 of whom were axillary pCR. The univariate analysis results showed that the estrogen receptor and progesterone receptor statuses, molecular type, NAT regimen, and MP grade were associated with the axillary pCR after NAT, then the logistic regression multivariate analysis results showed that the MP grade ≤3 and MP grade 4 decreased the probability of axillary pCR as compared with the MP grade 5 [OR=0.105, 95%CI (0.028, 0.391), P=0.001; OR=0.045, 95%CI (0.012, 0.172), P<0.001]. There were 51 patients of MP grade 5 after NAT, 46 of whom were axillary pCR. The negative predictive value and the false negative rate of MP grade 5 on predicting the postoperative residual axillary lymph nodes were 90.2% [95%CI (81.7%, 98.6%)] and 10.6% [95%CI (1.5%, 19.8%)], respectively, which of MP grade 5 without DCIS were 95.3% [95%CI (88.8%, 101.9%)] and 4.3% [95%CI (–1.7%, 10.2%)] , respectively. ConclusionsThe probability of axillary pCR for the patient with higher MP grade of breast primary after NAT is higher. It is probable of exempting axillary surgery when MP grade is 5 after NAT.
ObjectiveTo explore the value of multidisciplinary team (MDT) discussion in the comprehensive treatment of HER-2 positive breast cancer.MethodThe clinical data of 2 patients with HER-2 positive breast cancer admitted to the Affiliated Hospital of Southwest Medical University after MDT discussions were analyzed retrospectively.ResultsCase 1 was a 32-year-old woman diagnosed with left breast non-special type invasive carcinoma at admission, cT2N1M0, stage ⅡB, WHO grade 2, ER (–), PR (–), HER-2 (+++), Ki-67 (+, 20%). After MDT discussion, the patient was treated with neoadjuvant chemotherapy for 6 cycles, and the efficacy evaluation was partial response, received left breast conserving surgery and axillary lymph node dissection (ALND), postoperative staging ypT1aN1ycM0, stage ⅡA, Miller-Payne grade 4, the patient was satisfied with the shape of breast, received radiotherapy and anti-HER-2 therapy after surgery. At present, there was no recurrence and metastasis during anti-HER-2 therapy. Case 2 was diagnosed with right breast non-special type invasive carcinoma at admission, cT3N0M0, stage ⅡB, WHO grade 3, ER (–), PR (–), HER-2 (+++), Ki-67 (+, 40%), local advanced breast cancer. After MDT discussion, the patient was treated with neoadjuvant chemotherapy for 2 cycles, and the efficacy evaluation was progressive disease. After the replacement of two neoadjuvant chemotherapy regimen, the efficacy evaluation was still progressive disease. Finally after MDT discussion, the patient received right breast mastectomy and ALND, postoperative staging ypT4bN1ycM0, stage ⅢB, Miller-Payne grade 1, received radiotherapy, adjuvant treatment with pyrotinib and capecitabine after surgery. The patient was followed up for 3 months by telephone, the patient did not follow the doctor’ instructions, no recurrence and metastasis was found in the review.ConclusionUnder the precision medical system, comprehensive treatment of breast cancer based on the MDT model could target patients’ disease characteristics, physical conditions, previous diagnosis and treatment, family situation, and other individual factors, formulate the best personal treatment plan for patients, and bring greater benefits to patients.
Objective To investigate the clinicopathological characteristics of HER2 protein expression in different degrees in human epidermal growth factor receptor 2 (HER2) negative breast cancer and the factors related to the efficacy of neoadjuvant chemotherapy in breast cancer with low HER2 expression. Methods The clinicopathological data of 161 patients with HER2-negative breast cancer who received neoadjuvant chemotherapy in the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from March 2019 to March 2022 were retrospectively collected. The difference of clinical and pathological characteristics of patients with different levels of HER2 protein expression were analyzed, and the factors influencing the pathological complete remission (pCR) rate of breast cancer patients with low HER2 expression after neoadjuvant chemotherapy with unconditional logistic regression model were analyzed. Results Among 161 HER2 negative breast cancer patients, 108 cases were low HER2 expression, accounting for 67.1%. Compared with those with zero expression of HER2 [immunohistochemistry (IHC) 0], the patients with low HER2 expression had higher axillary lymph node metastasis rate (P=0.048), lower histological grade (P=0.006), and higher proportion of positive hormone receptor expression (P<0.001). There was no significant difference in pCR rate among the HER2 IHC 0, IHC 1+ and IHC 2+ / in situ hybridization (ISH)– (P=0.099) , and the pCR rate of low expression of HER2 was lower than that of zero expression of HER2 in the general population and Luminal subgroup, and the difference was statistically significant (P<0.05). There was no significant difference in triple negative breast cancer subgroup (P=0.814). The logistic regression analysis showed that age, histological grade and estrogen receptor expression status were independent influencing factors for pCR rate after neoadjuvant chemotherapy with low HER2 expression (P<0.05). Conclusions Different degrees of HER2 protein expressions in patients with HER2-negative breast cancer have unique clinicopathological characteristics. The pCR rate of neoadjuvant chemotherapy in patients with low HER2-expression breast cancer is lower than that in patients with zero HER2-expression breast cancer. Age, histological grade and estrogen receptor expression status are independent factors influencing the pCR rate of neoadjuvant chemotherapy in patients with low HER2-expression breast cancer.
ObjectiveTo observe the accuracy of magnetic resonance imaging (MRI) for predicting pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer, and to analyze the cause of the prediction error.MethodsData from 157 breast cancer patients who underwent NAC before surgery in Mianyang Central Hospital from January 2017 to January 2019 were analyzed. MRI parameters before and after NAC and pCR conditions were collected to analyze the parameters that produced false positives and false negatives.ResultsOf the 157 patients, 37 (23.6%) achieved pCR after NAC, and 33 (21.0%) achieved radiation complete remission (rCR) after NAC. The accuracy of MRI prediction was 70.7% (111/157), the sensitivity was 82.5% (99/120), and the specificity was 32.4% (12/37). A total of 25 cases did not achieve rCR, but postoperative evaluation achieved pCR (false positive), 21 cases achieved rCR, but postoperative evaluation did not achieve pCR (false negative). Diameter of tumor, peritumoral oedema, and background parenchymal enhancement were associated with MRI false positive prediction (P<0.05); gland density and tumor rim enhancement were associated with MRI false negative prediction (P<0.05).ConclusionMRI can be used as an important method to predict pCR after NAC in breast cancer patients, and its accuracy may be related to diameter of tumor, peritumoral oedema, background parenchymal enhancement, gland density, and tumor rim enhancement.
ObjectiveTo systematically review the prognostic value of circulating tumour cells (CTCs) in non-metastatic breast cancer patients. MethodsWe electronically searched PubMed, EMbase, WanFang Data, CNKI and CBM for collecting cohort studies about the prognostic relevance of CTCs in the peripheral blood of stage I to Ⅲ breast cancer patients from inception to March 20th, 2014. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and assessed methodological quality. Meta-analysis was conducted using RevMan 5.2 software. ResultsA total of 7 studies involving 1 780 patients were eligible for final analyses. The results of meta-analysis showed that, the presence of CTCs was associated with both poor DFS (RR=2.24, 95%CI 1.92 to 2.61, P < 0.000 01) and OS (RR=2.55, 95%CI 1.99 to 3.28, P < 0.000 01). The results of subgroup analysis by detection time of CTCs showed that CTCs detected before and after adjuvant chemotherapy was a statistically significant prognostic factor (P≤0.000 4). ConclusionCTCs is an adverse prognostic factor in non-metastatic breast cancer patients, which is not significantly influenced by adjuvant chemotherapy.
ObjectiveTo investigate the expression of epidermal growth factor receptor (EGFR) in triple-negative breast cancer (TNBC) and its relation with clinicopathologic features. MethodsA computer search of PubMed, Web of Science, CNKI, Wanfang Data, and VIP databases were conducted to select clinical studies on EGFR expression in the TNBC according to the inclusion and exclusion criteria, and the search period was from database establishment to January 2022. Two researchers independently screened the literature, extracted the data, and evaluated the quality of the literature before conducting meta-analysis using RevMan 5.4 software. ResultsA total of 28 studies including 7 956 patients were included. The results of meta-analysis showed that the positive rate of EGFR expression in the TNBC patients was higher than that in the non-TNBC patients [OR=5.16, 95%CI (4.04, 6.58), P<0.000 01], and the proportions of patients with axillary lymph node metastasis [OR=3.11, 95%CI (1.56, 6.19), P=0.001] and with tumor diameter >2 cm [OR=2.09, 95%CI (1.18, 3.72), P=0.01] in the patients with EGFR positive were higher than those the patients with EGFR negative, no correlation was found that the proportion of patients with histological WHO classification 3 between the patients with EGFR positive expression and EGFR negative expression (P=0.07). ConclusionFrom the results of this meta-analysis, EGFR expression might be associated with the occurrence, development, and metastasis of patients with TNBC.