Search Results (547)

Background: Plant-based diets are recommended in guidelines for the prevention of cancer and cardiometabolic diseases, which remain major causes of death in breast cancer survivors (BCS). Since not all plant foods are healthy, we calculated the plant-based dietary index (PDI), healthy (hPDI) and unhealthy (uPDI), and their associations with cardiometabolic targets in BCS. Methods: Baseline dietary and cardiometabolic data were derived from 492 (median age 51, IQR 46–59) female BCS participating in a multicentric lifestyle trial conducted in Italy. Dietary data were collected with 7-day food records. PDI, hPDI, and uPDI were calculated by assigning positive scores to all plant foods, healthy plant foods or less healthy plant foods, respectively, as defined by the literature (scores ranged from 18 to 90). Using logistic or multinomial regression models, we estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) between PDIs and cardiometabolic risk factors. Results: The OR of being obese (BMI ≥ 30 Kg/m²) was 0.47 (95%CI: 0.29–0.77), 0.37 (95%CI: 0.22–0.61) and 1.38 (95%CI: 0.83–2.28) with higher PDI, hPDI and uPDI, respectively. The OR of having a large waist circumference (≥88 cm) was 0.64 (95%CI: 0.42–1.00) with higher hPDI. The OR for hypercholesterolemia (≥200 mg/dL) was 1.80 (95%CI: 1.16–2.78) with higher uPDI. The ORs of hypertriglyceridemia (≥150 mg/dL) and metabolic syndrome were 0.38 (95%CI: 0.20–0.71) and 0.59 (95%CI: 0.35–0.97), respectively, with higher PDI. No other significant association was observed. Conclusions: Maintaining cardiometabolic risk factors within normal ranges is clinically relevant in BCS, and this may be more likely when a plant-based diet is consumed, especially if low in unhealthy plant foods. Full article

Background: The ability to derive growth from a traumatic event, such as a cancer diagnosis, can facilitate effective adaptation to the challenges associated with cancer survivorship. Objective: In two studies, we investigated the possible cognitive mechanisms explaining the relationship between post-traumatic stress and post-traumatic growth in female survivors of breast cancer. Specifically, Study 1 examined the role of interpretation bias, and Study 2 examined the role of cognitive restructuring of trauma. Methods: In Study 1, 113 participants completed questionnaires assessing stress- and anxiety-related symptomatology, post-traumatic stress and growth, perceived cognitive functioning, and positive interpretation bias. In Study 2, 117 participants completed questionnaires assessing stress and anxiety-related symptoms, rumination, perceived cognitive functioning, cognitive restructuring of trauma, and post-traumatic stress and growth. Results: In both studies, post-traumatic stress was negatively related to post-traumatic growth. In Study 1, positive interpretation bias explained a significant amount of variance in the relationship between post-traumatic stress and post-traumatic growth, with perceived cognitive functioning moderating the relationship between interpretation bias and post-traumatic growth. In Study 2, cognitive restructuring explained a significant amount of variance in the relationship between post-traumatic stress and post-traumatic growth, with deliberate rumination moderating the effects of cognitive restructuring on post-traumatic growth. Conclusions: Cognitive mechanisms are key to understanding the relationship between post-traumatic stress and growth and should be targeted in interventions to improve cognitive flexibility and resilience among breast cancer survivors. Full article

Background/Objectives: Cancer survivors are a growing population in the United States, with projections of 22.5 million by 2030. Cancers of the prostate (PC) and breast (BC) are among the most prevalent. Despite a high burden of disease, African American survivors are underrepresented in health behavior research. Leveraging two large databases, this study uniquely characterizes dietary supplement (DS) use among African American cancer survivors to explore potential intervention points. Methods: Characteristics from 376 African American cancer survivors (130 PC; 246 BC) in lifestyle intervention trials were examined. DS use was self-reported and categorized by type. A logistic regression model examined associations between use and survivor characteristics. Results: Overall, 215 (63.80%) survivors with baseline medication log data (N = 337) reported using at least one DS, with a higher prevalence among BC survivors (67.44%) than PC survivors (57.38%). Vitamin D ± calcium combinations, multivitamins, omega-3 fatty acids, calcium, Vitamin B12, and Vitamin C were the most frequently reported. Total comorbidities (mean = 2.38, SD = 1.66) significantly predicted increased DS use among BC and PC survivors. Educational attainment (≤12th grade vs. graduate/professional education) and diet quality (high vs. low) were significantly associated with lower odds of DS use for PC survivors. Only diet quality (moderate vs. low) was significantly associated with higher odds of DS use in BC survivors. Conclusions: DS use is common among African American PC and BC survivors participating in lifestyle interventions. These findings underscore the need for evidence-based guidelines regarding DS use among cancer survivors and the need to include diverse populations. Full article

Background: Breast cancer-related lymphedema (BCRL) remains a challenging complication for breast cancer survivors. Currently, there are no effective pharmacological options available to address this condition. Emerging research highlights the critical role of inflammation, lymphatic dysfunction, and T-cell activity in the development of BCRL. Tacrolimus, a calcineurin inhibitor, has demonstrated promising results in preclinical studies for reducing inflammation, enhancing lymphatic function, and modulating T-cell activity—key mechanisms implicated in BCRL pathogenesis. This study investigates whether topical tacrolimus ointment can reduce the incidence and severity of BCRL, providing a novel approach to mitigate this debilitating condition. Methods: A parallel, open-label non-randomized controlled multicenter clinical pilot trial was conducted from February 2020 to June 2022. Female participants undergoing axillary lymph node dissection (ALND) were recruited and divided into an intervention group (n = 22) receiving topical tacrolimus 0.1% ointment daily for 12 months and a control group (n = 39). Outcomes included lymphedema diagnosis (primary), arm volume, bioimpedance spectroscopy, quality of life (QOL) scores, and adverse events. Assessments were performed at baseline and at 3, 6, 9, and 12 months. Results: At 12 months, lymphedema was diagnosed in 3 of 18 patients (16.7%) in the intervention group and 4 of 37 patients (10.8%) in the control group (p > 0.05). Mean increase in at-risk arm volume was 80.7 mL in the intervention group versus 116.1 mL in the control group (p > 0.05). Disease-specific quality of life scores worsened in both groups, but scores returned to baseline at 12 months in the intervention group only. Adverse events were mild and manageable, with no serious events reported. Conclusions: While topical tacrolimus did not significantly reduce the incidence of lymphedema, exploratory patterns in symptom onset and quality-of-life measures indicate that further investigation in larger randomized trials may be warranted. Full article

Background: As survival rates among breast cancer (BC) patients continue to rise, Emotional Functioning (EF)—has become increasingly clinically relevant; however, researchers have yet to fully characterize its long-term, dynamic trajectories following surgery. This systematic review and meta-analysis aimed to (1) characterize the longitudinal trajectories of EF after BC surgery and (2) examine the moderating effects of surgical modality and age. Methods: We conducted this systematic review and meta-analysis in accordance with PRISMA 2020 guidelines. We synthesized data from studies published between 2000 and 2024 that assessed EF using the EORTC QLQ-C30 at multiple post-surgical time points. Using multilevel random-effects meta-analytic models, we examined EF trajectories across 116 effect sizes derived from 40 studies, and evaluated time, surgical modality (breast-conserving surgery (BCS), mastectomy (MA), mastectomy with immediate reconstruction (Mx + IR) and age group as moderators. Results: The overall pooled estimate for EF was 73.44 (95% CI: 70.29–76.58, p < 0.001). Time since surgery significantly influenced EF: scores were lowest during the initial 6 months (66.82, 95% CI: 59.75–73.89), peaked at 7–15 months (77.86, 95% CI: 74.51–81.22) and 31–54 months (77.52, 95% CI: 70.44–84.59), and showed lower values at 16–30 months (72.58, 95% CI: 61.45–83.72) and 55–72 months (69.81, 95% CI: 64.08–75.54). Surgical modality significantly shaped these trajectories (p = 0.013). The overall pooled estimate for EF was 73.44 (95% CI: 70.29–76.58, p < 0.001). Time since surgery significantly influenced EF: scores were lowest during the initial 6 months (66.82, 95% CI: 59.75–73.89), peaked at 7–15 months (77.86, 95% CI: 74.51–81.22) and 31–54 months (77.52, 95% CI: 70.44–84.59), and showed lower values at 16–30 months (72.58, 95% CI: 61.45–83.72) and 55–72 months (69.81, 95% CI: 64.08–75.54). Surgical modality significantly shaped these trajectories (p = 0.013). The BCS group showed a significant inverted-U trajectory in EF scores, with a positive linear slope (β = 1.22, SE = 0.50, p = 0.046) and a small negative quadratic term (β = −0.02, SE = 0.01, p = 0.046), indicating initial improvement followed by decline. A similar pattern was observed for MA, where the linear term (β = 1.19, SE = 0.51, p = 0.054) and quadratic curvature (β = −0.02, SE = 0.01, p = 0.054) suggested an early rise with subsequent decline. In contrast, Mx + IR displayed a high intercept (β = 71.46, SE = 4.46, p < 0.001) but no significant trajectory over time (p = 0.582), indicating stability. The 45–60 year group demonstrated a significant inverted-U trajectory in EF scores, with a positive linear coefficient (β = 0.87, SE = 0.38, p = 0.067) and a negative quadratic coefficient (β = −0.01, SE = 0.01, p = 0.067), suggesting an early rise in emotional functioning followed by a subsequent decline. Participants <45 years also showed a significant inverted-U pattern, starting from a moderately high baseline (β = 67.56, SE = 4.26, p < 0.001) with a positive linear slope (β = 0.82, SE = 0.34, p = 0.051) and a negative quadratic curvature (β = −0.01, SE = 0.01, p = 0.051). In contrast, the >60 year group reported the highest baseline scores (β = 75.60, SE = 5.18, p < 0.001) with no significant trajectory, indicating overall stability. These findings confirm that EF follows a significant inverted-U trajectory (p < 0.001) and is influenced by time, surgical modality, and age. Full article

Objectives: Breast cancer survivors often experience long-term neurological complications, including balance impairments, following treatment. This study aimed to investigate microstructural changes in white matter tracts in breast cancer survivors with balance impairment using diffusion tensor tractography. Methods: An open, single-center, prospective study was conducted including two groups—healthy age-matched volunteers (n = 28) and breast cancer survivors (n = 35) with balance impairment. All participants underwent diffusion tensor tractography at baseline and at the end of the follow-up period of six months. Quantitative anisotropy was analyzed using DSI Studio to assess white matter integrity. Results: At baseline, patients with balance impairment exhibited significantly reduced quantitative anisotropy values in the middle cerebellar peduncles (p = 0.046) and cerebellar hemispheres (p = 0.024, 0.055) compared to healthy controls. At the end of the follow-up, quantitative anisotropy values were increased across most tracts, though some differences persisted between groups (p < 0.001). Conclusions: Breast cancer survivors with balance impairment demonstrate sustained microstructural white matter changes, particularly in cerebellar and vestibular pathways. These findings suggest that diffusion tensor tractography can provide valuable insights into central nervous system alterations contributing to post-treatment balance dysfunction and may serve as a potential tool for early diagnosis and rehabilitation planning. Full article

Background/Objectives: Many patients with breast cancer are treated with chemotherapy, including taxanes. These regimens bear a significant risk of potentially burdensome peripheral neuropathy. A scoring system supported by a neuropathy tracker, which can be self-administered by the patients, likely facilitates and speeds up the diagnosis of chemotherapy-induced peripheral neuropathy (CIPN). Before such a scoring system can be used, determination of the optimal cut-off score to discriminate between CIPN and no CIPN is necessary. The prospective NEURO-BREAC trial (NCT07148336) aims to identify the optimal cut-off score in patients treated with chemotherapy and adjuvant irradiation for breast cancer. Methods: The main goal of the NEURO-BREAC trial is to provide the optimal cut-off of a scoring system to discriminate between moderate to severe CIPN and no CIPN in breast cancer survivors previously treated with paclitaxel- or docetaxel-based chemotherapy and irradiation. The scores (0 to 44 points) are obtained by using a neuropathy tracker. This tracker is based on self-evaluation of symptoms and signs of CIPN by study participants. In addition, satisfaction of the patients with the scoring system is assessed. Twenty-four patients (sixteen patients with moderate to severe CIPN and eight patients without CIPN) are required for the Full Analysis Set. Assuming that about 5% of patients will not qualify for this set, 26 patients should be recruited for the NEURO-BREAC trial. The results of this trial are considered an important step for the development of a scoring system contributing to the identification of CIPN in breast cancer patients. Full article

Background: Research on psychological abuse among patients with breast cancer and survivors of breast cancer in Saudi Arabia is scarce. This study aimed to identify psychological abuse and its associated factors among these individuals. Methods: This cross-sectional study included 146 patients with breast cancer and survivors of breast cancer. Data were collected from December 2024 to April 2025 using a modified survey instrument based on the United Nations Economic Commission for Europe violence against women module. An online questionnaire comprised two parts: the first collected demographic characteristics, including age, education, employment, breast cancer diagnosis, and mastectomy duration, and the second assessed psychological abuse via four items: insults, belittlement/humiliation, intimidation, and undermining of relationship stability. The association between psychological abuse and sociodemographic factors was assessed using the chi-square test. Significant associations in bivariate analyses were subsequently analyzed using exploratory logistic regression. Results: Approximately 20.5% of participants reported experiencing at least one form of psychological abuse. The most commonly reported behaviors were insults and undermining of relationship stability (both 20.5%), followed by belittlement/humiliation (17.8%) and intimidation (15.1%). Bivariate analyses indicated a greater incidence of humiliation among women whose spouses were unemployed or retired, as well as among those with more than six children. Logistic analysis indicated that spouse unemployment or retirement (OR = 5.36, 95% CI 1.62–17.74, p = 0.006) and having more than six children (OR = 5.84, 95% CI 1.33–25.55, p = 0.019) were associated with belittlement/humiliation, even after FDR correction. No significant correlations were identified regarding patient age, education, mastectomy status, or duration since diagnosis. Model diagnostics demonstrated a satisfactory fit (Nagelkerke R² = 0.22; accuracy = 82.2%) and a lack of multicollinearity (VIF = 1.00–1.03). Conclusions: Psychological abuse affects around 20% of women diagnosed with breast cancer, especially those with unemployed spouses and larger families. These results highlight the need for psychological screening and couple-based therapies in cancer care to mitigate marital stresses and enhance survivors’ well-being. Full article

Background/Objectives: Breast cancer is one of the most prevalent types of cancer globally and is also the leading cause of death from malignant tumors among women. This study investigated the experiences of women with breast cancer concerning nutritional care. Methods: A qualitative study conducted in San Luis Potosí, Mexico. Ten semi-structured interviews were conducted with women undergoing treatment and with survivors of breast cancer. Data were analyzed using basic grounded theory procedures. Results: Our findings revealed several barriers that hinder adequate nutritional care for women with breast cancer in Mexico. Key barriers include the structure of the health system, misinformation, the implications of the disease in daily life, medical treatment of the disease, the emotional impact, and changes in their perceived identity. The experiences of individuals with any disease, particularly chronic illnesses such as cancer, affect the implementation and follow-up of nutritional therapy. Conclusions: Consideration of these experiences is essential for creating policies and strategies focused on nutritional care that complement the treatment of breast cancer sufferers. Additionally, specialized nutrition personnel should form part of the comprehensive treatment of the disease. Full article

Breast cancer (BC), despite its high survival rate, can cause significant functional sequelae in the scapulohumeral joint after surgery. This study evaluated angular velocity during a lateral reach test, comparing the operated arm with the non-operated arm as a possible indicator of functional asymmetry. This study employed an observational, comparative, cross-sectional design. Twenty-two women voluntarily participated in the study. The anthropometric characteristics were as follows: mean age, 55.95 ± 6.34 years; height, 1.63 ± 0.06 m; body weight, 65.37 ± 11.10 kg; and BMI, 24.73 ± 3.60 kg/m². The participants, who were survivors of breast cancer and had undergone surgery on only one arm, regularly performed physical activity in the Department of Exercise, Education, and Cancer at the University of Murcia, BC. A lateral opening test was performed, measuring the angular velocity in both arms during 15 repetitions using the WIMU PRO™ inertial device. Results showed no significant main effects for arm (p = 0.369) or surgery side (p = 0.587) but a significant interaction (F = 29.44, p = 0.001), with lower velocity in the operated arm both for right-side surgery (right: 100.4 ± 31.1 vs. left: 111.7 ± 32.0 °/s) and left-side surgery (left: 92.1 ± 22.3 vs. right: 100.2 ± 20.2 °/s). Effect sizes were small to moderate (Hedges’ g = 0.35–0.36). This difference may suggest the presence of postoperative functional asymmetries, which may inform future research on therapeutic exercise approaches, though direct clinical applications cannot yet be established. These preliminary findings highlight the feasibility of using inertial devices to assess postoperative functional asymmetry in breast cancer survivors. Full article

Breast cancer associated with BRCA1 and BRCA2 mutations presents unique therapeutic challenges, traditionally favoring mastectomy due to concerns over recurrence and new primaries. However, evolving evidence and advances in multimodal therapy have reshaped this paradigm, positioning breast-conserving surgery (BCS) as a viable option for selected carriers. This narrative review synthesizes current data from meta-analyses, retrospective cohorts, and pivotal studies, including a multicenter analysis which affirmed oncologic equivalence between BCS and mastectomy when combined with radiotherapy and systemic therapy. While meta-analyses confirm higher local events following BCS, survival remains comparable, indicating that recurrence reflects genetic predisposition rather than surgical inadequacy. Optimized systemic treatments, including chemotherapy, endocrine therapy, risk-reducing salpingo-oophorectomy, and PARP inhibitors, further mitigate recurrence risk. Meanwhile, patient-centered outcomes favor BCS: studies consistently link it to improved body image, psychosocial well-being, and quality of life, especially for younger BRCA carriers. Fertility-preserving options remain viable, with evidence supporting the safety of pregnancy, breastfeeding, and assisted reproductive technologies in BRCA-mutated survivors. These findings support individualized surgical planning for BRCA carriers within multidisciplinary care, balancing oncologic safety, systemic strategies, and psychosocial priorities. BCS should be considered a standard option for well-selected patients in hereditary breast cancer management. Full article

Although traditionally contraindicated, the coadministration of tamoxifen and estradiol may hold clinical relevance in specific contexts, particularly in breast cancer survivors with premature menopause and a high risk of osteoporosis, thereby justifying the need to re-evaluate this therapeutic combination. This study presents an innovative physiologically based pharmacokinetic (PBPK) modeling approach to evaluate the coadministration of tamoxifen and estradiol in women with breast cancer and a high risk of osteoporosis. Using GastroPlus^® software, PBPK models were developed and validated for both drugs, based on physicochemical and kinetic data obtained from the literature and, where necessary, supplemented by estimates generated in ADMET Predictor^®. The simulations considered different hormonal profiles (pre and postmenopausal) and therapeutic regimens, evaluating potential interactions mediated by the CYP3A4 enzyme. Analysis of the pharmacokinetic parameters (F, C_max, T_max and AUC) revealed strong agreement between the simulated and experimental values, with prediction errors of less than twofold. The drug interaction studies, carried out in dynamic and stationary modes, indicated that estradiol does not significantly alter the pharmacokinetics of tamoxifen, even at increasing doses or in enlarged virtual populations. These results represent the first in silico evidence that, under certain conditions, the concomitant use of estradiol does not compromise the pharmacokinetic efficacy of tamoxifen. Although the study is computational, it provides a solid scientific basis for re-evaluating this therapeutic combination and proposes a pioneering model for personalized strategies in complex oncological contexts. All simulations assumed average enzyme abundance/activity without CYP polymorphism parameterization; findings are restricted to parent-tamoxifen pharmacokinetics and do not infer metabolite (e.g., endoxifen) exposure or phenotype effects. Full article

Background and Objectives: Resilience and perceived social support are crucial factors influencing psychological well-being among breast cancer survivors. Understanding their levels and interrelations can inform psychosocial interventions aimed at improving survivorship outcomes. This study aimed to examine the relationship between resilience and perceived social support, to evaluate the psychometric properties of the applied scales, and to explore their associations with key sociodemographic factors among breast cancer survivors. Materials and Methods: A total of 193 women in clinical remission, at least six months post-primary treatment, were recruited from the General Hospital Sombor. Participants completed sociodemographic and clinical questionnaires, the Connor–Davidson Resilience Scale (CD-RISC-25), and the Multidimensional Scale of Perceived Social Support (MSPSS). Descriptive statistics, Pearson’s correlations, and group comparisons (t-tests and ANOVA) were conducted to assess the relationships among study variables and sociodemographic factors. Results: Participants demonstrated moderate resilience (57 ± 18), with Coping and Hardiness as the strongest domains and Optimism the lowest. Perceived social support was also moderate (4.65–4.82) across all domains, highest for family and significant others. Resilience and perceived social support were positively correlated (r = 0.616, p < 0.001), with Hardiness most strongly associated with overall resilience (r = 0.899). Support from a significant other was particularly linked to adaptability (r = 0.617). Participants living in urban areas and those with higher income reported significantly higher resilience and social support, though with low effect sizes. No other sociodemographic associations were observed. Conclusions: Breast cancer survivors in this Serbian cohort reported moderate resilience and social support, with a strong interrelationship between the two. These findings underscore the importance of strengthening social support networks as a potential pathway to enhance resilience and psychological well-being in cancer survivorship care. Full article

Background/Objectives: Breast cancer survivors often experience adverse body composition changes and reduced quality of life (QoL) after chemotherapy. This study aimed to assess changes in body composition in postoperative breast cancer patients undergoing chemotherapy and to examine their associations with physical activity and QoL. Methods: This longitudinal observational pilot study included two repeated assessments (after surgery and before the third chemotherapy cycle – six weeks period). Sixty women (mean age 57 ± 10 years) who had undergone breast cancer surgery and were scheduled for chemotherapy were assessed twice: after surgery and prior to the third chemotherapy cycle. Body composition was analyzed using anthropometric and bioelectrical impedance methods. Physical activity was evaluated with the International Physical Activity Questionnaire–Long Form (IPAQ-L), while QoL was measured with the World Health Organization Quality of Life–bref version (WHOQOL-BREF) questionnaire as well. Results: During chemotherapy, participants showed significant increases in body weight (p = 0.001), BMI (p = 0.001), and muscle mass (p = 0.001), with stable fat percentage. Physical activity levels improved overall, particularly in moderate activity (p = 0.001), while sedentary time decreased (p = 0.020). QoL remained generally stable, with significant improvement in the environmental domain (p = 0.028). Higher fat percentage correlated negatively with physical (p = 0.040) and social (p = 0.049) QoL, while BMI correlated inversely with psychological well-being (p = 0.020). Waist-to-hip ratio was also negatively associated with psychological QoL (p = 0.017). Conclusions: Vigorous activity showed an association with more favorable body composition, whereas sedentary behavior correlated with higher BMI and muscle mass. Full article

Background/Objectives: Breast cancer diagnosis in lactating women is relatively uncommon. The term Pregnancy-Associated Breast Cancer (PABC) refers to breast cancer diagnosed during pregnancy or within the first year postpartum. There are several factors that limit the ability to breastfeed. Despite emerging evidence suggesting that breastfeeding may be feasible and should be supported in women with PABC, there is still limited evidence regarding the percentage of them who attempt breastfeeding, and the challenges they may encounter. This study aims to systematically reviewing the literature on the available evidence regarding breastfeeding in women diagnosed with PABC. Methods: PubMed and Scopus were systematically searched for studies on breastfeeding in PABC until 26 June 2025. Data on breastfeeding outcomes and diagnostic challenges in relation to PABC were extracted. The systematic review is registered in PROSPERO (CRD420251043141). Results: A total of 15 studies met the inclusion criteria and were included in this review. The results showed a scarcity of literature regarding the percentage of women with PABC who breastfeed. Existing data revealed that a small percentage successfully breastfeed. A common occurrence throughout the studies was the concern of breastfeeding during cancer treatment. In almost all cases, reduced milk production was reported, along with the co-administration of formula as a substitute for breast milk. Conclusions: Management of women with PABC should not be limited to oncologic treatment but should also encompass structured breastfeeding counseling and multidisciplinary support, ideally within specialized breast cancer centers. Such integrated care has the potential to optimize maternal health outcomes, improve quality of life, and promote a more favorable pregnancy and postpartum experience. Full article