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Tauber N, Amann N, Dannehl D, Deutsch TM, Dimpfl M, Fasching P, Hartkopf A, Heublein S, Hilmer L, Hörner M, Krawczyk N, Krückel A, Krug D, Marmé F, Michel LL, Reinisch M, Rody A, Schäffler H, Schneeweiss A, Utz D, Veselinovic K, Banys-Paluchowski M. Therapy of early breast cancer: current status and perspectives. Arch Gynecol Obstet 2025:10.1007/s00404-025-08028-0. [PMID: 40261372 DOI: 10.1007/s00404-025-08028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Accepted: 04/01/2025] [Indexed: 04/24/2025]
Abstract
Medical advancements in breast cancer are truly remarkable. Especially in recent years, numerous new therapeutics have been approved and surgical strategies have been de-escalated for specific patient groups. In the therapeutic setting, CDK4/6 inhibitors as oral maintenance therapy in early breast cancer and immune checkpoint inhibitors (Pembrolizumab) for triple-negative breast cancer (BC) are noteworthy. In the surgical field, prospective randomized controlled trials have currently explored the possibility to deescalate axillary surgery by omitting sentinel lymph node excision (INSEMA, SOUND). As a result, there have been significant improvements in prognosis and a reduction in surgical morbidity for patients. Many exciting trials are underway, and it remains to be seen whether antibody-drug conjugates beyond trastuzumab emtansine, will find their way into the treatment lines for early-stage BC. Furthermore, the integration of artificial intelligence in both diagnostics and treatment recommendation evaluation is a promising area with great potential.
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Affiliation(s)
- Nikolas Tauber
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
| | - Niklas Amann
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Dominik Dannehl
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, 72016, Tuebingen, Germany
| | - Thomas M Deutsch
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Moritz Dimpfl
- Department of Obstetrics and Gynecology, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Deutschland
| | - Peter Fasching
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Andreas Hartkopf
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, 72016, Tuebingen, Germany
| | - Sabine Heublein
- Department of Obstetrics and Gynecology, University Hospital Ulm, 89075, Ulm, Germany
| | - Lisbeth Hilmer
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Manuel Hörner
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Natalia Krawczyk
- Department of Obstetrics and Gynecology, University Hospital Duesseldorf, 40225, Duesseldorf, Germany
| | - Annika Krückel
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - David Krug
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frederik Marmé
- Department of Obstetrics and Gynecology, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Deutschland
| | - Laura L Michel
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center Heidelberg, 69120, Heidelberg, Germany
| | - Mattea Reinisch
- Department of Obstetrics and Gynecology, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Deutschland
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Henning Schäffler
- Department of Obstetrics and Gynecology, University Hospital Ulm, 89075, Ulm, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center Heidelberg, 69120, Heidelberg, Germany
- German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - David Utz
- Department of Internal Medicine VIII, Medical Oncology and Pneumology, University Hospital Tuebingen, 72016, Tuebingen, Germany
| | - Kristina Veselinovic
- Department of Obstetrics and Gynecology, University Hospital Ulm, 89075, Ulm, Germany
| | - Maggie Banys-Paluchowski
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Ebner F, de Gregorio N, Rempen A, Mohr P, de Gregorio A, Wöckel A, Janni W, Witucki G. To clip or not to clip the breast tumor bed? A retrospective look at the geographic miss index and normal tissue index of 110 patients with breast cancer. J Turk Ger Gynecol Assoc 2017; 18:67-71. [PMID: 28400348 PMCID: PMC5458438 DOI: 10.4274/jtgga.2016.0222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/16/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Planning of breast radiation for patients with breast conserving surgery often relies on clinical markers such as scars. Lately, surgical clips have been used to identify the tumor location. The purpose of this study was to evaluate the geographic miss index (GMI) and the normal tissue index (NTI) for the electron boost in breast cancer treatment plans with and without surgical clips. MATERIAL AND METHODS A retrospective descriptive study of 110 consecutive post-surgical patients who underwent breast-conserving treatment in early breast cancer, in which the clinical treatment field with the radiologic (clipped) field were compared and GMI/NTI for the electron boost were calculated respectively. RESULTS The average clinical field was 100 mm (range, 100-120 mm) and the clipped field was 90 mm (range, 80-100 mm). The average GMI was 11.3% (range, 0-44%), and the average NTI was 27.5% (range, 0-54%). The GMI and NTI were reduced through the use of intra-surgically placed clips. CONCLUSION The impact of local tumor control on the survival of patients with breast cancer is also influenced by the precision of radiotherapy. Additionally, patients demand an appealing cosmetic result. This makes "clinical" markers such as scars unreliable for radiotherapy planning. A simple way of identifying the tissue at risk is by intra-surgical clipping of the tumor bed. Our results show that the use of surgical clips can reduce the diameter of the radiotherapy field and increase the accuracy of radiotherapy planning. With the placement of surgical clips, more tissue at risk is included in the radiotherapy field. Less normal tissue receives radiotherapy with the use of surgical clips.
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Affiliation(s)
- Florian Ebner
- Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany
| | | | - Andreas Rempen
- Department of Obstetrics and Gynecology, Diakonie-Klinikum Schwäbisch Hall, Women’s Clinic with Breast Center and Genital Cancer Center, Schwäbisch Hall, Germany
| | - Peter Mohr
- Department of Radiotherapy, Diakonie-Klinikum Schwäbisch Hall, Schwäbisch Hall, Germany
| | - Amelie de Gregorio
- Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany
| | - Achim Wöckel
- University of Würzburg Head of Department Prof. A. Wöckel Women’s Clinic and Polyclinic, Würzburg, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany
| | - Gerlo Witucki
- Department of Radiotherapy, Diakonie-Klinikum Schwäbisch Hall, Schwäbisch Hall, Germany
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Caponio R, Ciliberti MP, Graziano G, Necchia R, Scognamillo G, Pascali A, Bonaduce S, Milella A, Matichecchia G, Cristofaro C, Di Fatta D, Tamborra P, Lioce M. Waiting time for radiation therapy after breast-conserving surgery in early breast cancer: a retrospective analysis of local relapse and distant metastases in 615 patients. Eur J Med Res 2016; 21:32. [PMID: 27514645 PMCID: PMC4982229 DOI: 10.1186/s40001-016-0226-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 01/25/2016] [Indexed: 12/12/2022] Open
Abstract
Background Postoperative radiotherapy after breast-conserving surgery (BCS) is the standard in the management of breast cancer. The optimal timing for starting postoperative radiation therapy has not yet been well defined. In this study, we aimed to evaluate if the time interval between BCS and postoperative radiotherapy is related to the incidence of local and distant relapse in women with early node-negative breast cancer not receiving chemotherapy. Methods We retrospectively analyzed clinical data concerning 615 women treated from 1984 to 2010, divided into three groups according to the timing of radiotherapy: ≤60, 61–120, and >120 days. To estimate the presence of imbalanced distribution of prognostic and treatment factors among the three groups, the χ2 test or the Fisher exact test were performed. Local relapse-free survival, distant metastasis-free survival (DMFS), and disease-free survival (DFS) were estimated with the Kaplan–Meier method, and multivariate Cox regression was used to test for the independent effect of timing of RT after adjusting for known confounding factors. The median follow-up time was 65.8 months. Results Differences in distribution of age, type of hormone therapy, and year of diagnosis were statistically significant. At 15-year follow-up, we failed to detect a significant correlation between time interval and the risk of local relapse (p = 0.09) both at the univariate and the multivariate analysis. The DMFS and the DFS univariate analysis showed a decreased outcome when radiotherapy was started early (p = 0.041 and p = 0.046), but this was not confirmed at the multivariate analysis (p = 0.406 and p = 0.102, respectively). Conclusions Our results show that no correlation exists between the timing of postoperative radiotherapy and the risk of local relapse or distant metastasis development in a particular subgroup of women with node-negative early breast cancer.
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Affiliation(s)
- Raffaella Caponio
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
| | - Maria Paola Ciliberti
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy
| | - Giusi Graziano
- Direzione Scientifica, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Rocco Necchia
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy
| | - Giovanni Scognamillo
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy
| | - Antonio Pascali
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy
| | - Sabino Bonaduce
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy
| | - Anna Milella
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy
| | - Gabriele Matichecchia
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy
| | - Cristian Cristofaro
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy
| | - Davide Di Fatta
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy
| | - Pasquale Tamborra
- U.O. Fisica Sanitaria, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Marco Lioce
- U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy
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Bodilsen A, Offersen BV, Christiansen P, Overgaard J. Pattern of relapse after breast conserving therapy, a study of 1519 early breast cancer patients treated in the Central Region of Denmark 2000-2009. Acta Oncol 2016; 55:964-9. [PMID: 27152670 DOI: 10.3109/0284186x.2016.1167955] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The continuous improvements in diagnosing and treatment of breast cancer are reflected in the ever changing pattern of recurrence. The aim of the study was to investigating recurrence pattern and prognostic factors of recurrence in a population-based cohort. MATERIAL AND METHOD In total 1519 consecutive patients treated with breast conserving therapy (BCT) for invasive carcinoma between 2000 and 2009 in the Central Region of Denmark was included. Patients received adjuvant irradiation and systemic treatment according to the guidelines of the Danish Breast Cancer Cooperative Group, including boost for young women and those with a narrow margin. RESULTS Median follow-up was 5.3 years (range 0.3-14.4). In total 183 women experienced breast cancer recurrence, 44 ipsilateral breast cancer recurrence, 13 regional recurrences, and 126 distant metastasis (DM). This corresponds to a cumulative risk of DM as first event at five and nine years of 6.5% and 12.6%, respectively. Further 42 women developed breast cancer in the contralateral breast. Disease-free survival (DFS) at five and nine years was 88% and 76%, respectively. Large tumor size (>20 mm), lymph node involvement, and vascular invasion were significantly associated with increased risk of DM. Margin width and age were not associated with risk of DM. CONCLUSION Acceptable recurrence rates and DFS were observed. Patients with large tumors, lymph node involvement, and vascular invasion had an increased risk of DM.
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Affiliation(s)
- Anne Bodilsen
- Department of Breast and Endocrine Surgery, Aarhus University Hospital, Denmark
| | | | - Peer Christiansen
- Breast Surgery Unit, Aarhus University Hospital/Randers Regional Hospital, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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Ventura F, Koinberg I, Karlsson P, Sawatzky R, Öhlén J. Purposeful Agency in Support Seeking During Cancer Treatment From a Person-Centered Perspective. Glob Qual Nurs Res 2016; 3:2333393616630672. [PMID: 28462327 PMCID: PMC5287323 DOI: 10.1177/2333393616630672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 12/31/2015] [Accepted: 01/07/2016] [Indexed: 11/15/2022] Open
Abstract
People diagnosed with early-stage breast cancer (ESBC) manifest high supportive needs. eHealth supportive programs successfully satisfy those needs, but the process of generating supportive outcomes is less understood. We conducted this study to explore patients' efforts to satisfy their supportive needs throughout the treatment course, not limited to but particularly considering their use of the Internet. Guided by interpretive description, 19 women undergoing treatment for ESBC participated in two phases of focus group meetings. Our results disclose women as self-driven resourceful agents, a perspective that underlay the process of reaching out as women appraised their need for support and intentionally engaged their supportive resources. Our findings convey a need to shift the paradigm of professionals' provision of support in scheduled appointments toward achieving a continuous reciprocal care partnership. This is especially significant for the development of eHealth supportive programs, which assist in the enhancement of the health care accessibility.
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Affiliation(s)
- Filipa Ventura
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingalill Koinberg
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Richard Sawatzky
- Trinity Western University, Langley, British Columbia, Canada.,Centre for Health Evaluation & Outcome Sciences, Vancouver, British Columbia, Canada
| | - Joakim Öhlén
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Ersta Sköndal University College, Stockholm, Sweden
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CEA in breast ductal secretions as a promising biomarker for the diagnosis of breast cancer: a systematic review and meta-analysis. Breast Cancer 2016; 23:813-819. [PMID: 26898373 DOI: 10.1007/s12282-016-0680-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 02/14/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Other studies have shown that levels of carcinoembryonic antigen (CEA) in breast ductal secretions (BDS) differ significantly between breast cancer (BC) patients and healthy individuals, providing direct evidence for CEA in BDS as a promising biomarker for BC. This meta-analysis was designed to assess the potential diagnostic value of CEA in BDS. METHODS Relevant articles were retrieved from Embase, Pubmed, and the Cochrane Library. Sensitivity, specificity, and diagnostic odds ratio (DOR) of CEA in BDS for diagnosing BC were pooled using random effects models. SROC and the area under the curve (AUC) were used to estimate overall diagnostic performance. RESULTS This meta-analysis comprised five studies with a total of 340 BC patients and 448 healthy controls. For CEA in BDS, the pooled sensitivity, specificity, and DOR to diagnose BC were 58 % [95 % confidence interval (CI): 52-63 %], 87 % (95 % CI: 84-90 %), and 7.07 (95 % CI: 3.10-16.12), respectively. Moreover, the AUC of CEA in the diagnosis of BC was 0.8570. CONCLUSIONS CEA in BDS is a promising biomarker in the diagnosis of BC and should be evaluated as a standard screening tool upon verification of our results in a larger study population.
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von Au A, Weiler U, Stefanovic S, Wallwiener M, Heil J, Golatta M, Rom J, Sohn C, Schneeweiss A, Schuetz F, Domschke C. Breast cancer presentation and therapy in migrant versus native German patients: contrasting and convergent data of a retrospective monocentric study. Arch Gynecol Obstet 2015; 294:145-52. [DOI: 10.1007/s00404-015-3938-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
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Jueckstock J, Kasch F, Jaeger B, Schramm A, Janni W, Scholz C. Adjuvant therapeutic decisions in elderly breast cancer patients: the role of chemotherapy in a retrospective analysis. Arch Gynecol Obstet 2015; 292:1101-7. [DOI: 10.1007/s00404-015-3728-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 04/20/2015] [Indexed: 12/29/2022]
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Kolacinska A, Morawiec J, Pawlowska Z, Szemraj J, Szymanska B, Malachowska B, Morawiec Z, Morawiec-Sztandera A, Pakula L, Kubiak R, Zawlik I. Association of microRNA-93, 190, 200b and receptor status in core biopsies from stage III breast cancer patients. DNA Cell Biol 2014; 33:624-9. [PMID: 24865188 PMCID: PMC4144366 DOI: 10.1089/dna.2014.2419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 04/15/2014] [Accepted: 04/17/2014] [Indexed: 12/23/2022] Open
Abstract
Oncologists now favor more personalized treatment strategies in breast cancer patients. Gene expression analysis has been widely used, but less is known about epigenetic factors, for example, microRNAs (miRNAs). The aim of this study was to determine the relationship between selected miRNAs and receptor status in core biopsies sampled before preoperative chemotherapy in stage III locally advanced breast cancer (LABC) patients. In 37 LABC core biopsies, three miRNAs per sample were analyzed: hsa-miR-93-5p, hsa-miR-190a, and hsa-miR-200b-3p, and hsa-miR-103a-3p as an endogenous control (TaqMan(®) RT-PCR; Applied Biosystems). Receptor status was determined by a dedicated pathologist. The Mann-Whitney U, Shapiro-Wilk, and Levene's tests were used to compare related samples. Levels of miRNA-93 differed significantly in core biopsies of LABC patients with different expressions of ER (estrogen receptor) and PR (progesterone receptor). Higher levels of miRNA-93 were found in ER-negative (p=0.0027) and PR-negative patients (p=0.0185). Levels of miRNA-190 and 200b did not differ significantly in core biopsies of LABC patients who expressed ER and PR differently (p=0.7727, p=0.9434, p=0.6213, and p=0.1717). Levels of miRNA-93, 190, and 200b were not significantly different in core biopsies of LABC patients with different HER2 (human epidermal growth factor 2) expressions (p=0.8013, p=0.2609, and p=0.3222). The assessment of core biopsy miRNA profiles and receptor-based subtypes may identify new signaling pathways for improved breast cancer classification.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Large-Core Needle
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Case-Control Studies
- Female
- Gene Expression
- Humans
- Mammary Glands, Human/metabolism
- Mammary Glands, Human/pathology
- MicroRNAs/genetics
- MicroRNAs/metabolism
- Middle Aged
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
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Affiliation(s)
- Agnieszka Kolacinska
- Department of Surgical Oncology, Cancer Center, Lodz, Poland
- Department of Head and Neck Cancer Surgery, Medical University of Lodz, Lodz, Poland
| | - Jan Morawiec
- Department of Surgical Oncology, Cancer Center, Lodz, Poland
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Zofia Pawlowska
- Central Laboratory, Medical University of Lodz, Lodz, Poland
| | - Janusz Szemraj
- Department of Medical Biochemistry, Medical University of Lodz, Lodz, Poland
| | | | - Beata Malachowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | | | | | - Lukasz Pakula
- Department of Anesthesiology, Copernicus Memorial Hospital, Lodz, Poland
| | - Robert Kubiak
- Department of Cancer Pathology, Medical University of Lodz, Lodz, Poland
| | - Izabela Zawlik
- Department of Medical Genetics, Institute of Nursing and Health Sciences, Medical Department, University of Rzeszow, Rzeszow, Poland
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