Breast cancer arises as a result of multiple interactions between environmental and genetic factors. Conventionally, breast cancer is treated based on histopathological and clinical features. DNA technologies like the human genome microarray are now partially integrated into clinical practice and are used for developing new “personalized medicines” and “pharmacogenetics” for improving the efficiency and safety of cancer medications. We investigated the effects of four established therapies—for ER+ ductal breast cancer—on the differential gene expression. The therapies included single agent tamoxifen, two-agent docetaxel and capecitabine, or combined three-agents CAF (cyclophosphamide, doxorubicin, and fluorouracil) and CMF (cyclophosphamide, methotrexate, and fluorouracil). Genevestigator 8.1.0 was used to compare five datasets from patients with infiltrating ductal carcinoma, untreated or treated with selected drugs, to those from the healthy control. We identified 74 differentially expressed genes involved in three pathways, i.e., apoptosis (extrinsic and intrinsic), oxidative signaling, and PI3K/Akt signaling. The treatments affected the expression of apoptotic genes ( TNFRSF10B [ TRAIL ], FAS , CASP3/6/7/8 , PMAIP1 [ NOXA ], BNIP3L , BNIP3 , BCL2A1 , and BCL2 ), the oxidative stress-related genes ( NOX4 , XDH , MAOA , GSR , GPX3 , and SOD3 ), and the PI3K/Akt pathway gene ( ERBB2 [ HER2 ]). Breast cancer treatments are complex with varying drug responses and efficacy among patients. This necessitates identifying novel biomarkers for predicting the drug response, using available data and new technologies. GSR , NOX4 , CASP3 , and ERBB2 are potential biomarkers for predicting the treatment response in primary ER+ ductal breast carcinoma.

Atypical ductal hyperplasia (ADH) is considered a benign lesion with increased malignant potential. ADH represents ~3% of total benign breast biopsy results. A 60-year-old woman with no family history of breast cancer presented with multiple painless lumps in the right breast and palpable right axillary lymph nodes. Ultrasonography and mammography showed typical features of breast cancer. However, core needle biopsy revealed ADH without infiltrating malignancy. Based on a multidisciplinary decision, a right simple mastectomy with sentinel lymph node biopsy was chosen as the best treatment plan. The postoperative histopathology report showed the spread of ductal carcinoma in situ (DCIS) in all quadrants without any evidence of invasive cancer. It is challenging to obtain an accurate diagnosis of clinically palpable and multicentric ADH or DCIS based on preoperative radiological and histological evaluation, especially when dissonance between these two evaluation modalities exists.

Background: The COVID-19 pandemic has significantly impacted the health-care system worldwide, and physicians face challenges in clinical practice, especially in managing cancer patients. This study aimed to assess the impact of COVID-19 on physicians managing breast cancer patients in Saudi Arabia.Methods: A cross-sectional study was conducted from May to October 2020 among physicians practicing in Saudi Arabia, using an online-based survey. The questionnaire included items on physicians’ sociodemographic, barriers faced with breast cancer patients, concerns about and satisfaction with breast cancer patients’ management, and treatment protocols they follow.Results: A total of 317 physicians participated in this study. Most of them faced difficulties in their work with breast cancer patients during this pandemic, and 77.3% reported that they diagnosed at least one breast cancer case. Many patients missed chemotherapy sessions, and half of the centres indicated that more than 10% of their patients missed at least one session. 83% of the physicians were satisfied with the way they managed breast cancer patients, and 73% follow a specific protocol in managing breast cancer patients.Conclusions: The study’s findings show that the active COVID-19 pandemic led to a more stressful situation among physicians, which has affected management of breast cancer patients. COVID-19 is reshaping the delivery of not only breast cancer care but also general oncology practice. Currently, due to the availability of effective vaccination and more understanding of COVID-19, we believe that breast cancer operations should be performed on their scheduled date.