International Journal of Breast Cancer最新文献

Background: Even though breast cancer (BC) is the most common female cancer worldwide, the role of tobacco, specifically chewing tobacco in the development of BC has not been widely studied. This study is aimed at assessing this association.

Methods: A multicentre hospital-based case-control study was utilised. Two thousand five hundred fifty-three histopathologically confirmed BC cases, and 2239 visitor controls were included. Self-reported information was collected regarding tobacco consumption and other potential confounders. A logistic regression model was used to calculate odds ratio (OR) and its 95% confidence interval (CI), after adjusting for age, current residential region, education, various reproductive factors, BMI and history of benign breast lump. Attributable fraction (AF) and population attributable fraction (PAF) of BC due to chewing tobacco were also calculated.

Results: An increased risk of BC was observed in women who ever used chewing tobacco (OR:1.19, 95% CI:1.00-1.41) as compared to those who never consumed tobacco (smoking and chewing), consistent across all subtypes of BC. A dose-response relation was observed for duration of tobacco chewing (OR_{>25 years}: 1.38, 95% CI: 1.04-1.83). Women who initiated chewing tobacco at < 20 years, before their first full-term pregnancy (FFTP), had more risk. Observed association was consistent even after stratification on menopausal status. The AF of BC due to tobacco chewing in our study was calculated to be approximately 3%, whereas the PAF for India was about 2%.

Conclusion: Our study suggests that chewing tobacco is associated with an increased risk of BC for all subtypes. This is particularly true when the duration of exposure is higher and exposure begins before FFTP. This highlights the need to target tobacco control policies to smokeless tobacco along with smoking, thus reducing the burden of BC to some extent.

Background: Vitamin B12 deficiency is classically associated with anemia and neurological dysfunction. However, recent studies suggest that elevated plasma vitamin B12 may indicate increased short-term cancer risk. This association remains largely unexplored in Middle Eastern populations, including Jordan, where cancer rates are rising and diagnosis often occurs at advanced stages due to limited screening.

Objective: This study is aimed at investigating the association between serum vitamin B12 levels and the risk of colorectal, breast, and lung cancers in a Jordanian population, evaluating differences by cancer type and stage.

Methods: A retrospective case-control study was conducted at King Abdullah University Hospital, Jordan, from January 2018 to December 2022. The study enrolled 260 patients diagnosed with colorectal, breast, or lung cancer and 260 matched healthy controls. Data collected included sociodemographic factors, clinical characteristics, and serum vitamin B12 levels.

Results: Serum vitamin B12 levels were significantly higher in cancer patients compared with controls (579.23 ± 468.72 vs. 492.70 ± 174.36 pg/mL; p = 0.005). High vitamin B12 levels (> 800 pg/mL) occurred in 15.8% of cancer patients versus 1.5% of controls (p < 0.001). Vitamin B12 levels varied significantly by cancer type, being highest in lung cancer patients (669.53 ± 566.59 pg/mL) compared with breast (594.86 ± 468.9 pg/mL) and colorectal cancer patients (439.62 ± 291.89 pg/mL; p = 0.024). There was a strong positive correlation between vitamin B12 levels and cancer stage, peaking in Stage IV cancers, r = 0.629, p = 0.001.

Conclusion: Elevated serum vitamin B12 levels are significantly associated with solid cancers in Jordanian patients, particularly pronounced in lung cancer and advanced stages. These findings do not imply a causal relationship, but rather suggest that serum vitamin B12 may function as a potential biomarker for cancer detection and disease monitoring in resource-limited settings.

Background: This systematic review was aimed at assessing methods used to measure oral anticancer medication (OAM) adherence at its three phases (initiation, implementation, and discontinuation) in women with breast cancer (BC) in Africa.

Methods: This review followed the Joanna Briggs Institute guidelines. Four databases were searched from 1990 to 2025 using keywords representing medication adherence, oral anticancer agents, breast cancer, measures, women, and Africa. The reporting followed the updated PRISMA guidelines.

Results: All 13 studies (100%) reviewed assessed OAM adherence at the implementation phase, four studies (30.8%) at the discontinuation phase, and one study (7.7%) at the initiation phase. Persistence was also assessed in four studies (30.8%). Prescription refill records were used to measure adherence at the initiation phase. Drug assays in blood, prescription refills, pill counts, medical records reviews, and self-report measures were used during the implementation phase. Prescription refills, medical records, and self-report measures were used at the discontinuation phase. Overall, self-report measures (46.2%; n = 6) were the most frequently used during the implementation phase. However, most studies that employed these measures did not report the psychometric properties, including reliability and validity.

Conclusions: The implementation phase was the most commonly assessed. Initiation and discontinuation phases were relatively less assessed. Self-report measures were the most frequently used, but the reliability and validity of these measures are lacking, hence limiting the evidence to guide practice. Thus, measures with sound psychometric properties, including reliability and validity, that can assess OAM adherence across its three phases are needed to improve adherence measurement and patient outcomes, particularly in Africa.

Breast cancer remains the most common cancer type among women, with invasive ductal carcinoma (IDC) responsible for almost 80% of cases. The exact histopathological segmentation of IDC is the premise of diagnosis, but manual observation of hematoxylin and eosin (H&E) stained slides is very time-consuming and results in interobserver variability. This work presents an automated IDC segmentation method with a lightweight hybrid deep learning framework by integrating U-Net with a MobileNetV2 encoder and a label propagation refinement module. This hybrid model leverages MobileNetV2's efficient depth-wise-separable convolutions for feature extraction, U-Net's encoder-decoder precision for boundary localization, and the label propagation step enhances spatial smoothness and anatomical consistency. Experiments are conducted on the BACH 2018 and BreakHis datasets at multiple magnification levels (40×, 100×, and 200×). The model reaches a precision of 94.85%, Dice coefficient of 94.63%, F1-score of 94.56%, and AUC of 94.65% on the BACH dataset and a precision of 93.87%, Dice of 94.24%, F1-score of 94.18%, and AUC of 93.93% on the BreakHis dataset. The proposed model surpasses several state-of-the-art techniques such as CNN and transformer-based models, including DeepLabV3, Mask R-CNN, Swin-UNet, and ViT-Histo. Cross-dataset validation yields a Dice of 92.10% and AUC of 93.70% from BACH → BreakHis, confirming robustness under domain shifts. Explainable AI analyses using Grad-CAM and SHAP confirmed accurate localization of diagnostically relevant regions. The proposed hybrid model of MobileNetV2 + U-Net with label propagation presents a computationally efficient and clinically reliable solution toward real-time, AI-assisted breast cancer histopathology.

Background: Breast density is increasingly recognized as a vital risk factor that affects early breast cancer detection. Therefore, this study was aimed at evaluating the agreement between different breast density measurements across multiple imaging modalities and identifying the best breast cancer predictor among these methods.

Methods: Data for women over 30 years old who underwent mammography, synthetic mammography of digital breast tomosynthesis (SM-DBT), ultrasound (US), and magnetic resonance imaging (MRI) were collected. Breast density was assessed by two breast radiologists using the American College of Radiology (ACR) categories and the visual analog scale (VAS) for percentage density (%PD). The agreement was calculated using the kappa coefficient (k) and Spearman correlation coefficient (ρ). Logistic regression odds ratios (ORs) were used to assess the best predictor of breast cancer based on breast density.

Results: Among 77 women (mean age 47.34 years), 25 had breast cancer. Categorical breast density assessments showed the highest agreement between mammography and SM-DBT (k = 0.535) and moderate agreement between mammography and MRI (k = 0.452). VAS analysis revealed moderate positive correlations between mammography and SM-DBT (ρ = 0.49), mammography and MRI (ρ = 0.56), and SM-DBT and MRI (ρ = 0.56), p < 0.05. Ultrasound showed the lowest correlation with all breast imaging modalities. Breast cancer risk prediction based on breast density showed significant associations for mammography (OR = 3.09) and MRI (OR = 4.16), p < 0.05.

Conclusion: The results suggest notable variability in radiologists' breast density assessment across different imaging modalities. MRI showed a greater ability to identify dense breast tissue and demonstrated potential value in breast cancer risk prediction, although these findings should be interpreted cautiously given the limited sample size. Establishing standardized approaches to breast density assessment remains important to improve the accuracy of breast cancer screening and risk prediction, and further research with larger cohorts is warranted.

Aims: This study aimed to compare the performance of immunohistochemistry (IHC)-based luminal subtyping of breast cancer against gene expression panels at our institute and to evaluate a CE-certified artificial intelligence (AI) Ki67 image analysis program for improving subtyping accuracy.

Methods and results: We retrospectively analysed IHC-based luminal subtyping in breast cancer biopsies diagnosed at our institute from 2019 to 2022 (n = 1736), and identified n = 104 (Oncotype DX) and n = 64 (EndoPredict) cases with gene expression tests requested by clinicians. Of the eligible ER-positive HER2-negative cases, 11.9% (n = 168) underwent multigene testing. After excluding incomplete data (n = 22), gene tests revealed 48 patients (32.9%) would benefit from chemotherapy, 86 (58.9%) could avoid it and 12 (8.2%) had inconclusive results. A moderate correlation was observed between Ki67 and EndoPredict EPClin scores (r = 0.47-0.58) and a weak correlation between Ki67 and Oncotype DX recurrence scores (r = 0.31-0.38). Ki67 scores were significantly higher in luminal B compared with luminal A tumours (difference of 9.1-15.2, p < 0.01). No significant difference was found between mean Ki67 scores reported by pathologists and AI (pathologists' mean Ki67 17.36 vs. AI mean Ki67 18.36, n = 146, p = 0.456) and the accuracy of luminal subtyping was similar between pathologists and AI (accuracy pathologists 66.4% vs. AI 62.7%, p = 0.538).

Conclusions: Our data provides a snapshot of the real-world allocation of multigene testing in early breast cancer, and supports other studies in highlighting the discrepancy between IHC-based and gene-based luminal subtyping. Ki67 evaluation remained consistent over time, and the use of AI for Ki67 scoring did not enhance the accuracy of IHC-based luminal subtyping.

Purpose: We set out to assess whether the extensive intraductal component (EIC) status in invasive breast cancers serves as an independent predictor of residual disease (RD) in re-excisions performed at our institution. This laboratory-based study provides insights into the thresholds for additional surgical intervention in cases with close ductal carcinoma in situ (DCIS) margins following initial breast-conserving surgery (BCS). We also examined the unique characteristics specific to EIC-positive cases.

Methods: BCS cases with invasive breast cancer and DCIS with close margins that had re-excisions following initial surgery (Dec 2019-Dec 2024) were selected and classified into EIC positive or EIC negative. Data collected on the initial excision included the EIC status and other clinicopathological information such as margin status, DCIS extent, cancer type and focality, TNM stage, biomarker status, and OncotypeDX Recurrence Score (RS). The RD status was collected on re-excision specimens.

Results: Ninety-one cases were included (57 EIC positive and 34 EIC negative), with most being invasive ductal carcinoma. The rate of RD on re-excision was 70.2% and 32.4% in EIC-positive and EIC-negative cases, respectively (p < 0.001). EIC-positive cases showed a higher tendency to involve multiple margins, had a lower T stage and greater DCIS extent, and they were more commonly associated with multifocal cancer. Finally, when assessing predictors of RD, EIC status emerged as the most significant factor among other variables (adjusted odds ratio = 3.39). Secondary findings included a relatively increased proportion of EIC-positive cases (19%) exhibiting mucinous morphology (p = 0.0063) and HER2-positive tumor status (p = 0.035).

Conclusion: Findings show that EIC status is the most significant predictor of RD following BCSs with close DCIS margins. This emphasizes the importance of identifying EIC-positive cases in pathology reports and prioritizing them for additional re-excision when DCIS margins are close.

Background: Breast cancer is among the leading causes of mortality in women globally, with a rising incidence in developing countries, including Saudi Arabia. Early detection through screening is essential for reducing the mortality rate among women. However, factors such as awareness, attitudes, and barriers significantly influence women's participation in screening programs, especially in resource-limited settings.

The aim of the study: The aim of this study is to assess the awareness, attitudes, and barriers to breast cancer screening among breast cancer screening health education week attendees at King Saud Medical City, Riyadh.

Materials and methods: The study was conducted during breast cancer screening health education week at King Saud Medical City in Riyadh, from October 13 to 17, 2024. A convenience sample of 277 women, aged 18-60, completed a structured, self-administered questionnaire. Data on awareness, attitudes, and barriers related to breast cancer screening were analyzed using descriptive and inferential statistics in SPSS Version 23.0.

Results: Among the women surveyed, 63.5% showed a good level of awareness about breast cancer screening, with an average awareness score of 12.6 ± 5.5 out of 23. Positive attitudes toward screening were common, with 97.8% expressing supportive views (p = 0.045). Higher awareness levels were significantly associated with age (p = 0.003) and occupation (p = 0.001), while attitudes toward screening were significantly linked to education. The main barriers reported were lack of time (30.3%), difficulty accessing services (15.2%), and fear of the procedure (15.2%). In the multiple logistic regression analysis, any significant predictors of awareness and attitude toward breast cancer screening were not identified.

Conclusion: The study indicates a relatively high level of awareness and a positive attitude toward breast cancer screening among participants. However, significant barriers, including time constraints, accessibility challenges, and fear of the procedure, limit regular participation. To increase screening rates and reduce breast cancer mortality in Saudi Arabia, it is recommended to implement targeted awareness campaigns, enhance service accessibility, and provide continuous education through healthcare providers.

Background: Virtual teleconsultation plays a pivotal role in managing diseases requiring long-term communication between patients and treatment teams, such as breast diseases. The Ruban Virtual Breast Clinic in Iran offers teleconsultation services focusing on nonurgent chronic complaints through offline messaging. This study aimed to evaluate patient satisfaction with these teleconsultation services.

Methods: A comprehensive questionnaire was designed with three sections: identifying the individual interacting with the clinic and prior teleconsultation use; collecting demographic data and reasons for consultation; and assessing satisfaction using 16 items rated on a Likert scale from 1 (poor) to 10 (excellent). The study included patients who received at least one consultation by a breast surgeon through the Ruban platform.

Results: Of 583 eligible cases, 367 (62.9%) consented to participate. The average satisfaction score was 91.6 out of 100, indicating a high level of patient satisfaction.

Conclusions: The high satisfaction rates suggest that telehealth services, particularly virtual consultations, are feasible and highly acceptable in meeting patients' healthcare needs. These findings underscore telehealth's potential to improve access to care, though further research is required to establish its clinical effectiveness.