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Objective: To synthesize contemporary evidence of the impact of contralateral prophylactic mastectomy (CPM) on survival outcomes in patients with unilateral breast cancer (UBC). Methods: PubMed, EMBASE and Scopus databases were searched for observational studies published up to November 15, 2023. Random-effects model was used to obtain pooled effect estimates that were reported as hazards ratio (HR) with 95% confidence intervals (CI). The outcomes of interest were overall survival (OS), breast cancer-specific survival (BCSS), recurrence free survival (RFS) and risk of contralateral breast cancer (CBC). Results: Twenty-one studies were included. Most studies had a retrospective design. CPM was associated with significant improvement of OS (HR 0.80, 95% CI: 0.75, 0.85), BCCS (HR 0.82, 95% CI: 0.74, 0.90), and RFS (HR 0.72, 95% CI: 0.60, 0.86) and significantly reduced risk of CBC (HR 0.05, 95% CI: 0.03, 0.09) in patients with UBC. No evidence of publication bias was detected. Conclusion: Our results provide strong evidence supporting the positive impact of CPM on survival outcomes in patients with UBC. Further research and long-term follow-up studies are warranted to validate these findings.

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Background: Breast cancer is among the most prevalent malignancies in women worldwide, with substantial morbidity and mortality. Upper limb lymphedema (ULL) is a common complication after breast cancer surgery that affects patients' daily activities and quality of life. Decongestive lymphatic therapy (DLT) and intermittent pneumatic compression (IPC) therapy are 2 primary treatment methods for ULL. Objectives: This study aimed to compare the efficacy of DLT with IPC versus DLT alone in the management of ULL following breast cancer surgery. Method: PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane Trial Registry, Google Scholar, and Clinicaltrials.gov databases were comprehensively searched for randomized controlled trials (RCTs) comparing DLT with IPC and DLT alone in patients with breast cancer-related ULL. The risk of bias was evaluated using the RoB 2 tool. Pooled effect sizes were calculated using random-effects models. Results: A total of 1,894 citations were identified by the systematic search. Of them, 9 RCTs were included in the analysis. The pooled standardized mean difference (SMD) for percentage volume reduction was 0.63 (95% confidence interval [CI]: -0.24 to 1.50; I 2 = 90.9%), showing no significant difference between the DLT alone and DLT combined with IPC (p = 0.15). Pain and heaviness scores were also comparable between the groups. However, there was a significant difference in external rotation joint mobility (SMD = 0.62; 95% CI: 0.08-1.16; I 2 = 23.8%), favoring DLT with IPC. Conclusions: Our findings suggest that DLT with IPC and DLT alone showed similar findings in managing ULL after breast cancer surgery, with DLT with IPC showing a greater impact on external rotation joint mobility. Healthcare providers should consider patient preferences and individual factors when selecting the most appropriate treatment modality for ULL management.

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This review pooled data from the literature to examine the association between preeclampsia (PE) and subsequent risk of breast cancer in women. Cohort studies published in the databases of PubMed, Embase, Scopus, and Web of Science up to 18 July 2023 were searched. Adjusted data were pooled to obtain the risk ratio (RR). Eleven studies with 15 cohorts and a cumulative sample size of 7,838,693 women were included. Meta-analysis of all studies demonstrated a reduced risk of breast cancer in women with PE as compared to those without PE (RR: 0.89 95% CI: 0.83, 0.95 p < 0.001 I2 = 50%). Follow-up ranged from 8 to 29.2 years. Results did not change during sensitivity analysis. Outcomes varied on subgroup analysis based on location, study type, data extraction method, incidence of breast cancer, and follow-up. To conclude, women with PE may have a reduced risk of breast cancer later in life. However, the risk reduction is minimal and may not have much clinical significance. The evidence is also limited by high inter-study heterogeneity and lack of adjustment of all possible confounders.

Asunto(s)

Neoplasias de la Mama , Preeclampsia , Embarazo , Humanos , Femenino , Preeclampsia/epidemiología , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/prevención & control , Estudios de Cohortes , Incidencia , Conducta de Reducción del Riesgo

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Objective: To assess prognostic nutritional index (PNI) and controlling nutritional status (CONUT) score could predict overall survival (OS) and disease-free survival (DFS) in patients with breast cancer. Methods: PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar were searched from 1st January 2000 to 10th October 2021 for studies assessing the association between PNI or CONUT and outcomes of breast cancer by following the PRISMA guidelines. Keywords used were "Prognostic nutritional index", "Controlling nutritional status", "CONUT", and "Breast cancer". Results: Nine studies were included. On pooled analysis, we noted a statistically significant improved OS in patients with high PNI as compared to low PNI. Meta-analysis revealed no significant difference in DFS between patients with high PNI and low PNI. However, on the exclusion of one study, we noted that high PNI was associated with significantly improved DFS as compared to low PNI. On pooled analysis, we also noted that a high CONUT score was associated with significantly reduced OS in breast cancer patients. Conclusion: Our results indicate that PNI is an important prognostic factor for patients with breast cancer. Pre-treatment low PNI is associated with worse OS and DFS. Scarce data also indicates that a high CONUT score is predictive of poor OS in breast cancer.

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Background: Studies have reported that exercise can effectively improve the quality of life of breast cancer (BC) patients. However, considering the differences in exercise form and intensity, it is difficult to quantify and unify the improved outcomes, and there are contradictions in the conclusions. This meta-analysis aimed to quantitatively evaluate the effects of exercise on the quality of life (QoL) of patients with BC based on the European Organization for Research and Treatment of Cancer QoL Questionnaire-C30 (QLQ-C30) scale, to provide optimization suggestions for the treatment plan of BC survivors. Methods: The literature were extracted from the databases of PubMed, Embase, Cochrane Library, Wanfang, and China National Knowledge Infrastructure. The main outcomes were extracted from the final included literature and chi square tests and I2 statistics were used to evaluate the heterogeneity among the included studies. Statistical analysis was performed by Stata/SE 16.0 software and Review Manager 5.4 software. The funnel plot was used to test for evaluation publication bias. Results: All 8 included articles were original studies. The risk bias evaluation showed that 2 articles had low risk of bias and 6 articles had uncertain risk of bias. The results of meta-analysis revealed the following: (I) exercise significantly improved the overall health status of BC patients [mean difference (Hedges's g) =0.81, 95% confidence interval (CI): 0.27, 1.34]; (II) exercise significantly improved the physiological function of patients (Hedges's g =0.78, 95% CI: 0.34, 1.22), daily life function (Hedges's g =0.45, 95% CI: 0.13, 0.77), emotional function (Hedges's g =0.52, 95% CI: 0.20, 0.84); (III) exercise significantly reduced the fatigue symptoms (Hedges's g =-0.51, 95% CI: -0.84, -0.19), nausea and vomiting symptoms (Hedges's g =-0.35, 95% CI: -0.60, -0.10), insomnia symptoms (Hedges's g =-0.59, 95% CI: -0.91, -0.26), and economic difficulties (Hedges's g =-0.48, 95% CI: -0.78, -0.18) of patients. Conclusions: Exercise can significantly improve the overall physical health and body functions of BC survivors. Exercise can also significantly reduce the symptoms of fatigue, nausea, vomiting, and insomnia in BC patients. Different levels of exercise have significant effects on improving the quality of life of BC survivors, which is worth being widely advocated.