High expression of claudin-7 and low expression of c-kit and protein p63 are associated with higher tumour grade. AR and CK5/6 expression seem to be important in LVI.

SUMMARY Male breast cancer (MBC) accounts for <1% of mammary neoplasia and because of its rarity, diagnosis and treatment is based on breast cancer in women. The PubMed database was searched for all English language articles from 1993 to May 2012. Search terms included: male breast cancer, diagnosis, treatment and management. Although rare, MBC incidence is rising. Risk factors include hormonal imbalance, Klinefelter’s syndrome, exposure to radiation and BRCA2 mutations. Clinical evaluation combined with fine-needle aspiration/core biopsy usually suffices for diagnosis, but mammography can be helpful. Modified radical mastectomy was the standard treatment; total mastectomy and sentinel node biopsy is now the treatment of choice in node-negative cases. Tamoxifen is the mainstay of adjuvant hormonal therapy, but a role for aromatase inhibitors is emerging. Given the low incidence of MBC, worldwide studies are needed to improve management and prognosis.

Correct diagnosis and treatment are crucial for DCIS because it is a direct precursor of potentially lethal invasive breast cancer (IBC). As a result of mammographic screening, the incidence of DCIS rose from 1.87% per 100,000 women from 1973-1975 to 32.5% per 100,000 in 2005. The incidence of DCIS is strongly associated with advanced age, an older age at the time of the first birth or nulliparity, family history of a first-degree relative with BC, BRCA1 and BRCA2 mutation carriers, history of biopsy, late age at menopause, and elevated body mass index, the use of HRT over 5 years. With the use of screening mammography, eight population-based trials showed an increase in DCIS incidence reaching 20% with significant reductions in breast cancer mortality. MRI is also used in combination with the mammography for the diagnosis of DCIS. Three grades of DCIS are ultimately recognized: grade 1/low grade, grade 2/intermediate grade, and grade 3/high grade. Several options are available for the management of DCIS, including breast-conserving surgery, with or without postoperative radiotherapy, and with the clear margin being the most important factor for reducing risk of local recurrence. A 2 mm margin is superior to <2 mm, but there was no significant difference in relapse rate in those with margins of 2 or 5 mm when combined with radiotherapy. The use of mastectomy for treatment of DCIS has declined steadily. Sentinel lymph node biopsy (SLNB) should be performed on patients undergoing mastectomy for DCIS, and a case-by-case decision should be made to perform SLNB in patients who have a high risk DCIS or large tumours. Prospective and retrospective studies have demonstrated excellent long-term results after BCS and radiotherapy, as opposed to BCS alone that has shown a higher rate of local recurrence. Tamoxifen also reduces ipsilateral and contralateral breast cancer events in women with DCIS and is the only systemic therapy approved by Food Drug Administration for this disease. Aromatase inhibitors and other targeted therapies are currently being evaluated in ongoing studies.

Purpose The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources. Methods This multicentre, multinational cohort study recruited 6045 patients from the UK, Spain and Portugal during the peak pandemic period (Feb–July 2020). Patients on BrET were followed up to investigate the duration of, and response to, BrET. This included changes in tumour size to reflect downstaging potential, and changes in cellular proliferation (Ki67), as a marker of prognosis. Results 1094 patients were prescribed BrET, over a median period of 53 days (IQR 32–81 days). The majority of patients (95.6%) had strong ER expression (Allred score 7–8/8). Very few patients required expedited surgery, due to lack of response (1.2%) or due to lack of tolerance/compliance (0.8%). There were small reductions in median tumour size after 3 months’ treatment duration; median of 4 mm [IQR − 20, 4]. In a small subset of patients (n = 47), a drop in cellular proliferation (Ki67) occurred in 26 patients (55%), from high (Ki67 ≥ 10%) to low (< 10%), with at least one month’s duration of BrET. Discussion This study describes real-world usage of pre-operative endocrine therapy as necessitated by the pandemic. BrET was found to be tolerable and safe. The data support short-term (≤ 3 months) usage of pre-operative endocrine therapy. Longer-term use should be investigated in future trials.

The relationship between breast cancer (BC) and inflammation remains unclear.Several well-established risk factors for BC, such as advancing age, obesity and late age of first pregnancy, are associated with increased levels of circulating proinflammatory cytokines and systemic inflammation.Tumor-associated macrophages may comprise 50% of the breast tumor mass and the extent of infiltration is associated with increased angiogenesis and poor prognosis.T-lymphocyte infiltration into invasive breast carcinoma is associated with extensive and higher-grade ductal carcinoma in situ and invasive carcinoma.Acute activation of B cells has an anticancer role; controversially, some studies suggest that B-lymphocytic infiltration may play a role in tumor progression.Myleoid-derived suppressor cells may contribute to tumor-induced bone disease. The prognostic value of breast tumor infiltration with mature dendritic cells in BC is limited.Increased levels of IL-6, IL-1b and TNF-a are associated with poorer prognosis.CLL5 and CLL2 chemokines are associated with advanced tumor growth and metastases.Major anti-inflammatory cytokines, such as IL-4, IL-10, IL-13, IL-35 and COX-2, have been found to be associated with aggressive BC, including larger tumor size and higher grade.A meta-analysis of 38 studies showed that the use of nonsteroidal anti-inflammatory drugs leads to a reduced risk of BC.NF-kB activity has been associated with estrogen receptor-negative tumors and a more aggressive phenotype in estrogen receptor-positive tumors.