Psychological intervention in breast cancer pathology

Breast cancer is an extremely important public health issue for doctors. Health professionals draw attention to the importance of early detection of the disease, so that treatment becomes effective. The experience of the disease can be extremely shocking and devastating for women. Studies show that women diagnosed with breast cancer experienced prolonged emotional difficulties during the year following diagnosis. This article proposes a review of some important methods and techniques used in the psychotherapy of breast cancer patients, such as: art therapy, cognitive-behavioral stress management, mindfulness-based stress reduction, acceptance and commitment therapy, compassion focused therapy and experiential psychotherapy. This paper is a review based on information from the literature. The analysis was limited to articles and guides in English published between January 1 and June 1 2021, on PubMed, ScienceDirect and Google Scholar, using the following keywords: breast cancer, women, depression, distress, anxiety, mental health, psychotherapy, interventions, treatment. In this review we discuss the characteristics of breast cancer pathology, the psycho-emotional effects and the interventions needed to optimize quality of life. The psychotherapeutic approaches presented draw attention to the fact that psychological interventions are part of the complementary procedures to the treatment in the pathology of breast cancer and can improve the quality of life of pacients.

Familial Genetic Cancer Risk Assessment with respect to a Silent BRCA2 mutation

Male Breast Cancer (BC) is relatively rarer, accounting for less than 1% of cancers in men. MBC is hereditary in nature and mainly attributed to BRCA1/2 germline mutations. Accordingly, National Comprehensive Cancer Network (NCCN) guidelines advise genetic counselling and testing for all cases of MBCs and their unaffected family members. In this report, we present an uncommon case of male patient primarily diagnosed with pancreatic cancer who later developed asynchronous bilateral hormone positive breast cancer. We describe the genetic screening and clinical management protocol for the proband and family members. Genetic testing with next generation sequencing by uses of a multi-gene germline mutation panel revealed a likely pathogenic BRCA2 variant (c.8754G>A, p.E2918E). Subsequently, 34 members of the extended family of the proband were tested for the BRCA2 variant by Sanger sequencing. 6 of the family members were identified as carriers of this BRCA2 variant. Of these, three presented with hereditary breast cancer and 3 were unaffected healthy carriers. In silico analysis for mechanistic insights in underlying pathogenicity revealed that the silent BRCA2 mutation is a spliceogenic variant that is likely to create an aberrant mRNA transcript via alternative splicing of BRCA2 gene. Our study demonstrates the clinical relevance of this silent BRCA2 mutation and emphasizes the need for further experimental studies to elucidate its functional role in breast cancer pathology.

Clinical utility of testing for PALB2 and CHEK2 c.1100delC in breast and ovarian cancer

Purpose To investigate the contribution of PALB2 pathogenic gene variants (PGVs, PALB2_PGV) and the CHEK2 c.1100delC (CHEK2_1100delC) PGV to familial breast and ovarian cancer, and PALB2_PGV associated breast cancer pathology. Methods Outcomes of germline PALB2_PGV and CHEK2_1100delC testing were recorded in 3,127 women with histologically confirmed diagnoses of invasive breast cancer, carcinoma in situ, or epithelial nonmucinous ovarian cancer, and 1,567 female controls. Breast cancer pathology was recorded in PALB2_PGV cases from extended families. Results Thirty-five PALB2 and 44 CHEK2_1100delC PGVs were detected in patients (odds ratio [OR] PALB2 breast–ovarian = 5.90 [95% CI: 1.92–18.36], CHEK2 breast–ovarian = 4.46 [95% CI: 1.86–10.46], PALB2 breast = 6.16 [95% CI: 1.98–19.21], CHEK2 breast = 4.89 [95% CI: 2.01–11.34]). Grade 3 ER-positive HER2-negative, grade 3 and triple negative (TN) tumors were enriched in cases with PALB2 PGVs compared with all breast cancers known to our service (respectively: 15/43, 254/1,843, P = 0.0005; 28/37, 562/1,381, P = 0.0001; 12/43, 204/1,639, P < 0.0001). PALB2_PGV likelihood increased with increasing Manchester score (MS) (MS < 15 = 17/1,763, MS 20–39 = 11/520, P = 0.04) but not for CHEK2_1100delC (MS < 15 = 29/1,762, MS 20–39 = 4/520). PALB2 PGVs showed perfect segregation in 20/20 first-degree relatives with breast cancer, compared with 7/13 for CHEK2_1100delC (P = 0.002). Conclusion PALB2 PGVs and CHEK2_1100delC together account for ~2.5% of familial breast/ovarian cancer risk. PALB2 PGVs are associated with grade 3, TN, and grade 3 ER-positive HER2-negative breast tumors.

Human cytomegalovirus and Epstein-Barr virus infections in breast cancer: A molecular study on Iranian women

BACKGROUND AND OBJECTIVES: The role of human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) infections in breast cancer pathology is not well understood. Our study aimed to investigate the association of HCMV and EBV infections with breast cancer and distinguish the types of positive EBV and LMP-1 samples in Iranian patients. METHODS: Seventy-two formalin-fixed paraffin-embedded (FFPE) breast cancer tissues were analyzed between December 2014 and April 2016. Samples were analyzed for HCMV and EBV using nested-PCR and conventional PCR assays, respectively. Statistical analysis was performed using SPSS software version 18. RESULTS: Overall, HCMV and EBV genomes were detected in 6.9% and 16.7% of FFPE breast cancer tissues, respectively. Clinical factors were not statistically associated with the presence of HCMV and EBV. CONCLUSION: In this study, we reported EBV and LMP-1 typing in breast carcinoma cases for the first time in Iran. Our findings indicate that HCMV and EBV infections are not associated with the development of breast cancer.

Breast cancer pathology services in sub-Saharan Africa: a survey within population-based cancer registries

Background Pathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA). The major problems identified as impairing the quality of pathology reports are shortcomings of equipment, organization and insufficiently qualified personnel. In addition, in the context of breast cancer, immunohistochemistry (IHC) needs to be available for the evaluation of biomarkers. In the study presented, we aim to describe the current state of breast cancer pathology in order to highlight the unmet needs. Methods We obtained information on breast cancer pathology services within population-based cancer registries in SSA. A survey of 20 participating pathology centres was carried out. These centres represent large, rather well-equipped pathologies. The data obtained were related to the known population and breast cancer incidence of the registry areas. Results The responding pathologists served populations of between 30,000 and 1.8 million and the centres surveyed dealt with 10–386 breast cancer cases per year. Time to fixation and formalin fixation time varied from overnight to more than 72 h. Only five centres processed core needle biopsies as a daily routine. Technical problems were common, with 14 centres reporting temporary power outages and 18 centres claiming to own faulty equipment with no access to technical support. Only half of the centres carried out IHC in their own laboratory. For three centres, IHC was only accessible outside of the country and one centre could not obtain any IHC results. A tumour board was established in 13 centres. Conclusions We conclude that breast cancer pathology services ensuring state-of-the-art therapy are only available in a small fraction of centres in SSA. To overcome these limitations, many of the centres require larger numbers of experienced pathologists and technical staff. Furthermore, equipment maintenance, standardization of processing guidelines and establishment of an IHC service are needed to comply with international standards of breast cancer pathology.