Current Breast Cancer Reports最新文献

Purpose of review: This article summarizes recent literature on locoregional management of patients with invasive lobular carcinoma (ILC), including approaches to breast surgery, axillary management, and neoadjuvant therapy.

Recent findings: Breast conservation therapy is safe in ILC, but has comparatively high rates of positive margins, which can be reduced by routine use of shave margins and oncoplastic surgery. Studies demonstrating the safety of de-escalation of axillary surgery have not included enough patients with ILC to draw strong conclusions; current guidelines do not support omission of sentinel node surgery in most patients with ILC. Neoadjuvant chemotherapy may improve breast conservation and increase nodal pathologic complete response in molecularly selected patients using genomic assays.

Summary: The locoregional management of patients with ILC requires special considerations based on its unique features. ILC specific studies are needed to address knowledge gaps for patients diagnosed with this common tumor type.

Purpose of the review: This paper aims to provide a comprehensive overview of breast cancer screening, clinical characteristics, treatment, and survivorship in American Indian/Alaska Native (AI/AN) women.

Recent findings: Breast cancer in AI/AN women is a complex public health issue marked by disparities in incidence, stage, treatment, and survival that vary regionally. Limited screening mammography, workforce shortages, and underfunded healthcare systems contribute to late diagnoses and poorer outcomes. Social and cultural factors, including historical trauma and medical mistrust, further hinder care. Data on breast cancer topics for AI/AN is limited and often compromised by misclassification and underrepresentation. The Indian Health Service (IHS) plays a crucial but underfunded role in providing care, often insufficient to meet the complex needs of AI/AN women, especially those living in urban areas.

Summary: As Indigenous surgeons working with AI/AN communities, we applied our perspectives to a comprehensive review of the literature. To reduce disparities, research must prioritize Indigenous leadership, respect tribal sovereignty, improve data accuracy, and foster equitable collaborations that center AI/AN priorities.

Definitions: The United States (US) Census Bureau defines American Indian and Alaska Natives (AI/ANs) as persons with origins from the Indigenous peoples of the Americas who maintain tribal affiliation and/or community attachment. Common terms for AI/ANs today include Native, Native American, Indigenous, First Nations, Native Hawaiian, Pacific Islander, among others. The most appropriate phrasing would be to use the specific tribe's self-designated name in that tribe's native language when possible. However, for simplicity and the purposes of this manuscript, we will use the term AI/AN.

Purpose of review: Breast cancer disparities for LGBTQ + individuals exist from screening to survivorship care and lead to worse breast cancer outcomes compared to cisgender, heterosexual individuals. The intent of this review is to provide information on differences in screening rates, risk profiles, treatment goals, and survivorship care plans in breast cancer care for LGBTQ + individuals, along with recommendations on how to reduce and eliminate these disparities.

Recent findings: There has been an expansion in the recognition of LGBTQ + cancer care and preliminary data on the effects of gender-affirming hormone therapy specific to breast cancer development. However, healthcare avoidance of LGBTQ + individuals remains a large barrier to care. Recent studies have found that subgroups within the LGBTQ + community have distinct needs from one another. Specifically, the transgender and gender-diverse population face increased discrimination within the healthcare system with non-uniform breast cancer screening measures.

Summary: Current research highlights the ongoing breast cancer disparities that impact the LGBTQ + community. There is a need for increased education on the needs of the LGBTQ + community to mitigate the breast cancer disparities in time to diagnosis and treatment, along with more tailored breast cancer survivorship care plans.

Purpose of review: The number of older adult breast cancer survivors is increasing. This growing demographic comprises both women diagnosed with breast cancer when they are 65 years or older as well as women diagnosed in younger adulthood who then survive to elderhood. Older adult breast cancer survivors face unique challenges, including possible increased baseline comorbidity, symptom burden and a greater propensity to experience functional and cognitive decline after treatment.

Recent findings: This review outlines survivorship concerns affecting older adults with a history of breast cancer, including osteoporosis, increased risks of hip fractures, and worsened survival associated with the development of comorbidity. The review also acknowledges the existing interventions to identify and mitigate survivorship concerns of older adults including comprehensive geriatric assessments.

Summary: Highlighting the unique needs of this population may better inform treatment decision-making at the time of diagnosis and identify opportunities for future investigation in this realm.

Limitations of poly adp‒ribose polymerase parp inhibitors: PARPis have demonstrated efficacy in BRCA-mutated cancers deficient in homologous recombination repair. Furthermore, PARPis have shown efficacy in BRCA-wild-type cancers with a homologous recombination deficiency phenotype known as BRCAness. Current clinically approved PARPis inhibit both PARP1 and PARP2, and their clinical promise is limited by toxicity, resistance, and a lack of combination partners.

Recent findings: PARP2 inhibition is associated with hematological toxicity, affecting the tolerability and efficacy of monotherapy and combination therapies. Furthermore, synthetic lethality in BRCA-mutated cancers depends mostly on PARP1, whereas PARP2 is not essential. These findings promoted the development of next-generation PARPis with greater selectivity for PARP1 than for PARP2.

Summary: In this review, we discuss the next-generation PARPis that target PARP1 and show promise in terms of improved safety, tolerability, pharmacological profiles, and efficacy compared to existing clinically approved PARPis. These next-generation PARP1-selective inhibitors hold significant promises for improving the survival and outcomes of cancer patients.

Purpose of review: To evaluate and describe the current indications, implementation, operative techniques, and patient outcomes for robotic nipple sparing mastectomy (RNSM).

Recent findings: The robotic approach to nipple-sparing mastectomies (NSM) has been shown to be feasible. The learning curve required by surgical teams can be overcome, but barriers to implementation exist, including higher cost and longer operative time compared to conventional nipple sparing mastectomies (CNSM). When performed, RNSM have been found to confer greater patient satisfaction and similar if not improved perioperative outcomes. However, the most critical current concern is the lack of long-term oncologic outcomes. The current available literature suggests short-term oncologic outcomes are not significantly different between RNSM and CNSM.

Summary: Randomized control trials with longer follow up are needed to determine the oncologic safety of RNSM and drive the future direction of this procedure.

Purpose of review: Breast cancer incidence, risk factors, and risk-reducing strategies are relatively well established for cisgender persons, but this information is limited in the transgender and gender-diverse (TGD) community. TGD persons have unique considerations that may affect risk, such as the need for gender-affirming hormone therapy or gender-affirming operations. This review outlines key literature informing our knowledge of breast cancer risk and summarizes screening recommendations for TGD persons.

Recent findings: Studies informing breast cancer risk in TGD persons have significant limitations. Generally, they suggest that transgender women have a higher incidence of developing breast cancer compared to cisgender men, but a much lower incidence compared to cisgender women; and that transgender men have higher rates of breast cancer compared to cisgender men, but lower rates compared to cisgender women. Screening guidelines put forth by professional societies are based on these retrospective cohort studies, expert consensus, and extrapolation from cisgender populations. The United States Preventive Services Task Force and American Cancer Society have not yet published guidelines.

Summary: Prospective data are needed to further define risk and best practices for breast cancer screening in the TGD community, an already marginalized population susceptible to worse oncologic outcomes.