Molecular imaging employs molecularly targeted probes to visualize and often quantify distinct disease-specific markers and pathways. Modalities like intravital confocal or multiphoton microscopy, near-infrared fluorescence combined with endoscopy, surface reflectance imaging, or fluorescence-mediated tomography, and radionuclide imaging with positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are increasingly used for small animal high-throughput screening, drug development and testing, and monitoring gene therapy experiments. In the clinical treatment of breast cancer, PET and SPECT as well as magnetic resonance-based molecular imaging are already established for the staging of distant disease and intrathoracic nodal status, for patient selection regarding receptor-directed treatments, and to gain early information about treatment efficacy. In the near future, reporter gene imaging during gene therapy and further spatial and qualitative characterization of the disease can become clinically possible with radionuclide and optical methods. Ultimately, it may be expected that every level of breast cancer treatment will be affected by molecular imaging, including screening.
Breast cancer; Molecular imaging; PET; MRI; Optical imaging; Receptor
Hemangiopericytoma (HPC) is a rare vascular tumor originating from the capillary pericytes, and HPC of the breast is extremely rare.
We describe a 50-year-old woman with HPC of the breast and focus on the diagnosis before operation and the extent of the operation. Under local anesthesia, a complete tumor excision was performed. Then, the fast-frozen material was pathologically examined and the diagnostic conclusion was ‘malignant tumor of the breast, perhaps original from lobus intermedius tissue’. Finally, a modified radical mastectomy was performed, after which all 7 lymph nodes from the axillary fossa position of the excision showed symptoms of reactive hyperplasia.
On the basis of reviewing the literature about the disease, we propose several basic ideas: an accurate biopsy together with an appropriate histological and im-munohistochemical examination is promising, and since lymph node metastasis is extremely rare, a simple mastectomy may be considered.
Hemangiopericytoma; Diagnosis, Therapy
The aim of this study was to assess the course of anxiety and depression in cancer patients over time and to detect determinants of the changes in the scores.
Patients and Method:
Women with breast cancer and gynaecological cancer (n = 367) were tested at the beginning (T1) and at the end (T2) of treatment in the hospital, 6 months later (T3), and 12 months later (T4), using the Hospital Anxiety and Depression Scale (HADS).
Anxiety and depression were highest at the start of the stay in the hospital. More than half of the women are at least doubtful cases in at least one of the two HADS dimensions. The mean scores declined from T1 to T4. After 1 year, depression scores are similar to those of the general population, while anxiety scores remain elevated. The decline of the HADS scores depends on treatment, time since diagnosis, and education.
Women receiving radio- or chemotherapy (compared with surgery only), with a long time since diagnosis, and with a low educational level are at high risk of maintaining high anxiety and depression scores over time.
Anxiety; Breast cancer; Depression; Longitudinal study; Psychological distress
Adjuvant therapy improves survival in breast cancer patients. However, both antihormonal agents and cytostatic chemotherapy meet with variable success. We have searched the literature for biological causes of variability in drug response. Evidence suggests that additional markers may be introduced because of their potentially predictive value in adjuvant therapy: i) overexpression of epidermal growth factor receptor is likely inversely correlated to the sensitivity to estrogen antagonists; ii) presence of the GAB2 adaptor protein and of the ABCC3 and mdr-1 efflux pumps modulates taxane sensitivity in HER2-positive breast cancer; and iii) CYP2D6 genotyping should be a routine measure to avoid failure of tamox-ifen treatment. In contrast, there is little in the way of genetic evidence for differences in the pharmacokinetics of other antihormonal or cytostatic drugs. Nevertheless, genotypes may affect efficacy and toxicity of cytostatic drugs (e.g. doxorubicin), but this evidence has to be confirmed by prospective trials.
Adjuvant breast cancer therapy; Tamoxifen resistance; Sensitivity to taxane treatment; Pharmacokinetics of antihormonal agents; Pharmacogenomics of cytostatic drugs
Core needle biopsies represent only a small portion of a breast lesion. Rare lesions with overlapping features may be underestimated in such small samples.
A 67-year-old female underwent core needle biopsy of a 27-mm breast tumour demonstrating infiltrative glands without significant desmoplasia. Periglandular collagen IV immunostaining and the small glands were reminiscent of microglandular adenosis, and despite the infiltrative look of the microglands, the lesion was interpreted as suspicious for malignancy. Finally, the tumour proved to be a tubulolobular carcinoma.
The tubules of tubulolobular carcinoma may show a basement membrane-like staining pattern with collagen IV, and this must be considered in the differential diagnosis of mammary lesions with small glandular architecture.
Basement membrane; Breast cancer; Collagen IV; Tubulolobular carcinoma
Myoepithelial cells are widely present in the breast, and their hyperplasia may result in a spectrum of disease ranging from myoepitheliosis to myoepithelial carcinoma.
A 46-year-old woman presented with a palpable mass in her right breast. Mammography and ultrasonography showed a lesion in the upper quadrant of the right breast with spiculated borders and shape. Excisional biopsy showed adenomyoepithelial adenosis.
Although considered benign, adenomyoepithelial lesions tend to recur due to inadequate excision. Therefore, possibility of recurrence and even metastasis should be considered during follow-up of patients with a diagnosis of adenomyoepithelial lesions.
Breast cancer; Adenomyoepithelial adenosis; Adenomyoepithelioma; Myoepithelial lesions
The world-wide incidence of cancer is expected to increase to 20 million by 2020. 70% of new cases occur in countries with 5% of the global cancer control resources. Breast cancer is the most common malignancy among women in high income, as well as low and middle income countries (LMCs). For the leading pharmaceutical companies, the current market for breast cancer systemic therapy (BCST) in LMCs is likely to decline in the future due to increasing costs of novel drugs. Breast cancer provides a strong example for multiple drug management of solid tumors. Development of economically sustainable scientific strategies for BCST in LMCs could improve affordability of therapy for other cancers throughout the world. Examples of recent and ongoing studies using protocols that could decrease costs of treatment without compromising outcomes are reviewed. The Win-Win initiative proposed by ICEDOC's (International Campaign for Establishment and Development of Oncology Centers) Experts in Cancer without Borders starts with small pilot meetings for oncologists with key stakeholders, including leading pharmaceutical companies. The participants would develop a roadmap for actionable strategies for crafting affordable BCST tailored to regional conditions and the diverse populations of women with breast cancer.
Breast cancer; Treatment; Cancer control; Low and middle income countries; Cancer chemotherapy; Health economics
Five years of adjuvant tamoxifen treatment has been the gold standard for women with early hormone-responsive breast cancer. Results from two large phase III, adjuvant studies have indicated that the third-generation aro-matase inhibitors (AIs) letrozole and anastrozole offer greater protection against recurrence than tamoxifen in upfront substitution strategies in the first 5 years. Similarly, changeover to an AI (exemestane or anastrozole) after 2-3 years of tamoxifen has been more efficient to prevent recurrence than 5 years of tamoxifen. Most early breast cancer recurrences occur 5 or more years after surgery. Letrozole has been shown to offer greater protection against recurrence than placebo in the 5 years after a standard course of tamoxifen. The optimal adjuvant use (duration and sequencing) of AIs requires further investigation. Safety implications of treatment with these AIs for 5 years or more are closely monitored. The anticipated effects of estrogen deprivation on bone health may be treatable with bisphosphonates. Effects on the cardiovascular system, and other estrogen-sensitive systems such as the central nervous system, are currently examined. The AIs letrozole, anastrozole, and ex-emestane have recently replaced tamoxifen as the recommended adjuvant endocrine therapy, on the basis of greater efficacy and better tolerability.
Early breast cancer; Aromatase inhibitors; Letrozole; Anastrozole; Exemestane; Tamoxifen
Women who suffer from large or locally advanced malignant breast tumors are now commonly treated with preoperative (‘neoadjuvant’) systemic therapy to improve surgical outcomes and to raise the chances for breast-conserving therapy (BCT). Until recently, chemotherapy was the treatment of choice, and primary systemic endocrine treatment was restricted to medically frail or older women with receptor-positive breast cancer. The development of modern aromatase inhibitors (Als) and their subsequent clinical evaluation in neoadjuvant trials now provides us with an alternative to chemotherapy that is thought to be equally effective, yet considerably better tolerated. Several large prospective trials have compared tamoxifen with the non-steroidal AIs letrozole and anastrozole and the steroidal Al exemestane, with improved outcomes for all AIs in terms of tumor remission and rate of BCT. A number of predictive biomarkers now also allow us to identify those tumors that most likely respond to a certain endocrine regimen.
Neo-adjuvant; Endocrine therapy; Breast cancer
Endocrine adjuvant therapy is the best-described molecular targeted treatment and should therefore be used for all patients with endocrine-responsive breast cancer. Ta-moxifen for 5 years is standard of care and has proven efficacy in premenopausal patients. The combination of tamoxifen with ovarian function suppression and/or chemotherapy has been extensively tested, and some controversial approaches are used in clinical practice. Cessation or suppression of ovarian function appears to be beneficial for premenopausal patients. Particularly for premenopausal women with highly endocrine-responsive disease and/or low risk for relapse, the additional benefit of cytotoxic chemotherapy may be minor or nonexistent. While the use aromatase inhibitors is investigated in clinical trials, their application outside an academic trial setting cannot be recommended based on first available results. In contrast, the use of adjuvant bispho-sphonates may offer another strategy of further improving clinical outcomes in this important patient subgroup.
Breast cancer; Premenopausal patients; Endocrine treatment; Aromatase inhibitors; Bisphosphonates; Tamoxifen; LHRH agonists
Compared to peripheral venous access, central lines greatly reduce the incidence of cytotoxic extravasation. Although implantable vascular systems are widely used in oncology, extended extravasation lesions in cancer patients remain complicated.
Patient and Method
A 67-year-old female breast cancer patient suffered from an extended lesion of a catheter port extravasation. A vacuum-sealing therapy was initiated to accelerate the healing of the anthracycline-induced wound.
The vacuum-sealing technique allowed a fast and successful treatment of the extravasation lesion.
Due to the myelosuppressive chemotherapy regimen, the risk of wound infections and prolonged healing processes is increased in cancer patients. Moreover, disruption or cancellation of anticancer therapies worsens the patients’ prognosis. To attenuate these complications the vacuum-sealing technique should be considered in wound management concepts.
Extravasation; Vacuum-sealing therapy; Venous catheter port; Breast cancer; Chemotherapy
Around one third of all patients reveal signs of stress disorder and adaptation difficulties following breast cancer or during the course of the illness, often manifested clinically as fear and depression. Supportive treatment should be made available to all patients in the form of psycho-educative group sessions introducing information and assistance to help overcome the illness. The indication for extensive treatment, e.g. psychotherapy, can be deduced from the somatopsychic disorders presented. Individual or group therapy will be offered to the patient corresponding to her diagnostics and motivation. The aim of therapy should be discussed openly with the patient, that is, an improvement in the quality of life and the possibility to overcome the situation. In general, the various intervention programmes have proved to be beneficial for patients with cancer. These include relaxation therapy and stress management as well as behavioural therapy and supportive psychotherapy. Patients have high expectations of the therapy offered and this should be taken into careful consideration by all physicians, psychologists and others responsible for administering treatment. The aim of this work is mainly to present the clinical experience gained in a breast centre.
Breast cancer; Psychooncology; Psychosocial interventions
Androgens, like estrogens, can be synthesized in the breast. As both active androgens and their corresponding receptors are present in breast tissue, we conclude that they play a role in breast physiology. This is supported by the fact that insufficient androgen production or sensitivity results in the development of gynecomastia. Complete androgen insensitivity due to receptor defects leads to normal female breast development in these XY women. While breast development is completely inhibited by male testosterone levels, partial but not total degradation of a developed breast by androgen treatment appears to be possible. Breast cancer in early stages seems to fulfill the prerequisites of androgen responsiveness. Androgen treatment of advanced breast cancer has shown similar effectiveness as anti-estrogen or estrogen-ablative therapy, but also considerable side effects. It has been speculated that the use of selective androgen modulators (SARMs), either alone or preferably in addition to anti-estrogens or aromatase inhibitors, may be a promising alternative to current therapy modalities in hormone-dependent breast cancer. In addition, future studies on the use of SARMs in prophylactic settings seem to be justified.
Androgens; Paracrine mechanisms; Breast; Breast cancer