Cancers

Research

14 pages, 953 KB

Open AccessArticle

A New Scoring System Administered by Patients to Identify Moderate-to-Severe Chemotherapy-Induced Peripheral Neuropathy: Final Results of the NEURO-BREAC Trial

by Dirk Rades, Maria Karolin Streubel, Christian Staackmann, Laura Doehring, Achim Rody, Maria Joy Normann Haverberg and Martin Ballegaard

Cancers 2026, 18(5), 835; https://doi.org/10.3390/cancers18050835 - 4 Mar 2026

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Abstract

Background/Objectives: Many breast cancer patients treated with taxanes experience chemotherapy-induced peripheral neuropathy (CIPN). The early detection of CIPN may be facilitated by scoring systems. The existing Utah Early Neuropathy Scale (UENS) requires the presence of medical staff members. A self-assessment tool usable [...] Read more.

Background/Objectives: Many breast cancer patients treated with taxanes experience chemotherapy-induced peripheral neuropathy (CIPN). The early detection of CIPN may be facilitated by scoring systems. The existing Utah Early Neuropathy Scale (UENS) requires the presence of medical staff members. A self-assessment tool usable by patients is desired. Such an instrument was recently developed but had not yet been evaluated for the detection of CIPN. This prospective study aimed to identify the optimal cut-off score for the identification of moderate-to-severe CIPN in breast cancer survivors. Methods: Twenty-six breast cancer survivors (patients) who previously received taxane-based chemotherapy were included. Eighteen patients presenting with moderate-to-severe CIPN and eight patients without CIPN used the new scoring system (0–44 points). For each cut-off score, sensitivity, specificity, Youden index, and positive (PPV) and negative (NPV) predictive values were calculated. Patients rated their satisfaction with the tool. Dissatisfaction rates of >20% and >40%, respectively, would mean that it needed optimization or could not be used. Afterwards, the UENS (0–42 points) was applied by medical staff members. Results: For the new tool, a cut-off score of 9 points was found to be optimal for identifying moderate-to-severe CIPN. The sensitivity, specificity, Youden index, and PPV and NPV were 100% in each case. The dissatisfaction rate was 7.7%. When applying the UENS, the sensitivity, specificity, Youden index, and PPV and NPV were each 100% for a cut-off score of 6 points. Conclusions: The new self-assessment scoring system was highly accurate regarding the identification of moderate-to-severe CIPN. Patient satisfaction was high. When considering the limitations of this trial, the new instrument may be used in future studies. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

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14 pages, 959 KB

Open AccessArticle

Clinical Outcomes of Palliative Radiotherapy for Breast Lesions in Symptomatic Advanced Breast Cancer: A Decade of Experience at a Regional Tertiary Hospital

by Yoon Young Jo, Jae Won Park, Ji Woon Yea, Se An Oh and Jaehyeon Park

Cancers 2026, 18(5), 769; https://doi.org/10.3390/cancers18050769 - 27 Feb 2026

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Abstract

Background/Objectives: Palliative radiotherapy (RT) to the breast or chest wall is an effective option for symptom relief in advanced or metastatic breast cancer. However, real-world data on clinical outcomes, prognostic factors, and optimal RT dose and timing in the modern systemic therapy era [...] Read more.

Background/Objectives: Palliative radiotherapy (RT) to the breast or chest wall is an effective option for symptom relief in advanced or metastatic breast cancer. However, real-world data on clinical outcomes, prognostic factors, and optimal RT dose and timing in the modern systemic therapy era remain limited. This study aimed to evaluate the efficacy of palliative breast RT and explore the optimal integration of systemic therapy with RT. Methods: We retrospectively reviewed 38 patients treated with palliative RT between 2015 and 2024 at a regional tertiary center. The median gross tumor volume (GTV) dose was 50 Gy (range, 30–62.5 Gy), corresponding to a median biologically effective dose (BED) to the GTV (α/β = 4) of 78.9 Gy. Treatment response, symptom relief, toxicity, and survival outcomes were analyzed. Results: With a median follow-up of 9.5 months, median overall survival (OS) was 12.8 months. 1- and 2-year in-field local control (LC) rates were both 79.6%. In a parsimonious multivariate analysis, ≥3 prior lines of systemic therapy (HR 3.500, 95% CI 1.278–9.590, p = 0.015) was independently associated with worse OS, whereas use of SIB or GTV boost was associated with improved OS (HR 0.351, 95% CI 0.145–0.848, p = 0.020). Higher planning target volume (PTV)-BED (α/β = 4) correlated with improved LC (HR 0.909, 95% CI 0.839–0.985, p = 0.019). Symptom relief within 3 months occurred in 82%. Treatment-related toxicities were generally mild, with no grade ≥ 4 acute or grade ≥ 2 late toxicities observed. Conclusions: Palliative breast RT achieved durable local control and effective symptom palliation with acceptable toxicity. Dose-tailored RT and earlier integration within the disease course may optimize outcomes in selected patients. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

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10 pages, 648 KB

Open AccessArticle

Impact of Postoperative Radiotherapy on the Risk of Ischemic Heart Disease and Survival in Patients with Ductal Carcinoma In Situ: A Nationwide Claims-Based Cohort Study

by Van Hung Nguyen, Seung Yeun Chung and O Kyu Noh

Cancers 2025, 17(23), 3805; https://doi.org/10.3390/cancers17233805 - 27 Nov 2025

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Abstract

Background: Postoperative radiation therapy (RT) after lumpectomy reduces the risk of locoregional recurrence in ductal carcinoma in situ (DCIS). However, the potential association between RT and ischemic heart disease (IHD) remains uncertain. This nationwide cohort study evaluated the long-term impact of postoperative RT [...] Read more.

Background: Postoperative radiation therapy (RT) after lumpectomy reduces the risk of locoregional recurrence in ductal carcinoma in situ (DCIS). However, the potential association between RT and ischemic heart disease (IHD) remains uncertain. This nationwide cohort study evaluated the long-term impact of postoperative RT on IHD risk and overall survival (OS) in women with DCIS using real-world data from the Korean National Health Insurance Service (NHIS). Methods: Women diagnosed with DCIS who underwent breast-conserving surgery between 2003 and 2020 were identified from the NHIS claims database. Patients with invasive breast cancer, age under 20 years, a prior history of IHD, or missing smoking or body mass index (BMI) data were excluded. Multivariable Cox regression was performed to assess the association between postoperative RT, IHD incidence, and OS, adjusting for key cardiovascular risk factors. Results: Among 4633 eligible patients (RT, 2778; no RT, 1855), the median follow-up duration was 86.1 months, and baseline characteristics were well balanced between groups without major differences in cardiovascular risk factors. A total of 126 patients (3.4%) developed IHD, with a 10-year cumulative incidence of 4.7%. Older age, hypertension, and hyperlipidemia were independent risk factors for IHD, whereas postoperative RT was not significantly associated with increased IHD risk (hazard ratio [HR] = 1.07, 95% confidence interval [CI] = 0.77–1.48; p = 0.690). The 10-year OS rate was 98.0%, and postoperative RT remained an independent predictor of improved survival (HR = 0.47, 95% CI = 0.28–0.79; p = 0.004). Conclusions: Postoperative RT did not increase the long-term risk of IHD but was associated with improved OS in patients with DCIS. These findings provide population-based evidence supporting the cardiac safety and oncologic efficacy of postoperative RT, while recognizing that unmeasured differences in health behavior or medical care utilization could have contributed to the observed survival benefit. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

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16 pages, 682 KB

Open AccessArticle

Exploratory Evaluation of Topical Tacrolimus for Prevention of Breast Cancer-Related Arm Lymphedema: A Multicenter Non-Randomized Pilot Study

by Frederik Gulmark Hansen, Mads Gustaf Jørgensen, Kim Gordon, Christina Kjær, Lena Felicia Carstensen, Mette Tambour, Bibi Gram, Jørn Bo Thomsen and Jens Ahm Sørensen

Cancers 2025, 17(23), 3753; https://doi.org/10.3390/cancers17233753 - 24 Nov 2025

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Abstract

Background: Breast cancer-related lymphedema (BCRL) remains a challenging complication for breast cancer survivors. Currently, there are no effective pharmacological options available to address this condition. Emerging research highlights the critical role of inflammation, lymphatic dysfunction, and T-cell activity in the development of BCRL. [...] Read more.

Background: Breast cancer-related lymphedema (BCRL) remains a challenging complication for breast cancer survivors. Currently, there are no effective pharmacological options available to address this condition. Emerging research highlights the critical role of inflammation, lymphatic dysfunction, and T-cell activity in the development of BCRL. Tacrolimus, a calcineurin inhibitor, has demonstrated promising results in preclinical studies for reducing inflammation, enhancing lymphatic function, and modulating T-cell activity—key mechanisms implicated in BCRL pathogenesis. This study investigates whether topical tacrolimus ointment can reduce the incidence and severity of BCRL, providing a novel approach to mitigate this debilitating condition. Methods: A parallel, open-label non-randomized controlled multicenter clinical pilot trial was conducted from February 2020 to June 2022. Female participants undergoing axillary lymph node dissection (ALND) were recruited and divided into an intervention group (n = 22) receiving topical tacrolimus 0.1% ointment daily for 12 months and a control group (n = 39). Outcomes included lymphedema diagnosis (primary), arm volume, bioimpedance spectroscopy, quality of life (QOL) scores, and adverse events. Assessments were performed at baseline and at 3, 6, 9, and 12 months. Results: At 12 months, lymphedema was diagnosed in 3 of 18 patients (16.7%) in the intervention group and 4 of 37 patients (10.8%) in the control group (p > 0.05). Mean increase in at-risk arm volume was 80.7 mL in the intervention group versus 116.1 mL in the control group (p > 0.05). Disease-specific quality of life scores worsened in both groups, but scores returned to baseline at 12 months in the intervention group only. Adverse events were mild and manageable, with no serious events reported. Conclusions: While topical tacrolimus did not significantly reduce the incidence of lymphedema, exploratory patterns in symptom onset and quality-of-life measures indicate that further investigation in larger randomized trials may be warranted. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

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14 pages, 266 KB

Open AccessArticle

The B-S₂CALED Score’s Utility in Predicting Stroke Risk in Breast Cancer Patients with Atrial Fibrillation

by Lakshya Seth, Nickolas Stabellini, Aditya Bhave, Gaurav Gopu, Sandeep Yerraguntla, Ahmed Shetewi, John Lester, Vraj Patel, Stephanie Jiang, Madison James, Stanley Joseph, Sai Kollapaneni, Viraj Shah, Susan Dent, Michael G. Fradley, Lars Køber, Anne Blaes and Avirup Guha

Cancers 2025, 17(22), 3600; https://doi.org/10.3390/cancers17223600 - 7 Nov 2025

Viewed by 1105

Abstract

Background: Breast cancer (BC) patients have heightened risks of atrial fibrillation (AF) and ischemic stroke (IS). Standard IS scores are poorly validated in cancer, omit cancer-specific factors, and guidelines offer no cancer-tailored management. Objectives: To develop and validate a novel score to predict [...] Read more.

Background: Breast cancer (BC) patients have heightened risks of atrial fibrillation (AF) and ischemic stroke (IS). Standard IS scores are poorly validated in cancer, omit cancer-specific factors, and guidelines offer no cancer-tailored management. Objectives: To develop and validate a novel score to predict IS risk in BC patients with AF. Methods: Data sources: UH Seidman Cancer Center (derivation; 40% set aside for internal validation) and MCG Cancer Center (external validation). Adults ≥ 18 years old with DCIS or stage I–IV BC who developed AF after diagnosis were included. Variable selection by LASSO Cox regression; continuous predictors dichotomized via cubic splines; points assigned from multivariable hazards to form B-S₂CALED. Continuous scores were split into risk groups. Discrimination of categorized B-S₂CALED versus CHA₂DS₂-VASc was assessed with the concordance index (C-index) and net reclassification improvement (NRI). Results: In the internal validation cohort (n = 935), 87 patients experienced IS/TIA. The B-S₂CALED score achieved a C-index of 0.64 (95% CI 0.59–0.70) compared with 0.54 (95% CI: 0.51–0.56) for CHA₂DS₂-VASc, yielding a total NRI of 0.188. In the external validation cohort (n = 95), 8 patients developed IS/TIA. The B-S₂CALED score produced a C-index of 0.77 (95% CI: 0.72–0.83) versus 0.53 (95% CI: 0.51–0.56) for CHA₂DS₂-VASc, with a total NRI of 0.563. Similar advantages were observed when the score was treated as a continuous variable. Conclusions: The BC-specific B-S₂CALED score outperformed CHA₂DS₂-VASc for predicting thromboembolic events in BC patients with AF. Validation in larger datasets is needed before clinical adoption. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

17 pages, 2779 KB

Open AccessArticle

Self-Reported Outcomes of Endocrine Therapy with or Without Ovarian Suppression in Premenopausal Breast Cancer Patients: A Brazilian Quality-of-Life Prospective Cohort

by Natália Nunes, Giselle Carvalho, Bernardo Ramos, Juliana Pecoraro, Lilian Lerner, Debora Azevedo, Thamirez Ferreira, Larissa Santiago de Moura, Carolina Galvão and Mariana Monteiro

Cancers 2025, 17(19), 3229; https://doi.org/10.3390/cancers17193229 - 4 Oct 2025

Viewed by 1403

Abstract

Background: Endocrine therapy (ET) with or without ovarian function suppression (OFS) is a cornerstone treatment for estrogen receptor-positive (ER+) breast cancer (BC) in premenopausal women, but its impact on quality of life (QoL) and sexual health remains a concern. Methods: We conducted a [...] Read more.

Background: Endocrine therapy (ET) with or without ovarian function suppression (OFS) is a cornerstone treatment for estrogen receptor-positive (ER+) breast cancer (BC) in premenopausal women, but its impact on quality of life (QoL) and sexual health remains a concern. Methods: We conducted a multicenter, prospective, observational study including premenopausal women (≤50 years) diagnosed with stage I–III ER+ BC and treated in private healthcare facilities in Brazil between 2013 and 2023. Patients received ET alone (ET-only) or combined with OFS (OFS-ET). QoL was assessed at baseline and 3, 6, 9, 12, and 24 months using the EORTC QLQ-BR23. Sexual functioning and sexual enjoyment were prespecified primary outcomes. Logistic regression identified factors associated with OFS use, and Fisher’s exact test was applied for categorical comparisons at 24 months. Results: Among 363 patients (80% ET-only, 20% ET + OFS), younger age, advanced stage, and chemotherapy were independently associated with OFS use. Both groups reported early declines in sexual functioning and enjoyment. By 24 months, ET-only patients had returned to baseline, whereas OFS patients remained below baseline. At the item level, no significant differences were observed in sexual desire (51.5% vs. 42.0%; p = 0.33) or enjoyment (26.0% vs. 13.5%; p = 0.20). Lack of sexual activity was more frequent in the OFS group (60.6% vs. 41.2%; p = 0.05). Body image was significantly more impaired with OFS, with a higher proportion of patients reporting feeling less attractive (38.2% vs. 19.9%; p = 0.04) and less feminine (26.5% vs. 11.7%; p = 0.05). Conclusions: ET impairs sexual health in young BC survivors, particularly when combined with OFS. These findings underscore the need for routine sexual health assessments and supportive interventions in survivorship care. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

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25 pages, 3724 KB

Open AccessArticle

The Effects of Concurrent Training on Molecular, Functional, and Clinical Outcomes in Breast Cancer Survivors: A Pilot Study

by Celia García-Chico, Susana López-Ortiz, Salvador Santiago-Pescador, Paloma Guillén-Rogel, Saúl Peñín-Grandes, Lisa Musso-Daury, Francisco Javier Iruzubieta-Barragán, José Pinto-Fraga, Sergio Maroto-Izquierdo, Lourdes del Río Solá and Alejandro Santos-Lozano

Cancers 2025, 17(12), 1967; https://doi.org/10.3390/cancers17121967 - 13 Jun 2025

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Abstract

Background: Breast cancer survivors (BCS) experience long-term adverse effects, with breast cancer-related lymphedema (BCRL) being one of the most common complications. Exercise is suggested as a safe strategy to improve functionality in BCS with or at risk of developing BCRL. However, the [...] Read more.

Background: Breast cancer survivors (BCS) experience long-term adverse effects, with breast cancer-related lymphedema (BCRL) being one of the most common complications. Exercise is suggested as a safe strategy to improve functionality in BCS with or at risk of developing BCRL. However, the effects of concurrent training in these patients are poorly understood. The aim of the study was to analyze the effects of a 12-week supervised concurrent training program and a 12-week follow-up period without training on molecular, functional, and clinical outcomes in BCS. Methods: A single-arm study was conducted in 11 BCS with or at risk of BCRL to analyze the effects of a 12-week concurrent training and a 12-week follow-up period on molecular (92 inflammation-related proteins), functional (upper- and lower-body strength, handgrip strength, and cardiorespiratory fitness), and clinical (body mass index, arm volume, subcutaneous and muscle thickness, range of motion, physical activity levels and heart rate variability, pain, and quality of life [QoL]) outcomes. Results: The 12-week concurrent training program significantly improved upper-body muscle strength, handgrip strength, pain, emotional well-being, and total QoL. In addition, after the 12-week follow-up period, the increase in row strength was maintained, and a significant decrease in various inflammation-related proteins was observed. Conclusions: A 12-week concurrent training program improved strength, pain, and QoL in BCS without increasing inflammation. After the follow-up period, inflammation-related protein levels decreased, and row strength gains were maintained, supporting the potential effects of concurrent training. Further larger and controlled studies are needed to confirm the results. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

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23 pages, 679 KB

Open AccessArticle

Pain Self-Management Behaviors in Breast Cancer Survivors Six Months Post-Primary Treatment: A Mixed-Methods, Descriptive Study

by Kaitlin M. McGarragle, Sunny Zheng, Lucia Gagliese, Doris Howell, Elizabeth Edwards, Cheryl Pritlove, David McCready, Christine Elser, Jennifer M. Jones and Lynn R. Gauthier

Cancers 2025, 17(7), 1087; https://doi.org/10.3390/cancers17071087 - 24 Mar 2025

Cited by 1 | Viewed by 1810

Abstract

Background/Objectives: One-third of breast cancer (BC) survivors experience chronic treatment-related pain (CTP) that requires multimodal management strategies, which may include pain self-management behaviors (PSMBs). Most studies exploring PSMBs focus on patients with advanced cancer, who may differ from survivors in their pain management [...] Read more.

Background/Objectives: One-third of breast cancer (BC) survivors experience chronic treatment-related pain (CTP) that requires multimodal management strategies, which may include pain self-management behaviors (PSMBs). Most studies exploring PSMBs focus on patients with advanced cancer, who may differ from survivors in their pain management needs and access to resources. This mixed-methods study explored PSMBs of survivors of BC, referral sources, and goals for pain relief, and examined the relationship between PSMB engagement and pain intensity/interference. Methods: Survivors of BC who were six months post-treatment completed measures assessing their pain intensity/interference and PSMB engagement. Purposive sampling identified a subset of participants who completed interviews, which were analyzed using thematic analysis. Results: Participants (n = 60) were 60 ± 10 years old. Worst Pain Intensity and Pain Interference were 3.93 ± 2.36 and 2.09 ± 2.11, respectively. Participants engaged in 7 ± 3.5 PSMBs. The most common were walking (76%) and distraction (76%). PSMBs described in the interviews (n = 10) were arm stretching and strengthening exercises, seeking specialized pain management services, and avoidance. Most PSMBs were self-directed or suggested by friends. All pain relief goals were to minimize pain interference. PSMB engagement was not associated with Worst, Least, or Average Pain Intensity (all r_s ≤ −0.2, p ≥ 0.05) but was associated with Pain Interference (r_s = 0.3, p ≤ 0.01). Conclusions: The survivors of BC engaged in many PSMBs, with varying levels of effectiveness and a varying quality of supporting evidence. Most PSMBs were self-directed and some required intervention from healthcare providers or other people, while others required access to limited specialized pain management services. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

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13 pages, 243 KB

Open AccessArticle

Evaluating Outcomes for Women with Metastatic Breast Cancer: Palliative Care Consultations, Hospital Charges, and Length of Stay

by Leslie J. Hinyard, Divya S. Subramaniam, Alexandria M. Jenkins, Zachary Timmer and Noor Al-Hammadi

Cancers 2024, 16(22), 3724; https://doi.org/10.3390/cancers16223724 - 5 Nov 2024

Cited by 2 | Viewed by 2120

Abstract

Introduction: Women with late-stage metastatic breast cancer are at an increased risk of pain and distress from symptoms and often struggle with associated emotional and financial burden of their disease. Palliative care is known to alleviate symptom burden in patients with end-stage, [...] Read more.

Introduction: Women with late-stage metastatic breast cancer are at an increased risk of pain and distress from symptoms and often struggle with associated emotional and financial burden of their disease. Palliative care is known to alleviate symptom burden in patients with end-stage, terminal diseases but is often underutilized in both inpatient and outpatient settings. The current study aims to investigate the prevalence of palliative care consultation on inpatients with metastatic breast cancer and examine the association between palliative care consultation and length of hospital stay and total hospital charges. Methods: Patients diagnosed with metastatic breast cancer between 1998–2017 were abstracted from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Database (NIS). The primary outcome was the presence of a palliative care consultation (PCC) during the inpatient stay. Secondary outcomes were hospital length of stay and total hospital charges. Multivariable logistic regression was used to examine factors associated with the presence of a PCC. The relationship between PCC and hospital length of stay and total hospital charges were investigated using linear regression. Results: 513,509 cases of metastatic breast cancer were identified, 5.7% had a documented in-hospital palliative care encounter. Of those who received PCC, total hospital charges were about USD 5452 less than those who did not receive consultation. Women who received PCC had higher odds of a longer hospital stay. Predictors of PCC were older age, non-White race, and residing in a lower-income ZIP code. Conclusions: Palliative care remains to be an underutilized resource among patients with end-stage metastatic breast cancer. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

Review

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18 pages, 328 KB

Open AccessReview

Chemotherapy-Induced Alopecia in Breast Cancer Patients: Treatment-Specific Incidence and Risk of Persistent Hair Loss

by Simonetta I. Gaumond, Sophie Shrestha, Isabella Kamholtz, Gabriela E. Beraja and Joaquin J. Jimenez

Cancers 2026, 18(5), 861; https://doi.org/10.3390/cancers18050861 - 7 Mar 2026

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Abstract

Chemotherapy-induced alopecia (CIA) is one of the most common and visible toxicities of breast cancer treatment, yet its true incidence, severity, and long-term outcomes remain inconsistently reported. Although CIA is frequently cited as affecting approximately 65% of patients and persistent alopecia has historically [...] Read more.

Chemotherapy-induced alopecia (CIA) is one of the most common and visible toxicities of breast cancer treatment, yet its true incidence, severity, and long-term outcomes remain inconsistently reported. Although CIA is frequently cited as affecting approximately 65% of patients and persistent alopecia has historically been considered uncommon (1–15%), emerging data suggest a substantially greater burden. We conducted a scoping review of PubMed, EMBASE, SCOPUS, and Cochrane databases to synthesize regimen-specific evidence on the incidence, severity, and persistence of CIA in breast cancer patients. Anthracycline- and taxane-based regimens were associated with the highest risk, with severe alopecia reported in more than 70% of patients and rates approaching 90–100% in combination regimens. Cyclophosphamide further amplified acute CIA when combined with doxorubicin, with reported incidence up to 93%. In contrast, capecitabine and vinorelbine were consistently associated with lower alopecia incidence. Importantly, CIA was not uniformly reversible. Persistent CIA (pCIA) occurred in up to 67% of patients treated with doxorubicin-based regimens and nearly 50% of those receiving docetaxel combinations, substantially higher than historically reported. Despite its high frequency and potential permanence, CIA remains underreported in oncology trials and insufficiently addressed in survivorship care. Recognizing CIA as both an acute toxicity and a potential long-term survivorship concern underscores the need for standardized reporting, longitudinal follow-up, and development of effective preventive strategies in breast cancer care. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

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24 pages, 946 KB

Open AccessReview

Long-Term Adverse Events Following Early Breast Cancer Treatment with a Focus on the BRCA-Mutated Population

by Berta Obispo, Caroline Bailleux, Blanca Cantos, Pilar Zamora, Sachin R. Jhawar, Jajini Varghese, Lucia Cabal-Hierro, Paulo Luz, Luis Berrocal-Almanza and Xiaoqing Xu

Cancers 2025, 17(15), 2506; https://doi.org/10.3390/cancers17152506 - 30 Jul 2025

Cited by 5 | Viewed by 3061

Abstract

Breast cancer (BC) is the most prevalent malignancy in women worldwide. Despite most cases being diagnosed in the early stages, patients typically require a multimodal treatment approach. This typically involves a combination of surgery, radiotherapy, systemic treatments (including chemotherapy or immunotherapy), targeted therapy, [...] Read more.

Breast cancer (BC) is the most prevalent malignancy in women worldwide. Despite most cases being diagnosed in the early stages, patients typically require a multimodal treatment approach. This typically involves a combination of surgery, radiotherapy, systemic treatments (including chemotherapy or immunotherapy), targeted therapy, and endocrine therapy, depending on the disease subtype and the risk of recurrence. Moreover, patients with BC and germline mutations in the breast cancer genes 1 or 2 (BRCA1/BRCA2), (gBRCAm), who are typically young women, often require more aggressive therapeutic interventions. These mutations present unique characteristics that necessitate a distinct treatment approach, potentially influencing the side effect profiles of patients with BC. Regardless of the clear benefit observed with these treatments in terms of reduced recurrence and mortality rates, long-term, treatment-related adverse events occur that negatively affect the health-related quality of life (HRQoL) of BC survivors. Thus, long-term adverse events need to be factored into the treatment decision algorithm of patients with early BC (eBC). Physical, functional, emotional, and psychosocial adverse events can occur and represent a significant concern and a challenge for clinicians, patients, and their families. This review article provides an overview of the various long-term adverse events that patients with eBC may experience, including their associated risk factors, as well as management and prevention strategies. We also explore the evidence of the long-term impact of treatment on the HRQoL of patients with gBRCAm. By providing a comprehensive overview of current evidence and recommendations regarding patients’ HRQoL, we aim to equip clinicians with scientific and clinical knowledge and provide guidance to optimize care and improve long-term outcomes. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

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Other

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25 pages, 3135 KB

Open AccessSystematic Review

Is There an Immune Effect of Exercise in Patients with Breast Cancer? A Systematic Review and Meta-Analysis

by Celia García-Chico, María Merino-País, Simone Lista, Piercarlo Minoretti, Enzo Emanuele, Alejandro Santos-Lozano and Susana López-Ortiz

Cancers 2026, 18(4), 621; https://doi.org/10.3390/cancers18040621 - 13 Feb 2026

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Abstract

Background/Objectives: Physical exercise reduces breast cancer (BC) risk and improves survival, yet the biological mechanisms remain incompletely understood. Exercise may modulate systemic immunity and local immune cell infiltration in the tumor microenvironment. In this systematic review and meta-analysis, we examined the effects [...] Read more.

Background/Objectives: Physical exercise reduces breast cancer (BC) risk and improves survival, yet the biological mechanisms remain incompletely understood. Exercise may modulate systemic immunity and local immune cell infiltration in the tumor microenvironment. In this systematic review and meta-analysis, we examined the effects of exercise on immune cells and immune-related markers in patients with BC. Methods: This study followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251082444). Four databases (PubMed, Web of Science, Scopus, and Cochrane Library) were searched from inception through December 2025. Randomized controlled trials evaluating exercise interventions in patients with BC or BC survivors and reporting immune cell outcomes were included. Meta-analyses were performed on studies reporting natural killer cells, natural killer cell activity, T-cell subpopulations, and B cells. Results: A total of 18 studies involving 911 participants (539 in exercise intervention groups) were included in the systematic review, with eight studies included in meta-analyses. Exercise interventions did not show significant effects on circulating natural killer cell counts, natural killer cell activity, T-cell subpopulations (CD3⁺, CD4⁺, and CD8⁺), or B-cell levels when compared to control groups. Conclusions: Exercise does not appear to induce consistent changes in resting circulating immune cell populations in patients with BC or BC survivors, indicating that exercise is immunologically safe while potentially exerting effects beyond circulating cell counts. Further large-scale research is required. Full article

(This article belongs to the Special Issue Breast Cancer Survivorship: Challenges and Innovations from Treatment to Long-Term Care)

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