Current Breast Cancer Reports

Wehring, Spencer; Roark, Ashley; Watson, Alfred; Ortiz-Perez, Tamara

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00482-6

Purpose of ReviewMany processes in the male breast are similar to those encountered in female patients, with a few notable differences. While the majority of male breast pathology is benign, a working knowledge of varying imaging presentations of both benign and malignant pathology is necessary to guide appropriate management. The focus of this review is to highlight the classic mammographic and sonographic appearances of benign and malignant pathologies in the male breast.Recent findingsMammography is the initial modality of choice for symptomatic male patients who are 25 years of age or older. In patients younger than 25, however, ultrasound should be performed first. Screening mammography for the general male population is not currently widely recommended due to the low prevalence of breast cancer in men. Additionally, although no current guidelines exist regarding the utilization of breast magnetic resonance imaging (MRI) in men, it can be used as an adjunct imaging modality for treatment planning in patients with breast cancer.SummaryMammography and ultrasound are the mainstay imaging modalities for evaluating the symptomatic male breast. Core needle biopsy can be performed in cases of suspicious findings.

Sellers, Cortlandt M.; Ortiz-Perez, Tamara; Dhamne, Sagar; Roark, Ashley; Gilman, Luke

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00484-4

Purpose of ReviewMetastases to the breast (intramammary metastases, IM) from extramammary malignancies (EM) are uncommon. As prognosis is poor, timely diagnosis is key to direct patients towards appropriate treatment. We will review recent literature regarding the epidemiology, presentation, and diagnosis of IM.Recent FindingsIM commonly present as palpable masses, with imaging findings often based on hematogenous versus lymphatic spread. While many IM are diagnosed with a history of EM, IM may also be the first presentation of distant metastatic disease. In most cases, immunohistochemical testing is required to differentiate between primary breast cancer (PBC) and IM.SummaryRecent research, focused on immunohistochemical markers, can guide diagnosticians in differentiating IM from PBCs. Key factors to consider when diagnosing any breast mass include a prior history of cancer, imaging characteristics, histologic findings that are atypical for PBCs, and the immunohistochemical profile of each lesion.

De Jesus, Charles; Moseley, Tanya W.; Diaz, Valentina; Vishwanath, Varnita; Jean, Shanen; Elhatw, Ahmed; Ferreira Dalla Pria, Hanna R.; Chung, Hannah L.; Guirguis, Mary S.; Patel, Miral M.

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00481-7

Purpose of ReviewIncreased breast density, among other calculated risk factors, decreases the sensitivity of screening mammography. Several supplementary imaging modalities including breast ultrasound, breast MRI, contrast-enhanced mammography (CEM), and molecular breast imaging (MBI) can be used in addition to screening mammograms to increase the sensitivity of cancer detection in above-average-risk women and will be discussed here.Recent FindingsUltrasound is the most widely used and accessible supplementary screening method that improves the cancer detection rate. MRI, the most sensitive supplemental breast imaging modality, is used to detect and visualize additional cancers in those with a lifetime risk of breast cancer at or greater than 20%. Small studies indicate that CEM has cancer detection rates equivalent to MRI; nevertheless, more evidence is needed to demonstrate its use. MBI has shown promise to be an adjunct to mammography for patients with dense breasts and for situations in which breast MRI is contraindicated. Despite this promising research, the American College of Radiology currently does not recommend the use of MBI for screening.SummaryIn women who have a higher-than-average risk of developing breast cancer, additional imaging modalities, such as breast ultrasound, breast magnetic resonance imaging, contrast-enhanced mammography, and molecular breast imaging, can be used in conjunction with screening mammograms to increase the sensitivity of cancer detection.

De Jesus, Charles; Moseley, Tanya W.; Diaz, Valentina; Vishwanath, Varnita; Jean, Shanen; Elhatw, Ahmed; Pria, Hanna R. Ferreira Dalla; Chung, Hannah L.; Guirguis, Mary S.; Patel, Miral M.

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00479-1

Purpose of ReviewBreast cancer is the most commonly diagnosed cancer worldwide. Early detection through screening mammography has been proven to reduce mortality, morbidity, and years of life lost. The purpose of this review is to discuss the benefits of screening mammography and the latest recommendations from the American College of Radiology (ACR).Recent FindingsApproximately 300,000 new cases of breast cancer are diagnosed in the USA yearly. Screening mammography has allowed for early cancer detection with increasing efficacy leading to 500 prevented deaths for every 100,000 women screened and a 5-year survival rate of 91%.SummaryMammography screening promotes the earlier detection of breast cancer, hence minimizing mortality, years of life lost, and treatment morbidity associated with advanced breast cancer at the time of diagnosis.

Elhatw, Ahmed; Chung, Hannah L.; Kamal, Rasha M.; De Jesus, Charles; Jean, Shanen; Vishwanath, Varnita; Ferreira Dalla Pria, Hanna R.; Patel, Miral M.; Guirguis, Mary S.; Moseley, Tanya W.

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00483-5

Purpose of ReviewTo discuss how advanced breast imaging modalities can supplement standard breast imaging with mammography, ultrasound, and MRI.Recent FindingsFor the last 40–50 years, the primary breast cancer screening examination has been mammography which has undergone many changes from xeromammography, film-screen analog, to digital mammography techniques. Digital breast tomosynthesis (DBT) and contrast-enhanced mammography (CEM) are the most recent advances to digital mammography. Molecular breast imaging (MBI) and positron emission mammography (PEM) are nuclear medicine breast examinations that utilize mammographic positioning and are useful supplements to standard breast imaging examination.SummaryAdvances in mammographic techniques have improved the sensitivity and specificity of mammography in detecting breast cancer, demonstrating the extent of disease, and evaluating the response to systemic treatments. Understanding how advanced mammographic techniques fit in with other available breast imaging examinations helps ensure optimal evaluation to help guide treatment decisions.

Jean, Shanen; Vishwanath, Varnita; Chung, Hannah L.; Moseley, Tanya W.

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00480-8pmid: 37293273

Purpose of ReviewThe purpose of this review is to discuss disparities in breast health care access and outcomes related to race, gender, cultural diversity, sexual orientation, socioeconomic status, geographic location, and disability. The authors recognize the complexity of eliminating inequalities in health care but are optimistic that all patients will one day have equal access to care through dialogue, acknowledgment, recognition, and action.Recent FindingsAfter lung cancer, breast cancer is the second leading cause of death among American women. Mammography as a preventative screening tool has resulted in significant reductions in breast cancer mortality. Despite existing breast cancer recommendations, it has been projected that 43,250 women will die from breast cancer in 2022.SummaryDisparities in healthcare outcomes exist for many reasons including inequalities based on race, gender, cultural diversity, religion, sexual orientation, and socioeconomic status. Disparities, no matter how large or complex, are not insurmountable.

Chung, Hannah L.; Joiner, Jana; Ferreira Dalla Pria, Hanna R.; Jean, Shanen; Vishwanath, Varnita; De Jesus, Charles; Elhatw, Ahmed; Guirguis, Mary S.; Patel, Miral M.; Moseley, Tanya W.

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00485-3

Purpose of ReviewBenign and malignant breast diseases in young, pregnant and lactating women including pregnancy associated breast cancers will be reviewed.Recent FindingsCompared to breast cancer in older women, poor prognostic indicators such as high nuclear grade, high Ki67 proliferation, estrogen receptor (ER) negativity, and overexpression of human epidermal growth factor 2 (HER2) may be present in young women. Even among ER + /HER2 cancers, young patients have a poorer prognosis. For pregnant women, the timing of care may be personalized based on gestational age, tumor subtype, clinical stage, and family planning considerations, including induction of labor and preservation of fertility for future pregnancies. Neoadjuvant chemotherapy can be safely administered during the second and third trimesters, and if necessary, radiation therapy can be given after birth.SummarySymptomatic concerns warrant prompt imaging evaluation with biopsy to distinguish benign from malignant causes of breast disease in young, pregnant, and lactating women.

Park, Ko Un; Cha, Chihwan; Pozzi, Giada; Kang, Young-Joon; Gregorc, Vanesa; Sapino, Anna; Gazzetta, Guglielmo; Marrazzo, Emilia; Toesca, Antonio

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00487-1pmid: 37293274

Purpose of reviewThe purpose of this review is to summarize the recent technical advancements in RNSM, describe the ongoing teaching programs, and discuss the ongoing controversies.Recent findingsRobot-assisted nipple sparing mastectomy (RNSM) is the newest addition to the armamentarium of surgical techniques for patients who require a mastectomy. The potential benefits of using the da Vinci® Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA) are the small 3D camera and lighting offering superior visualization, the Endowrist robotic instruments offering greater range of motion, and surgeon being at a seated position at the console rendering a more ergonomic operating position.SummaryRNSM can potentially help overcome the technical difficulties of performing a conventional NSM. Further studies are needed to elucidate the oncologic safety and cost-effectiveness of RNSM.

Thaper, Arushi; Tran, Jennifer; Ali, Azka

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00486-2

Purpose of ReviewApproximately 1 in 5 breast cancers over-express human epidermal growth factor receptor 2 (HER2). In this review, we discuss the changing landscape of treatments for early and metastatic HER2 breast cancers, new therapies for HER2-low breast cancers, and future investigational directions of HER2-driven disease.Recent FindingsHistorically, HER2 breast cancers have been treated with anti-HER2-targeted therapies in combination with chemotherapy. Recently, clinical trials have established antibody–drug conjugates (ADCs) as an effective additional line of therapy. Previously, patients with HER2-low breast cancers did not derive significant benefit from traditional HER2-directed therapies. However, the treatment paradigm for HER2-low disease has rapidly changed with noted efficacy of fam-trastuzumab deruxtecan in this population.SummaryIn this review, we outline key historical and recent clinical trials that have shaped HER2 breast cancer management. Active investigation is ongoing to identify and understand mechanisms of resistance.

Das, Diganta; Iyer, Mukund; Roussos Torres, Evanthia T.; Chow, Frances E.; Neman, Josh

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00488-0

Purpose of ReviewBrain metastasis is a significant cause of mortality in breast cancer patients and treatment options are limited. This article will focus on the dynamic intercellular communication between metastatic cancer cells, the tumor microenvironment, and neighboring brain cells to breach the brain’s defenses and promote tumor progression.Recent FindingsRecent advances have further elucidated how tumor cells traverse through the blood–brain barrier and implicated the blood–cerebrospinal fluid barrier as a potential entry point. Tumor cells once within the brain milieu utilize factors secreted by and dynamically reprogram neurons, glial cells, and infiltrating leukocytes for their own colonization and survival.SummaryCurrent research has illuminated key mechanisms metastatic breast cancer cells utilize to infiltrate the brain and assimilate in their new environment. New multimodal treatments are investigating not only chemotherapy and radiation that can target metastatic tumor cells, but also immune checkpoint inhibitor–based therapies to sensitize the immune microenvironment.