Breast Cancer

Assoc. Prof. Theophil Sedloev MD, PhD is a chief of the Breast Unit at the Department of Surgery, Medical University Sofia, Bulgaria. His professional interests include surgical treatment of breast cancer - breast conserving and oncoplastic surgery with intraoperative radiotherapy for early breast cancer, neoadjuvant chemotherapy and surgery of locally advanced breast cancer.

Introduction: The incidence of breast cancer (BC) in Bulgaria is lower than the average in Europe (76.3 out of 100 000 females to average in Europe 94.2/100 000 females). The data from Bulgarian National Cancer Registry for the last 40 years shows continuous growth in the number of newly diagnosed cases – from 1632 patients in 1976 to 4000 in 2014. The staging distribution for 2013 is the following: stage I (A, B) – 29%, stage II (A, B) – 42 %, stage III (A, B, C) – 20 %, stage IV – 5 %, unclassified – 4%. Purpose: The purpose of this study is to analyze the choice of therapeutic management in patients with BC, diagnosed and treated at the Breast Unit, University Hospital ''Tzaritza Joanna – ISUL'', Medical University (MU) of Sofia in 2016 according to the stage of the disease. Materials and method: All patients, diagnosed with BC were staged according to the TNM- classification (8th edition). The University of Southern California/Van Nuys Prognostic Index (USC/VNPI), the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Medical University Sofia (MUS) prognostic model for evaluating the probability of local recurrence were used in determining the treatment options for patients with non-invasive form of BC (DCIS). The selection of patients with early breast cancer, suitable for breast-conserving surgery (BCS) with simultaneous intraoperative radiotherapy (IORT), was accomplished according to The Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) Breast Cancer Working Group (2009) criteria. SPECT/CT was the preferred method for a preoperative maping of sentinel lymph nodes, followed by intraoperative detection with Europad Gamma Probe camera. We used the INTRABEAM® system (Carl Zeiss Surgical Gmbh, Oberkochen, Germany) to complete the process. Result: In 2016 386 BC patients were treated at our Breast Unit. The mean age of the group of 136 newly diagnosed cases (132 females and 5 males) is 59,2 (29-91). Invasive ductal carcinoma was the most frequent finding (76%) and invasive lobular carcinoma occurs in 16 % of all cases. We had one male patient with malignant fibrous histiocytoma of the breast. Conclusion: Important factors for successful results are the modern complex treatment, which requires individualized approach, and the consequtive modules in standard limits that we provide. The role and advantages of the specialized structures (Breast Units) are undeniable, since they ensure the highest level of diagnosis and treatment, i.e. for the past year at our Breast Unit newly-diagnosed patients were 33% without a single patient with unclear stage. Nationally these numbers are 29% and 4%, respectively.

Sheng-Miauh Huang has completed her PhD at the age of 35 years from National Yang-Ming University, Taipei, Taiwan. She is the assistant professor at the department of nursing, Mackay Medical College in Taiwan. She has published more than 20 papers in reputed journals, especially for cancer care.

Background: Previous evidences indicated that female cancer patients suffered from infertility after cancer-related treatment. Use of complementary and alternative medicine (CAM), particularly traditional Chinese medicine (TCM) and natural products, in pregnancy preparation and fertility management is becoming increasingly common in Taiwan. Objective: The study purposes are to describe the use of CAM among breast cancer women after cancer-related treatment in pregnancy preparation in Taiwan and to examine factors associated with the use of CAM. Methods: Reproductive-age (20-49 years old) women with breast cancer after cancer-related treatment between January 2011 and December 2014 in a Taiwan city participated in the study. Interview was completed with 178 (62%) of those 287 eligible, asking about sociodemographic variables, disease/treatment characteristics, and the use of CAM. Results: The CAM was used after cancer-related treatment by 8.4% of women with breast cancer. Approximately one-quarter (25.7%) of those women ever used CAM to increase the probability of pregnancy. The TCM was the most popular option (24.6%). Age was significantly different between CAM users and those who did not use CAM. The result of binary logistic regression showed that younger women less than 40 years old was the key predictor for using CAM when considering pregnancy (OR = 1.47; 95% CI: 1.84, 10.22). Conclusions: This study found that younger women with breast cancer would search CAM, especially for TCM, to prepare pregnancy in Taiwan. Health providers should help them to choose safe TCM and increase the quality of cancer and pregnancy care.

Kuei-Hui Chu has completed her PhD from National Yang-Ming University. Her professional interests include women's health, child health and neonatal care.

Background: The rise in the breastfeeding rate comes with an increase in the prevalence of neonatal jaundice in ethnic Chinese babies. Objective: The objective of this study was to explore the breastfeeding experiences of mothers of infants with neonatal jaundice. Method: In-depth qualitative interviews and content analysis were conducted with nine mothers of newborns with neonatal jaundice and breastfed their babies during the first year postpartum. Results: Mothers’ experiences can be described in four phases and six themes. (1) Prenatal stage: Build breastfeeding belief, i.e., breastfeeding is best and a natural behavior, without awareness of neonatal jaundice; (2) Stage after neonatal jaundice started to appear: Including two themes, questioning beliefs in breastfeeding and happiness about being a mother. Mothers lacked knowledge and ignored the threat of neonatal jaundice, mainly focused on their physical discomforts and worrisome about insufficient breast milk, they also felt an intimate mother-infant bond through breastfeeding; (3) Stage when newborns had neonatal jaundice: Including two themes, neonatal jaundice and phototherapy caused negative emotions and regaining original beliefs about breastfeeding. They struggled through emotional swings and inconsistent advices about whether phototherapy and formula supplementation is needed. Then they decided neonatal jaundice is only temporary then retrieved initial beliefs of breastfeeding; (4) Stage after neonatal jaundice faded and mothers continued breastfeeding: Insist and adapt. Conclusions: When their babies had neonatal jaundice, women experienced physical discomfort, external pressures and negative emotions concurrently. It is essential for health professionals to provide assistance and for family to provide support during this time.

Zhang Guochao is working as a resident for the second year in Peking Union Medical College and Hospital at present.

Background: Programmed death ligand-1 (PD-L1) is an immunological checkpoint protein that has recently been found to be associated with the prognosis of various malignancies. However, the association between PD-L1 expression and the survival of breast cancer patients has remained unclear. Therefore, the aim of the present meta-analysis was to assess the clinical value of PD-L1 in breast cancer patients. Methods: MEDLINE/PubMed, EMBASE, Cochrane Library, and Grey Literature databases were searched up to 30 March 2016 for articles involving an association between PD-L1 expression and breast cancer prognosis. Hazard ratios for overall survival with 95% confidence intervals (CIs) according to the expression status of PD-L1 were calculated. Odds ratios (ORs) were also analyzed to evaluate the association between clinicopathological parameters and PD-L1 expression. Results: Ten studies were included in this meta-analysis and 7 of these described clinicopathological features. Elevated levels of PDL1 were only significantly associated with histological grade (OR = 1.86, 95% CI: 1.38–2.51; Pheterogeneity = 0.0196), estrogen receptor status (ER) (OR = 0.36, 95% CI: 0.17–0.75; Pheterogeneity = 0.000), and progesterone receptor status (PR) (OR = 0.31, 95% CI: 0.11–0.86; Pheterogeneity = 0.000). Conclusion: There were trends observed in the present meta-analysis, although PD-L1 status as a predictor of prognosis for patients with breast cancer could not be confirmed. Therefore, further studies of mechanism(s) related to PD-L1 expression level and immune escape and antitumor immune responses are needed, especially in relation to breast cancer subtypes. Furthermore, an evaluation standard for PD-L1 expression would facilitate all future studies.