Search

BACKGROUND AND PURPOSE: The Breast and Cervical Cancer Treatment Program (BCCTP) Act, passed by Congress in 2000, provides time-limited coverage to uninsured breast or cervical cancer patients. We examine survival differences between BCCTP cases and insured controls. METHODS: Stage I-III breast cancer patients, covered under California’s BCCTP from 2005–2009 (N=6,343), were 1:1 matched with California Cancer Registry (CCR) controls on age, race/ethnicity, and cancer stage. Overall and disease-specific (OS and DSS) survival were compared using multivariate regression. RESULTS: BCCTP cases were more often unmarried (Odds Ratio [OR]=2.47, 95% Confidence Interval [CI]=2.30–2.66), with poorly/undifferentiated tumors (OR=1.26, CI=1.13–1.40), classified as ER negative (OR=1.10, CI=1.02–1.20) and/or PR negative (OR=1.09, CI=1.01–1.17). Cases were more likely to undergo mastectomy (OR=1.13, CI=1.05–1.21) or no surgery (OR=1.64, CI=1.31–2.05) versus lumpectomy. Cases were also more likely to undergo radiation (OR=1.11, CI=1.03–1.19). Endocrine therapy rates were marginally lower in cases (OR=0.93, CI=0.86–1.00). OS and DSS were shorter in BCCTP cases on multivariate analysis (HR=1.29, CI=1.17–1.42 and HR=1.27, CI=1.14–1.42, respectively). When stratified by socioeconomic status (SES), cases had significantly shorter OS and DSS except in the lowest quintile. When stratified by stage, cases had significantly shorter OS and DSS, except for stage I. CONCLUSIONS: The BCCTP provides uninsured breast cancer patients with comprehensive and timely care. Although our results suggest that BCCTP delivers quality care, BCCTP patients have shorter survival rates, even after accounting for SES and stage differences. Further assistance to vulnerable populations is warranted, including longer duration of treatment coverage, and surveillance adhering to NCCN compliant surveillance programs.

Amac: Bu calisma hemsirelik ogrencilerinin stresle bas etme duzeyleri ile algilanan sosyal destek arasindaki iliskinin incelenmesi amaciyla yapildi. Yontem: Calismanin evrenini bir universitenin saglik bilimleri fakultesinde lisans egitimi goren hemsirelik ogrencileri olusturdu. Herhangi bir ornekleme yontemine basvurulmayip calismaya katilmayi kabul eden butun ogrenciler calisma kapsamina alindi. Calismaya katilmayi kabul eden ogrencilere tanimlayici ozellikleri iceren form, Stresle Basetme Tarzlari Olcegi ve Algilanan Sosyal Destek Olcegi uygulandi. Verilerin degerlendirilmesinde yuzdelik, ortalama, Kruskall Wallis Varyans Analizi, Mann Whitney-U testleri ve Pearson korelasyon analizi kullanildi. Bulgular : Ogrencilerin stresle bas etme tarzlari olcegi puani 73.09±10.48 olarak belirlendi. Olcegin alt boyutlarindan puan ortalamasi en yuksek KGY 20.39±4.33, en dusuk CY 16.53±5.20 oldugu saptandi. Algilanan sosyal destek olcegi ortalama puani 124.77±13.26’dir. Ayni olcegin alt boyutlarina iliskin puan ortalamalarinda en yuksek AID 54.77±5.32, en dusuk OGD 37.00±9.33 oldugu saptandi. Hemsirelik ogrencilerinin stresle basa cikma duzeyleri ile algilanan sosyal destek duzeyleri arasindaki korelasyon analizinde aile ve arkadas destegi duzeyi ile stresle basa cikmada aktif/etkili tarz olan kendine guvenli yaklasim (sirasiyla r=.194 p

De novo Stage IV breast cancer compromises 5–6% of woman with breast cancer. Systemic staging at the time of initial presentation is recommended for patients with clinical Stage IIIA disease or patients who have symptoms concerning for metastatic disease. Patients were suspected to have metastatic disease should be referred to medical oncology. A biopsy of the metastatic focus should be performed to confirm the diagnosis and tumor markers including ER, PR, and HER-2/neu should be tested. Surgery has limited role in metastatic breast cancer. After excellent response to systemic therapy resection of single metastatic, focus in lung or liver may be considered. Resection of the primary breast lesion may also be considered in selected patients with well-controlled oligometastatic disease. These patients should be discussed in a multidisciplinary setting with the input of medical oncology, surgery, radiation oncology, and pathology. Surgery may be necessary for palliation in the setting of infection, bleeding, or unrelenting pain.

Paget’s disease is a rare presentation of breast cancer. It presents with itching and bleeding of the nipple or areola and yellowish exudates or ulceration may be present. Ninety percent of patients are found to have DCIS or invasive breast cancer as the underlying pathology. Full-thickness skin biopsy is recommended for diagnosis of Paget’s. Diagnostic imaging includes mammography and ultrasound to detect an associated lesion in the breast. MRI is recommended if these do not demonstrate a cancer or to evaluate the extent of the disease for surgical planning. Surgical treatment depends on the location of the cancer within the breast which may not always be in the vicinity of the nipple areolar complex. Sentinel node biopsy is recommended if the surgical treatment is going to be mastectomy or if there is evidence of invasive disease on biopsy. If a patient has isolated Paget’s disease of the nipple, the surgical management options include central lumpectomy with or without sentinel node biopsy and radiation or mastectomy with sentinel lymph node biopsy.

The patient presenting with an enlarged axillary node should be first evaluated with a detailed history and physical examination. Imaging studies should then be ordered depending on the patient’s symptoms and physical examination findings. If breast cancer is suspected or the patient does not have a recent screening study done, a mammography and ultrasound should be ordered. A core needle biopsy of the lymph node is performed. Tumor markers help identify the primary cancer. If the lymph node is suspicious for metastatic carcinoma from a breast primary and mammography and ultrasound does not demonstrate a lesion, MRI is recommended. Further systemic staging is also recommended. Patient is then managed depending on the clinical stage and tumor markers. Occult breast cancers represent less than 1% of all newly diagnosed breast cancers. These patients are managed with axillary dissection with mastectomy or whole breast radiation and systemic therapies depending on the tumor markers. Multidisciplinary decision-making is recommended in the setting of occult breast cancers.

Patients with breast cancer diagnoses are routinely monitored for local and distant recurrence after initial treatment. Patients are followed with history, including a detailed review of systems and physical examination. Diagnostic imaging studies are selected depending on the type of prior surgical treatment and patient’s symptoms. If a local-regional recurrence is suspected, this is confirmed with a biopsy, and tumor markers including ER, PR, and HER-2 are repeated. Next, it is important to investigate the presence of a distant metastasis. Once the distant disease is ruled out, local-regional recurrence is managed with a combination of surgery, systemic therapies, and radiation depending on the patient characteristics. For this reason, patients with recurrent breast cancer should be managed in a multidisciplinary fashion including surgery, medical oncology, and radiation oncology, with plastic surgery and genetics as necessary for the best outcome.

Breastfeeding can reduce breast cancer risk; however, unknown factors modify this protective effect. Zinc (Zn) modulates an array of cellular functions including oxidative stress, cell proliferation, motility and apoptosis. Marginal Zn intake is common in women and is associated with breast cancer. We reported that marginal Zn intake in mice leads to mammary gland hypoplasia and hallmarks of pre-neoplastic lesions. In the present study, we tested the hypothesis that marginal Zn intake confounds the protective effect of lactation on breast cancer. Nulliparous mice fed control (ZA, 30 mg Zn/kg) or a marginal Zn diet (ZD, 15 mg Zn/kg), were bred and offspring were weaned naturally. Post-involution, mice were gavaged with corn oil or 7,12-dimethylbenz(a)anthracene (DMBA, 1 mg/wk for 4 weeks) and tumor development was monitored. A ZD diet led to insufficient involution, increased fibrosis and oxidative stress. Following DMBA treatment, mice fed ZD had higher oxidative stress in mammary tissue that correlated with reduced levels of peroxiredoxin-1 and p53 and tended to have shorter tumor latency and greater incidence of non-palpable tumors. In summary, marginal Zn intake creates a toxic mammary gland microenvironment and abrogates the protective effect of lactation on carcinogenesis.

The mammary gland is composed of an epithelial system of ducts and lobuloalveolar secretory units embedded in a mesenchymally derived fat pad. The growth and morphogenesis of the epithelial structures of the breast occur in various stages and are associated with concurrent hormonal changes and affected by genetic mutations. Each stage reflects the effects of systemic hormones on the glandular epithelium as well as the paracrine effects of locally derived growth factors and other regulatory products produced in the stroma. Appreciating the relationship of epithelium to mesenchyme in normal growth is essential for understanding developmental abnormalities and factors that may lead to disease.

Zinc (Zn) regulates numerous cellular functions. Zn deficiency is common in females; ~80% of women and 40% of adolescent girls consume inadequate Zn. Zn deficiency enhances oxidative stress, inflammation and DNA damage. Oxidative stress and inflammation is associated with breast disease. We hypothesized that Zn deficiency increases oxidative stress in the mammary gland, altering the microenvironment and architecture. Zn accumulated in the mammary glands of Zn deficient mice and this was associated with macrophage infiltration, enhanced oxidative stress and over-expression of estrogen receptor α. Ductal and stromal hypercellularity was associated with aberrant collagen deposition and disorganized e-cadherin. Importantly, these microenvironmental alterations were associated with substantial impairments in ductal expansion and mammary gland development. This is the first study to show that marginal Zn deficiency creates a toxic microenvironment in the mammary gland impairing breast development. These changes are consistent with hallmarks of potential increased risk for breast disease and cancer.

Breast cancer is the most common cancer among women. While breastfeeding can reduce breast cancer risk, several studies found no protective effect. We showed that marginal zinc (Zn) intake compromi...

Prolactin receptor (PRL-R) activation regulates cell differentiation, proliferation, cell survival and motility of breast cells. Prolactin (PRL) and PRL-R over-expression are strongly implicated in breast cancer, particularly contributing to tumor growth and invasion in the more aggressive estrogen-receptor negative (ER-) disease. PRL-R antagonists have been suggested as potential therapeutic agents; however, mechanisms through which PRL-R antagonists exert their actions are not well-understood. Zinc (Zn) is a regulatory factor for over 10% of the proteome, regulating critical cell processes such as proliferation, cell signaling, transcription, apoptosis and autophagy. PRL-R signaling regulates Zn metabolism in breast cells. Herein we determined effects of PRL-R attenuation on cellular Zn metabolism and cell function in a model of ER-, PRL-R over-expressing breast cancer cells (MDA-MB-453). PRL-R attenuation post-transcriptionally increased ZnT2 abundance and redistributed intracellular Zn pools into lysosomes and mitochondria. ZnT2-mediated lysosomal Zn sequestration was associated with reduced matrix metalloproteinase 2 (MMP-2) activity and decreased invasion. ZnT2-mediated Zn accumulation in mitochondria was associated with increased mitochondrial oxidation. Our results suggest that PRL-R antagonism in PRL-R over-expressing breast cancer cells may reduce invasion through the redistribution of intracellular Zn pools critical for cellular function.