Littérature scientifique sur le sujet « Post-partum breast cancer »

265 Background: Breast cancer (BC) is the most common cancer in women. 12% of BC occur in women age 20–34. BC is classified as “pregnancy associated” if it is diagnosed during pregnancy or within one year after the delivery (PABC). We propose two distinct subtypes of PABC: BC diagnosed during pregnancy and BC diagnosed post-partum. This distinction is important because epidemiologic data highlights worsened outcomes specific to post-partum cases. The safety of pregnancy after treatment of BC is an important issue for many young women. Current research does not indicate that pregnancy negatively affects survival. Methods: There are about 95 young women being diagnosed each year with BC in the Czech Republic. A project of clinical registry named “Project 35” was launched in 2005 with the aim to collect data on epidemiology of the disease in young women. The standardization of the multidisciplinary medical treatment, genetic counselling and psychosocial support should result in better clinical outcomes and improve the quality of life. Results: In our project (n=225) were referred 25 women with PABC, 9 patients with the diagnosis of breast cancer during the pregnancy, 16 patients within one year after the delivery. 2 patients underwent termination of the pregnancy (first trimester) before oncological treatment, in 2 patients anthracycline-based chemotherapy was administered (second trimester), and in 5 patients were induced preterm delivery (third trimester). After delivery we followed standard therapeutic guidelines. All patients are alive but three of them have metastatic disease. From 16 women treated for post-partum BC, 11 patients have complete remission, 2 are alive with metastatic disease, 1 is recovering after the surgery for local recurrence and 2 patients died due to progressive disease. 8 women are BRCA1/2 carriers. 8 women after the successful treatment of breast cancer have delivered of healthy children and are in a complete remission, despite 1 of them with local reccurence of breast cancer. Conclusions: PABC is rare situation, which needs to be managed individually. These patients should be treated under the supervision of the Oncological Centres. Project 35 is useful framework for the counselling in PABC.

ImportanceIn young-onset breast cancer (YOBC), a diagnosis within 5 to 10 years of childbirth is associated with increased mortality. Women with germline BRCA1/2 pathogenic variants (PVs) are more likely to be diagnosed with BC at younger ages, but the impact of childbirth on mortality is unknown.ObjectiveTo determine whether time between most recent childbirth and BC diagnosis is associated with mortality among patients with YOBC and germline BRCA1/2 PVs.Design, Setting, and ParticipantsThis prospective cohort study included women with germline BRCA1/2 PVs diagnosed with stage I to III BC at age 45 years or younger between 1950 and 2021 in the United Kingdom, who were followed up until November 2021. Data were analyzed from December 3, 2021, to November 29, 2023.ExposureTime between most recent childbirth and subsequent BC diagnosis, with recent childbirth defined as 0 to less than 10 years, further delineated to 0 to less than 5 years and 5 to less than 10 years.Main Outcomes and MeasuresThe primary outcome was all-cause mortality, censored at 20 years after YOBC diagnosis. Mortality of nulliparous women was compared with the recent post partum groups and the 10 or more years post partum group. Cox proportional hazards regression analyses were adjusted for age, tumor stage, and further stratified by tumor estrogen receptor (ER) and BRCA gene status.ResultsAmong 903 women with BRCA PVs (mean [SD] age at diagnosis, 34.7 [6.1] years; mean [SD] follow-up, 10.8 [9.8] years), 419 received a BC diagnosis 0 to less than 10 years after childbirth, including 228 women diagnosed less than 5 years after childbirth and 191 women diagnosed 5 to less than 10 years after childbirth. Increased all-cause mortality was observed in women diagnosed within 5 to less than 10 years post partum (hazard ratio [HR], 1.56 [95% CI, 1.05-2.30]) compared with nulliparous women and women diagnosed 10 or more years after childbirth, suggesting a transient duration of postpartum risk. Risk of mortality was greater for women with ER-positive BC in the less than 5 years post partum group (HR, 2.35 [95% CI, 1.02-5.42]) and ER-negative BC in the 5 to less than 10 years post partum group (HR, 3.12 [95% CI, 1.22-7.97]) compared with the nulliparous group. Delineated by BRCA1 or BRCA2, mortality in the 5 to less than 10 years post partum group was significantly increased, but only for BRCA1 carriers (HR, 2.03 [95% CI, 1.15-3.58]).Conclusions and RelevanceThese findings suggest that YOBC with germline BRCA PVs was associated with increased risk for all-cause mortality if diagnosed within 10 years after last childbirth, with risk highest for ER-positive BC diagnosed less than 5 years post partum, and for ER-negative BC diagnosed 5 to less than 10 years post partum. BRCA1 carriers were at highest risk for poor prognosis when diagnosed at 5 to less than 10 years post partum. No such associations were observed for BRCA2 carriers. These results should inform genetic counseling, prevention, and treatment strategies for BRCA PV carriers.

AbstrakAsi merupakan makanan yang paling sempurna bagi bayi, dimana kandungan gizi sesuai kebutuhan pertumbuhan dan perkembangan yang optimal. Asi mengandung zat untuk perkembangan kecerdasan, zat kekebalan (mencegah tubuh dari berbagai penyakit) dan dapat menjalani hubungan cinta kasih antara ibu dan bayi. Manfaat menyusui bagi ibu dapat mengurangi perdarahan setelah melahirkan, mempercepat pemulihan ibu, seperti involusi Rahim, menunda kehamilan dan mengurangi resiko terkena kanker payudara. Asi yang tidak sering dikeluarkan dapat berkembang menjadi bendungan asi, payudara terisi sangat penuh dengan asi aliran susu menjadi terhambat dan akan menyebabkan payudara bengkak. Tujuan : Menganalisis ibu postpartum dengan bedungan asi. Metode : pencarian artikel ini menggunakan google scholar, pudmed, science direck, kemudian ditemukan 10 artikel sesuai kriteria inklusi dan eklusi yang selanjutnya dilakukan review. Hasil : berdasarkan 10 jurnal artikel secara umum menyatakan bahwa faktor-faktor yang mempengaruhi ibu postpartum dengan bendungan asi disebabkan oleh umur, pendidikan, perawatan payudara. Kesimpulan : Analisis ibu postpartum dengan bendungan asi yaitu, umur, pendidikan, perawatan payudaraKata Kunci: Ibu postpartum, Kejadian Bendungan Asi, PengetahuanAbstractBreast milk is the most perfect food for babies, where the nutritional content is according the needs of optimal growth and development. Breast milk contains subtances of the development of intelligence immune subtances (prevents the body from various diseaces) and can undergo a loving relationship between mother and baby. The benefits of breast feeding of mothers can reduce bleedinh after childbirth, accelerate the speed of recovery of the mother such as uterine involution, delay pregnancy and reduce the risk of breast cancer. Breast milk that is not often expelled can development breast milk dams, the breasts are very full with milk the flow of milk becomes blocked and wiil cause the breasts to swell. Desination : analysis post partum mothers with breast milk Method : searching for this article using google scholar, pudmed, science director, then found 10 articles according to tehe criteria which were then reviewed. Results : Based on 10 jurnal articles, it is generally stated that the Analysis of post partum mother with breast milk are coused by the influence of age, education, breast care Conclusion : Description of the analysis of post partum mothers with breast milk, age,education, breast careKeywords : Post partum mother, Breast milk dam incident, Knowledge

OBJECTIVES/GOALS: Reveal common immune mechanisms in dysregulated age-related lobular involution (ARLI) and post-partum lobular involution (PPLI) to understand their link to increased breast cancer risk, challenging the traditional view of their distinctiveness. Ultimately, to improve breast cancer risk assessment and personalized prevention METHODS/STUDY POPULATION: The Mayo Clinic Benign Breast Disease (BBD) cohort comprises of ~20,000 women with benign biopsies, including ~1000 women with sequential benign biopsies. Lobular involution (LI) status was assessed by selecting perimenopausal women, ages 45-55, with sequential biopsies, comparing acini number and lobule size between initial and subsequent biopsies. NanoString IO360/ BC360 RNA profiling identified differentially expressed genes associated with dysregulated LI. Using multiplex immunofluorescence (mIF), I'll analyze and spatially map immune biomarkers related to dysregulated ARLI and PPLI in BBD tissue from perimenopausal women who did or did not go on to develop breast cancer, assessing the commonality of ARLI and PPLI markers and exploring their potential as risk biomarkers for breast cancer. RESULTS/ANTICIPATED RESULTS: Preliminary findings link patients who display dysregulated ARLI with an increased breast cancer risk and identify vital PPLI biomarkers in perimenopausal women. I expect the biopsies of women who developed post-menopausal breast cancer (PMBC) and post-partum breast cancer (PPBC) to exhibit elevated levels of dysregulated ARLI immune biomarkers and PPLI biomarkers. Spatially mapping these markers promises to provide a more comprehensive understanding of their interactions, potentially revealing common immunological pathways. These findings could transform our current paradigm of ARLI and PPLI as distinct processes and demonstrate their interconnection in shaping breast cancer risk. DISCUSSION/SIGNIFICANCE: PMBC and PPBC dominate majority of breast cancer cases. Both involve activation of the understudied process of lobular involution, which has been shown to have pro-tumorigenic traits. Elucidating these mechanisms will aid more efficient risk stratification and personalized prevention to reduce incidence and mortality of breast cancer.

e13099 Background: Reports on delay to diagnosis of cancer in young women are based on retrospective studies and conflicting. The purpose of this study was to investigate time to cancer diagnosis in women presenting to a surgeon with breast-related complaints; and particularly, the role of age. Methods: A population-based cohort study including all women aged 18 to 44 presenting to a surgeon with a breast-related complaint between 2005 and 2015 in a large Israeli healthcare plan (N = 157,264). We collected data including demographics, diagnosis codes, breast imaging and biopsies. Breast cancer diagnosis within one year of the visit was ascertained from the national cancer registry. Time to breast imaging and biopsy was compared between the different age groups. Logistic regression analysis was used to determine the association between age and delay to biopsy while adjusting for possible confounders. Results: During the first year after the visit, 45,434 (29%) women had a breast imaging study; 5,767 (3.7%) women had a breast biopsy; and 676 (0.43%) were diagnosed with breast cancer. Overall, time to first breast imaging (mean, 53 days) and biopsy (mean, 68 days) did not differ significantly between the age groups. Non-specific visit codes (other than breast mass) were associated with delays to imaging and biopsy. This was more pronounced in the women ultimately diagnosed with breast cancer. Among women diagnosed with breast cancer, age under 40 (OR 2.3, 95% CI 1.4; 3.9), being post-partum (OR 2.6, 95% CI 1.1; 5.9) and a non-specific visit code (OR-8.3, 95% CI 4.9; 14.2) were associated with delay to biopsy. Conclusions: Symptomatic women with lower a-priori likelihood of breast malignancy (younger age, post-partum, or non-specific visit code) are at a significantly greater risk of delayed diagnosis of cancer. Physicians should be aware of the challenging diagnosis in young women with non-specific symptoms.

Post-partum period is the period following child birth which lasts for 6 weeks. Early post-partum period lasts from child birth to 7 days. Breast feeding is universally recognised as the best way to feed an infant. Lactational problems are the complaints during initial puerperium which hinders breast feeding. Mother who is failing to breast feed is associated with increased risk of premenopausal breast cancer, ovarian cancer, type 2 diabetes & metabolic syndrome. The main objective of the study was to identify problems of lactation among the post-natal mothers during early post-partum period at selected hospitals of Surat district, Gujarat. Quantitativedescriptive research method was used for the study. Total 30 postnatal mothers irrespective of their gravidity, parity, mode of delivery, any complications in present pregnancy were selected by non-probability convenient sampling technique. Tool for the data collection comprises of questionnaire for socio demographic information and observation & inventory checklist for assessment of lactational problems. The data were collected by interview method and analysed with the help of descriptive statistics. Findings of the study revealed that 66.67 percent belonged to the age group of 21-30 years, 56.6 percent were following mixed diet pattern, 80 percent were primi gravida & para, 56.67 percent were having caesarian delivery, 83.33 percent were in the gestational age of 38-42 weeks, 43.33 percent were having 2nd postnatal day & 93.33 percent have initiated breast feeding after 30 min. With regards to the 'Agrave; ndings of lactational problems, 20 percent mothers had redness, 33.34 percent had swelling, 100 percent had tenderness, 56.67 percent had excessive hotness, 86.66 percent had hard mass, 19.99 percent had rashes on breast, 9.99 percent had inverted nipple, 58.89 percent mothers had pain in breast, 100 percent had heaviness in breast, 6.66 percent had burning sensation, 20 percent had itching on breast, 70 percent had breast discomfort, 100 percent had insuf'Agrave;cient milk supply and 6.66 percent had over stretching of breast. Study 'Agrave;ndings concluded that lactational problems are common in post-natal period. Identi'Agrave;cation of problems at earliest and helping the mother to deal with them is major responsibility of nurse.

e23166 Background: An oncological diagnosis during pregnancy, or the choice of motherhood following cancer may be accompanied by anxiety, distress and depression. The aim of the study is to explore the possible risk factors in the perinatal period in women who experienced an oncological diagnosis before or during pregnancy. Methods: 32 pregnant women (25 breast, 3 cervix, 1 lung, 1 Hodgkin's lymphoma, 1 perivascular epithelial cell neoplasia, 1 epatic PEComa) were assessed during their 3rd trimester (T1) and three months’ post-partum (T2). At T1 mood states and post-traumatic symptoms were evaluated, at T2 parenting stress and perceived quality of life (QoL). Results: Depression, anger and anxiety correlated with lower physical and psychological QoL in the post-partum. Moreover, mothers who expressed higher levels of fatigue and confusion during pregnancy are associated to lower levels of perceived psychological QoL. Women who manifested hypervigilance and hyperarousal during pregnancy were more likely to perceive lower psychological QoL three months after birth. Finally, post-traumatic symptoms of intrusiveness during pregnancy correlated with higher levels of parenting stress and higher risk of dysfunctional parenting, together with a stronger perception of having a child with a difficult temperament in the post-partum period. Conclusions: Mood states and post-traumatic symptoms can decrease the mother’s quality of life and heighten parental distress. These preliminary results suggest implementing psychological support for women with current or previous oncological diagnosis during pregnancy in order to prevent the onset of dysfunctional parenting and/or problem behaviours in their children. [Table: see text]

Pregnancy-associated cancer is defined as malignancy diagnosed during gestation or up to 1 year post partum. Treatment of cancer during pregnancy is complicated by the risk of harm to the fetus and limitations in safety data. Postpartum patients receiving chemotherapy, tyrosine-kinase inhibitors or hormonal agents should avoid breast feeding to avoid drug excretion in breast milk. Patients who will receive cytotoxic chemotherapy should be advised of the potential impact on their future fertility and offered fertility-preservation options. Breast cancer is the most common pregnancy-associated malignancy and is most frequently either invasive ductal or lobular carcinoma. Breast lymphoma is an exceedingly rare diagnosis that typically presents with unilateral disease in the seventh decade of life. Here, we present the case of a woman who presented with bilateral breast masses during the second trimester of pregnancy and was ultimately diagnosed with primary breast Burkitt’s lymphoma.

6575 Background: Delays in diagnosis (dx) and treatment (tx) affect breast cancer (BC) outcomes. We sought to identify factors associated with delays among young women, who do not undergo routine screening and often have pregnancy or breastfeeding-related breast changes that may mask a BC. Methods: The Young Women’s Breast Cancer Study is a multicenter, prospective cohort that enrolled 1302 women with newly dx BC age ≤40 between 2006-2016. Women reported the method and timing of cancer detection on the baseline survey. 231 were ineligible or excluded due to missing information. Among those reporting self-detected cancers, using multivariable regression we evaluated factors associated with delays ≥90 days (d) from symptom to presentation (self delay) and presentation to dx (care delay); in stage 0-III BC we evaluated delays ≥60d from dx to tx (tx delay). Results: 1071 eligible women had median age at dx of 37 yrs (17-40) and 74% reported self-detected cancers. Self delay or care delay ≥90d was reported in 17% and 13%, respectively. Factors inversely associated with self delay included pregnancy at dx (vs nulliparous, OR 0.10, CI 0.01-0.78) and perceived financial comfort (vs not, OR 0.62, CI 0.41-0.93). Women dx ≤1 year post-partum who breastfed (vs nulliparous, OR 2.60, CI 1.14-5.93) and those with a family history of breast/ovarian cancer (vs none, OR 1.79, CI 1.00-3.19) were more likely to have a care delay. Age was inversely associated with care delays (OR 0.94, CI 0.89-0.99). Tx delay was reported by 10% (105/1015), and associated with being single (vs partnered, OR 1.61, CI 1.02-2.56 ), non-white (vs white, OR 1.85, CI 1.09-3.13) and having Stage 0 BC (vs stage 1, OR: 3.08, CI 1.65-5.77); women with stage 3 BC (vs stage 1, OR 0.13, CI 0.03-0.56) were less likely to have a tx delay. Conclusions: In this cohort, most young women with BC underwent timely dx and tx initiation. Women dx ≤1 year post-partum who breastfed were more likely to experience a care delay, likely because lactational changes may mask BC signs and symptoms. The associations of perceived financial status with self delay and non-white race with tx delay underscore the need for additional support to ensure timely care for underserved populations with the goal of eliminating disparities in outcomes.

Pregnancy-associated breast cancer (PABC) is a rare, yet significant clinical entity which presents itself during pregnancy or within one year postpartum. This case report and literature review discusses the case of a 33-year-old G1P0 woman diagnosed with PABC at 38 weeks’ gestation with an uncomplicated pregnancy and no significant risk factors. Fine needle aspiration revealed a left-sided metaplastic grade 3 invasive ductal carcinoma with heterogeneous mesenchymal differentiation and focal ductal carcinoma in situ, and an uncomplicated nipple-sparing mastectomy was undertaken at three weeks’ post-partum. This case report emphasises the need for early diagnosis and the importance of screening for breast cancer during pregnancy, and advocates for a low threshold to screen for PABC in all pregnancies. The literature review also provides updated insights into the presentation, diagnosis, and management of PABC. We explore the diagnostic challenges associated with PABC, including physiological changes in breast tissue during pregnancy, limitations of imaging modalities, and the importance of considering PABC as a differential diagnosis.

La sénescence est une réponse à un stress biologique, caractérisée par un arrêt stable du cycle cellulaire. Néanmoins, les cellules restent métabolliquement actives et acquièrent un phenotype sécrétoire associé à la sénescence, avec la production d’un sécrétome complexe composé de cytokines, chémiokines, facteurs de croissance et modulateurs du remodelage de la matrice extracellulaire. La sénescence est associée à de nombreux processus pathologiques, comme la tumorigénèse et le vieillessement. Cependant, où, quand et comment la sénescence contribue aux processus physiologiques reste méconnu. Pour répondre à cette question, nous avons tiré profit de la glande mammaire (GM), un organe avec une plasticité remarquable pendant le développement post-natal. L’involution de la GM est l’un des évenements majeurs de mort cellulaire et de remodelage tissulaire chez les mammifères, lorsque les cellules épithéliales produisant le lait sont éliminées et que la GM retourne à son état pré-grossesse, attendant la prochaine gestation. Au cours de ma thèse, nous avons montré que la sénescence était induite transitoirement pendant la phase irréversible de l’involution. De plus, le programme de sénescence apparaissait spécifiquement dans les cellules luminales productrices de lait et corrélait à l’expression de l’inhibiteur du cycle cellulaire p16. En parallèle, nous avons établi un nouveau modèle d’organoides pour mimer la gestation, la lactation et l’involution de la GM. Dans ce modèle ex-vivo, nous avons aussi relever la présence de cellules sénescentes strictement lors du processus d’involution. Pour évaluer l’impact biologique de la sénescence in vivo, nous avons utilisé une méthode de scellement des mamelons pour découpler les phases réversible et irréversible de l’involution. Nous avons dévoilé une association étroite entre le sevrage des hormones lactogéniques qui a lieu lors de la seconde phase d’involution, et l’induction du programme de sénescence. Pour mieux définir les rôles physiologiques de la sénescence pendant l’involution, nous avons traités des souris avec de l’ABT-263, un composé sénolytique induisant l’apoptose des cellules sénescentes. Nous avons observé une altération du remodelage tissulaire suite à l’élimination des cellules sénescentes, avec des alvéoles résiduelles plus larges et un remplissage adipocytaire retardé. De plus, dans des organoides provenant de souris transgéniques p16-3MR, nous avons éliminé les cellules sénescentes avec succès grâce à l’administration de ganciclovir, ce qui a retardé le processus d’involution. Dans leur ensemble, les modèles in vivo et ex-vivo suggèrent un rôle important de la sénescence pour moduler la phase de remodelage tissulaire dans l’involution de la GM. Enfin, le processus d’involution est intiment lié avec le cancer du sein post-partum, un cancer diagnostiqué dans les 10 ans suivant une grossesse et associé à un mauvais pronostic. Explorer comment la sénescence impacte le microenvironnement lors de l’involution pourrait ainsi fournir de nouvelles connaissances pour mieux comprendre le cancer du sein post-partum
Cellular senescence is a biological stress response characterized by a stable cell cycle arrest. Nonetheless, cells remain metabolically active and acquire a senescence-associated secretory phenotype (SASP), a complex secretome composed of cytokines, chemokines, growth factors, and extracellular matrix remodeling modulators. Senescence is associated with various pathological processes, such as tumorigenesis and aging. However, it is unknown when, where and how senescence contributes to physiological processes. To answer this question, we took advantage of the mammary gland (MG), an organ with remarkable plasticity throughout postnatal development. The MG involution is one of the major mammalian cell death and tissue remodeling events, when milk-producing epithelial cells are removed, and the MG returns to its pre-gestation state, resting for further pregnancy. During my Ph.D., we showed that senescence was transiently induced during the irreversible phase of involution. The senescent program occurred specifically in the alveolar milk-producing luminal cells and correlated with the expression of the cell cycle inhibitor p16. In parallel, we established a novel organoid system to mimic MG gestation, lactation, and involution. In this ex-vivo model, we also highlighted the presence of senescent cells strictly during the involution-like process. To assess the biological impact of senescence in vivo, we used a teat sealing method to uncouple the reversible and irreversible phases of involution. We unveiled a close association between the withdrawal of lactogenic hormones occurring in the second phase of involution and the induction of the senescence program. To further define the physiological roles of senescence during involution, we treated mice with ABT-263, a senolytic compound inducing apoptosis of senescent cells. Interestingly, we observed an impaired tissue remodeling upon senescence elimination, with larger remaining alveolar structures and delayed adipocyte refilling. Moreover, in organoids from transgenic p16-3MR mice, we successfully removed senescent cells with ganciclovir and delayed the involution-like process. Taken together, both in vivo and ex-vivo models suggest an essential role of senescence in modulating the tissue remodeling phase of MG involution. Importantly, the involution process is intimately associated with postpartum breast cancer (PPBC), a cancer diagnosed within 10 years following delivery with a poor prognosis. Investigating how senescence impacts the microenvironment during the involution process might provide major insights to understand PPBC