Silvia Pecchio

Body mass index (BMI) and breast cancer: impact on tumor histopathologic features, cancer subtypes and recurrence rate in pre and postmenopausal women.

The study aims to analyze the association between body mass index (BMI) at time of diagnosis, breast cancer histopathologic features (tumor size, nuclear grade, estrogen and progesterone receptor (ER and PgR) and HER-2/neu expression, histological subtypes, Ki-67 index, lymphatic/vascular invasion, axillary nodes involvement) and incidence of different subtypes defined using hormone receptors and HER2/neu expression, according to menopausal status; to evaluate the impact of BMI on disease free survival (DFS) at multivariate analysis. A total of 2148 patients (592 premenopausal, 1556 postmenopausal) were classified into subgroups according to BMI distribution. High BMI was significantly associated with larger size tumor both in pre (p = 0.01) and postmenopausal women (p = 0.00). Obese premenopausal women showed worse histopathologic features (more metastatic axillary lymphnodes, p = 0.017 and presence of vascular invasion, p = 0.006) compared to under/normal weight group. Postmenopausal patients with BMI > 25 developed more frequently ER/PgR positive cancers (87% versus 75%, p 0.017), while no association was found in premenopausal women. We could not found any statistically significant correlation between breast cancer subtypes (luminal A, B, HER-2 and basal-like) and BMI both in pre and postmenopause. Higher BMI was significantly associated with a shorter DR-FS in postmenopausal women but the independent prognostic role of obesity was not confirmed in our analysis.

Clinical-pathologic features, long term-outcome and surgical treatment in a large series of patients with invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC)

PURPOSE OF THE STUDY A retrospective analysis on 1407 patients with invasive ductal carcinoma (IDC) and 243 invasive lobular carcinoma (ILC) was performed in order to compare the histological features, the immunohistochemical characteristics, the surgical treatment and the clinical outcome in the two groups. RESULTS ILC seems to be more likely multifocal, estrogen receptor positive, HER-2 negative and to have a lower proliferative index compared to IDC. ILC, when treated with conservative surgery, required more frequently re-excision and/or mastectomy because of positive resection margins. No difference was observed in terms of 5-year disease free survival and local relapse free survival between the two groups, in the whole series and in the subgroup of patients treated with breast-conserving treatment. CONCLUSION ILC can be safely treated with conservative surgery but a more accurate preoperative evaluation of tumor size and multifocality could be advocated, in order to reduce the re-excision rate.

Chemoprevention or mastectomy for women at high risk of developing breast cancer

Breast cancer (BC) is the most commonly diagnosed invasive cancer among women; in developed countries, BC occurs in one out of eight women during her lifetime. Many factors, both genetic and non-genetic, determine a womans risk of breast cancer and several mathematical models have been proposed that determine the risk. It is important to identify those at high risk, as there are now effective preventive strategies, such as chemoprevention therapy and risk-reduction surgery. Risk-reduction agents are recommended for women aged 35 years or more who are at high risk of breast cancer. Tamoxifen is presently deemed to be the agent of choice. However, raloxifene may be preferable, at least for some postmenopausal women, because of its lack of effect on the endometrium and the reduced incidence of venous thromboembolic events compared with tamoxifen. Prophylactic surgery has been widely investigated. Bilateral mastectomy decreases the risk of developing breast cancer by approximately 90% in women at moderate or high risk and in known BRCA1/2 mutation carriers. This review summarizes the recent advances in the identification of women at high risk of developing breast cancer and reports on the strategies used to prevent breast cancer; the risk-benefit balance of such preventive choices is also briefly analyzed.

Pregnancy After Breast Cancer

Receiving cancer diagnosis can be devastating for many patients but thanks to advances in cancer therapies it is not a death sentence anymore. Cancer survival rates are increasing and life after cancer is a real chance for many patients worldwide. In Europe, about one third of cancer patients have a relative 5-year survival rate greater than 80 % [1]. Similar survival rates are seen in the United States, Canada and Australia. Lower survival rates in developing countries are most likely due to late diagnosis and limited availability of up-to-date standard treatments [2, 3].

Satisfaction and Impact on Quality of Life of Clinical and Instrumental Surveillance and Prophylactic Surgery in BRCA-mutation Carriers

Introduction: BRCA 1 and 2 mutation carriers are invited to follow intensive clinical and instrumental surveillance programs or are offered prophylactic breast and ovarian surgery. These recommendations impact many aspects of their life. This study aims to evaluate the satisfaction with surveillance and prophylactic surgery and the impact of these procedures on the quality of life. Patients and Methods: An anonymous questionnaire was administered to 174 BRCA1‐2 mutation carriers. Results: A total of 95% of women comply with the scheduled checks every 6 months. Periodic examinations are considered useful for early diagnosis of breast/ovarian cancer by 91.5% of responders. Among those women who received prophylactic breast surgery, 95% believe that this procedure can reduce cancer risk, but only 65% were completely satisfied by the cosmetic outcome. Among women who underwent prophylactic ovarian surgery, 90.5% would choose it again, mainly owing to a lower degree of concern about ovarian cancer risk. The early onset of menopausal symptoms was the most frequently reported side effects, but only 21% of patients use any treatment to relieve them. Conclusion: Women who follow a surveillance program show a good level of satisfaction, thanks to the lowering of concerns of cancer risk. The degree of satisfaction about the prophylactic surgery is generally high. Risk‐reducing mastectomy is usually well‐accepted, despite the fact that cosmetic results are not entirely satisfactory. Bilateral salpingo‐oophorectomy may impact on quality of life because of the symptoms associated with early surgical menopause, even if it can be treated with hormonal replacement therapies.

Fertility Preservation and Pregnancy After Breast Cancer: When and How?

Around 6 % of breast cancer cases occur in women younger than 40 years; these patients show specific issues compared to older women. The effects of local and systemic treatments such as the distortion of body image, sexuality complaints, and fertility reduction have a higher impact in this population of young women. Fertility issues should be discussed before starting any type of anticancer treatment. The optimal type of fertility preservation, the endocrine treatment duration, and the effect of subsequent pregnancies on breast cancer prognosis remain research priorities. Currently, fertility preservation techniques rely on cryopreservation of embryos, cryopreservation of mature oocytes, cryopreservation of ovarian tissue and on the administration of GnRHa concomitant to chemotherapy. Advantages and disadvantages of each technique must be evaluated in each single patient. Many studies have shown that pregnancy after breast cancer does not impair the prognosis, both in ER+ and ER− patients; a protective effect of pregnancy has even been suggested. Young patients should not be undertreated to satisfy their eagerness for pregnancy; physicians should share with them all the available options for fertility preservation and the evidence about safety of pregnancy after cancer, to make a customized and informed decision.