Dauren Sarsenov

Is Administration of Trastuzumab an Independent Risk Factor for Developing Osteonecrosis of the Jaw Among Metastatic Breast Cancer Patients Under Zoledronic Acid Treatment

AbstractOne of the most important adverse effects of zoledronic acid (ZA) is osteonecrosis of the jaw (ONJ). In previous literature, several risk factors have been identified in the development of ONJ. In this study, we aimed to determine the role of trastuzumab, an antiangiogenic agent, as an independent risk factor for the development of this serious side effect.Our study included 97 patients (mean age: 54 ± 10 years) with breast cancer, recorded in the archives of the Istanbul Florence Nightingale Breast Study Group, who received ZA therapy due to bone metastases between March 2006 and December 2013. We recorded the patients’ ages, weights, duration of treatment with ZA, number of ZA infusions, dental procedures, anticancer treatments (chemotherapy, aromatase inhibitor, trastuzumab), the presence of diabetes mellitus or renal dysfunction, and smoking habits.Thirteen patients (13.40%) had developed ONJ. Among the patients with ONJ, the mean time of exposure to ZA was 41 months (range: 13–82) and the mean number of ZA infusions was 38 (range: 15–56). The duration of treatment with ZA and the use of trastuzumab were observed to be 2 factors that influenced the development of ONJ (P = 0.049 and P = 0.028, respectively).The development of ONJ under ZA treatment may be associated solely with the duration of ZA treatment and the concurrent administration of trastuzumab. These findings show that patients who are administered trastuzumab for metastatic breast cancer while undergoing ZA treatment are prone to developing ONJ. Therefore, we recommend intense clinical observation to avoid this particular condition in patients receiving ZA and trastuzumab.

Possible role of stress, coping strategies, and life style in the development of breast cancer

Objective The aim of the present study was to investigate the possibility of the effect of life long stressful events, along with coping method used, perception of social support, and life style on the development of breast cancer. Methods In this hospital-based case control study, the study group comprised 250 women with breast cancer who were followed by Florence Nightingale Breast Study Group. Control group included 250 women, who had similar sociodemographic characteristics to the study group. Data were collected with semi-structured interview form, Healthy Life Style Behavior Scale, Coping Strategy Indicator, and Stress Evaluation Form developed by us. Results In multivariate analysis, family history of cancer (OR: 1.55, 95% CI: 2.29–1.05), inadequate social support (OR: 1.83, 95% CI: 1.23–2.73), and loss of father during childhood (OR: 2.68, 95% CI: 5.52–1.30) and serious stressor within the last five years (OR: 4.72, 95% CI: 7.03–3.18) were found to be risk factors increasing the risk of breast cancer. When family history of cancer was excluded from the model, the presence of psychiatric disorder history (OR: 1.95, 95% CI: 3.26–1.17) and major life events (OR: 2.24, 95% CI: 4.07–1.24) were added to the model as risk factors. Conclusion The present study indicates that especially the stressful events experienced within the last five years plays an undeniable role in the risk of breast cancer. Social support may be as important in the period before the diagnosis as in the period after diagnosis.

Radiation Fibrosis Syndrome Imitating Breast Cancer Recurrence; A Case Report

Nowadays, surgery, radiotherapy and chemotherapy are the most frequently used modalities in the treatment of breast cancer. It is very well-known that some severe complications may result from after these treatments. Early and late complications of radiotherapy are well known. The complications of radiation therapy may be seen in (early) or after three months (late-delayed) of periods. These complications may be related with direct or indirect effect of radiation. The radiation fibrosis syndrome is a progressive fibrotic tissue sclerosis together with various clinical symptoms in the irradiation field. It is usually a late finding of radiation therapy and may be seen weeks or even years after the treatment. Many systems such as musculo-skeletal, soft tissue, neural tissue and cardiopulmonary system may be affected. In this report, we present a case of a breast cancer treated with breast conserving surgery and radiation therapy twelve years ago. The patient had ipsilateral lymphedema, right axillary mass, and pain during arm and shoulder mobilization. Her physical examination and radiologic findings revealed a big mass invading right thoracic wall, thoracic cavity and the axilla. Histopathological evaluation performed after tru-cut and open biopsy from the mass showed fibrosis resulting from radiation therapy.

Secretory Carcinoma of the Breast

Secretory carcinoma is a very rare subtype of breast carcinoma. These tumors are generally associated with a favorable prognosis, although having triple-negative phenotype (estrogen receptor (ER), progesterone receptor (PR) negative and c-erbB2 (HER2) negative). In this presentation, a rare secretory carcinoma of the breast in a woman aged 24 years is discussed and the literature is reviewed.

The Prognostic Impact of Molecular Subtypes and Very Young Age on Breast Conserving Surgery in Early Stage Breast Cancer.

Background Premenopausal breast cancer with a triple-negative phenotype (TNBC) has been associated with inferior locoregional recurrence free survival (LRFS) and overall survival (OS) after breast conserving surgery (BCS). The aim of this study is to analyze the association between age, subtype, and surgical treatment on survival in young women (≤40 years) with early breast cancer in a population with a high rate of breast cancer in young women. Methods Three hundred thirty-two patients ≤40 years old with stage I-II invasive breast cancer who underwent surgery at a single institution between 1998 and 2012 were identified retrospectively. Uni- and multivariate analysis evaluated predictors of LRFS, OS, and disease free survival (DFS). Results Most patients (64.2%) underwent BCS. Mean age and follow-up time were 35 (25 ± 3.61) years, and 72 months (range, 24–252), respectively. In multivariate analysis, multicentricity/multifocality and young age (<35 years) independently predicted for poorer DFS and OS. Those aged 35–40 years had higher LRFS and DFS than those <35 in the mastectomy group (p=0.007 and p=0.039, respectively). Patients with TNBC had lower OS compared with patients with luminal A subtype (p=0.042), and those who underwent BCS had higher OS than patients after mastectomy (p=0.015). Conclusion Young age (< 35 years) is an independent predictor of poorer OS and DFS as compared with ages 35–40, even in countries with a lower average age of breast cancer presentation. In addition, TNBC in the young predicts for poorer OS. BCS can be performed in young patients with TNBC, despite their poorer overall survival.

Prognostic Significance of Adjuvant Chemotherapy Induced Amenorrhea in Luminal A and B Subtypes

Objective In this retrospective study, chemotherapy induced amenorrhea in patients with early stage breast cancer and its effects on survival were investigated. Materials and Methods Two hundred fifty-two patients received adjuvant chemotherapy without ovarian suppression treatment (OST) from 600 premenopausal patients were included in the study. Patients were divided into two groups; with amenorrhea and without, and compared with clinicopathologic features and survival. SPSS version 17 was used. Results Chemotherapy-induced amenorrhea (CIA) was observed in 145 (57.5%) of 252 patients who received no OST during follow-up. The 5-year OS rate of patients with CIA was significantly higher than patients without CIA (p= 0.042, 95.9% vs. 89.7% vs. 158.88 vs. 135.33 months, respectively). In the subgroup analysis, the OS in patients with hormone receptor (+) was significantly higher than in those receptor (-) in patients with CIA (p=0.011, 97.5% vs. 90.9% vs. 162.13 vs. 126.16 months, respectively). The OS was significantly longer in the luminal A molecular subtype than in those with luminal B molecular subtype, in patients with CIA, but the difference was not significant in patients without CIA (p=0.027 vs. p=0.074, respectively). Conclusion As a conclusion; survival advantage of the chemotherapy induced amenorrhea more pronounced with hormone receptor positivity, lymph node involvement, and advanced disease over patients who do not develop amenorrhea. This advantage of amenorrhea development further prolongs survival compared with luminal B in the luminal A molecular subtype.

Embracing the Future of Surgery: Gastric Cancer Resection Within One Month of Left Ventricular Assist Device Implantation

Left ventricular assist devices (LVADs) have been implanted recently, with increasing frequency, to treat advanced heart failure with good survival rates. Since heart failure is most prevalent in patients above 70 years of age, LVAD implantations are increasing particularly in this cohort. On the other hand, due to a higher incidence of malignant tumors in the elderly population, there is a significant cohort of patients having concurrent indications for LVAD implantation. Herein, we report a case of complicated gastric malignancy that was encountered soon after the implantation of an emergent LVAD with ensuing treatment difficulties and ethical considerations. Keeping in mind the fairly high life expectancy for both groups, there is a predisposition to the notion that simultaneous procedures can and should be applicable to a selected group of patients with end-stage heart failure.

Roles of Biopsychosocial Factors in the Development of Breast Cancer

OBJECTIVE The aim of this study was to determine the roles of biopsychosocial risk factors in the development of breast cancer. MATERIALS AND METHODS This hospital-based case-control study included 491 women with breast cancer (study group) and 512 women who did not have cancer or other serious diseases (control group). Biological, psychological, and social risk factors were compared between the two groups. Data were collected using the semi-structured interview, the Stress Assessment Form, and the Coping Strategy Indicator to assess these factors. RESULTS When the significantly different biopsychosocial variables between the study and the control groups were evaluated together, independent breast cancer risk factors were found as follows: a stressor experienced in the last 5 years, age 40 years and older, inadequate social support perception, use of avoidance coping strategy, being a housewife, having a family history of cancer, and having a body mass index ≥25. CONCLUSION This study showed a relationship between breast cancer risk and manageable variables (obesity, stressor and coping strategy, social support, and employment status), age and family history of cancer, which are biopsychosocial factors. Biopsychosocial aspects are becoming a greater part of many different healthcare systems.

Persistent Left Superior Vena Cava Incidentally Recognized Postoperatively After Venous Port Placement

Persistent left superior vena cava is the most common congenital venous anomaly of the thoracic venous system, occurring in 0.3% to 0.5% of individuals in the general population. It may remain asymptomatic throughout life and be incidentally found in healthy individuals undergoing vascular procedures such as venous access device placements and endovascular cardiac interventions. Here we present a case of persistent left superior vena cava incidentally realized during chemoport insertion in a patient with breast cancer.

The Relationship between Bone Mineral Density and Estrogen Receptor Positivity in Patients with Breast Cancer

OBJECTIVE The effect of estrogen on bone mineral density (BMD) and breast cancer has been known for a long time. The aim of this study was to compare of the BMD of patients with breast cancer and healthy individuals, and to investigate the degree of correlation of estrogen receptor (ER) with BMD. MATERIALS AND METHODS Seventy-one patients with postmenopausal breast cancer and 79 healthy dividuals were included in the study. The patient demographics (age, menopause age, body mass index, number of children, BMD, Z scores, and estrogen status for breast cancer patients) were taken from hospital records. RESULTS No significant difference was detected between the case and control groups in lumbar region Z scores (p=0.074). At the femur neck, the control group Z scores was higher than patient group (p=0.002). BMI was higher in the patients with breast cancer (p=0.001). There was no statistically significant correlation between ER positivity, BMD, and BMI in ER-positive patients (p=0.495, p=0.8, p=0.846, respectively). There was no difference between the Z scores when the patients were divided into two groups as ER positive and negative (p=0.156, p=0.335, respectively). CONCLUSION This study revealed that there is no difference in lumbar region Z scores between patients with breast cancer and heathy controls; however, the Z scores were higher in the femur neck in the control group, and the BMI was lower in the patient group. Tumor ER positivity does not positively affect BMD.