Breast cancer is the most common form of cancer which struck women around the world. When a human is exposed to threat or stress, e.g. breast cancer, different coping strategies are used in order to cope with the situation by the afflicted person. The aim of this literature study was to describe how women, who suffered from breast cancer, experienced coping with their situation. Scientific articles were found in the databases Medline (Pub Med) and Cinahl. A total of 14 articles were chosen regarding to the inclusion criteria and were assessed, analyzed and compiled. The result of the study showed that the women coped with their situation with different and varied strategies. These strategies were categorised in all ready known main categories: problem based, emotional, meaning based and religious coping. The sub categories that emerged under problem based were: seek and find support, educate oneself, have a positive attitude and remaining strategies, under emotional; avoidance and distraction, live a normal life, emotionally composed activities, the use of humour, have a passive attitude, under meaning based; acceptance, the will to survive, lean on hope, newfound meaning and personal development, under religious; faith and spirituality, the relationship to God, prayer for strength and support and remaining categories. Altogether the result displayed a variety of coping strategies that were different depending on the person and the unique situation and it is of great importance that medical staff possesses this knowledge in order to understand patients different ways to cope with their illness. / Bröstcancer är den vanligaste cancerformen som drabbar kvinnor världen över. När människan utsätts för hot och påfrestningar, som t ex vid bröstcancer, används olika copingstrategier av de drabbade för att hantera situationen. Syftet med denna litteraturstudie var att beskriva hur kvinnor med bröstcancer upplever att de hanterade sin situation. Vetenskapliga artiklar söktes i databaserna Medline (Pub Med) och Cinahl. Utifrån fastställda inklusionskriterier valdes 14 artiklar ut, dessa värderades, analyserades och sammanställdes. Resultatet visade att kvinnorna hanterade sin situation med olika och varierande strategier. Dessa strategier kategoriserades i de kända huvudkategorierna: problembaserad, emotionell, meningsbaserad och religiös coping. De underkategorier som framkom under problembaserad var; söka och finna stöd, utbilda sig, ha en positiv attityd och övriga strategier, under emotionell; undvikande och distraktion, leva ett normalt liv, känslostillande aktiviteter, använda humor, ha en passiv attityd, under meningsbaserad; accepterande, viljan att överleva, förlita sig på hopp, nyfunnen mening och personlig utveckling, under religiös; tro och andlighet, relationen till Gud, böner för styrka och stöd och övriga strategier. Sammantaget visade resultatet på en mångfald av copingstrategier som var olika beroende på individ och situation och det är av stor vikt att vårdpersonal har vetskap om detta för att kunna förstå patienters olika sätt att hantera sin situation.

The human epidermal growth factor receptor (HER-2) is over-expressed in 20-30% of breast carcinomas and is a prognostic marker for poor patient outcome. We previously identified the transcription/translation factor Y-box binding protein-1 (YB-1) to be a novel substrate of AKT which binds to epidermal growth factor receptor (EGFR) and HER-2 promoters once phosphorylated (Wu J et al. 2006). YB-1 is over-expressed in approximately 40% of breast cancers; its expression is strongly correlated with HER-2 and is associated with poor patient survival. In order to gain a deeper understanding of the functional role of YB-1 in HER-2 over-expressing breast cancer, we silenced the expression of this factor in BT474-m1 and MDA-MB-453 cells. The loss of YB-1 inhibited the growth of BT474-m1 and MDA-MB-453 cells in monolayer and/or in soft agar. Consistent with this, we found a decrease in the expression of YB-1 responsive gene egfr and/or her-2 in BT474-m1 and MDA-MB-453 cells, which could begin to explain how growth is promoted by this factor. Furthermore, loss of YB-1 expression induced apoptosis in BT474-m1 cells. Beyond its role in tumor growth, YB-1 is also strongly linked to drug resistance. We therefore addressed whether it could play a part in Herceptin sensitivity. Herceptin is currently being used to treat patients with HER-2 positive breast cancer; however, only 30% of the patients respond to the therapy and many of them develop resistance within the first year of treatment. Therefore, it is of utmost importance to understand the biology of HER-2 over-expressing breast cancer to develop novel therapies that can benefit more patients. First we established that Herceptin inhibited BT474-m1 cell growth in anchorage-independent conditions whereas MDA-MB-453 cells were resistant to this treatment. We subsequently demonstrated that knock-down of YB-1 increased sensitivity of BT474-m1 cells to Herceptin while MDA-MB-453 cells failed to respond to the combination treatment. The mechanism for Herceptin resistance in MDA-MB-453 cells still remains elusive and requires further investigation. Thus far, we conclude that YB-1 is needed for the growth and survival of HER-2 positive BT474-m1 and MDA-MB-453 breast cancer cells by inducing members of the HER family.

Organochlorine pesticides (OCs) are environmental toxicants with important links to human health. They have been found to activate signalling pathways within cells and thereby affect cell survival and proliferation. Receptor Activator of Nuclear Factor kB (RANK) ligand and its receptor RANK are crucial for mammary epithelial proliferation in pregnancy and have recently been linked to hormone induced breast cancers. The objectives of this study were to confirm the proliferative effects of an OC (endosulfan) on human MCF-7 breast cancer cells, identify activated intracellular signaling pathways and investigate changes in RANK and RANKL gene expression. This study showed that endosulfan has a stimulatory effect on human MCF-7 cell proliferation, which may be invoked through activated intracellular signaling pathways (JNK, ERK1/2 and p38). In addition, there was a down regulation of RANK and upregulation of RANKL gene expression suggesting endosulfan is capable of modulating both cellular behavior and gene expression. / UOIT

It has long been known that vitamin D is important for calcium absorption and bone health. More recently, vitamin D has been found to modulate breast cancer cell growth and increasingly epidemiologic studies suggest vitamin D may be associated with reduced breast cancer risk. The primary objective of this thesis was to evaluate the associations between vitamin D from all sources (food, supplements and sunlight exposure) and breast cancer. Secondary objectives were focused on methodological issues including the development of a solar vitamin D score and adapting the measurement of vitamin D from foods for use among Canadians. The data source for this study was the “Ontario Women’s Diet and Health Study”, a population-based case-control study of women in Ontario. Cases (n = 3,101) diagnosed between 2002 and 2003 were identified through the Ontario Cancer Registry and controls (n = 3,471) were identified through random digit dialing of Ontario households. Study participants completed mailed risk factor and food frequency questionnaires. Vitamin D intake from supplements (>400 IU/day compared to none) was found to be associated with reduced breast cancer risk (OR = 0.76; 95% CI: 0.59, 0.98). However, total vitamin D intake (from food and supplements) and intake from food alone were not associated with breast cancer risk. Time spent outdoors during 4 periods of life (including adolescence) was associated with reduced breast cancer (e.g., highest versus lowest categories of exposure at age 40 to 59: OR = 0.74; 95% CI: 0.61, 0.88). The novel solar vitamin D score, derived from time spent outdoors, skin color, sun protection practices, and ultraviolet radiation of residence, was also associated with reduced breast cancer risk. In summary, there is some evidence to suggest that vitamin D intake from supplements and determinants of cutaneous vitamin D production are associated with reduced breast cancer risk.

A pilot study was conducted to evaluate whether premenstrual syndrome was a risk factor for breast cancer among premenopausal women. As subjects, 54 women between the ages of 26 and 46 years, each diagnosed with breast cancer, were compared to three separate control groups, consisting of 193 female patients seen in medical offices for routine physical exams, 51 female nursing students, and 559 female graduate students. Each eligible subject was either mailed or personally given a survey questionnaire probing premenstrual and menstrual symptomatology and general descriptive characteristics. An association between premenstrual syndrome and breast cancer was evaluated by estimating exposure odds ratios and associated confidence intervals. Analysis of the data suggested that premenstrual syndrome did not pose a breast cancer risk among premenopausal women. / Graduation date: 1993

Epithelial-mesenchymal transition (EMT) has a critical role in tumor progression and has been correlated with the basal-like subtype of human breast cancers. Here I report a novel β-catenin binding protein, which I have shown to be expressed in invasive breast cancer and hypothesized to have a role in breast tumor progression. In normal breast tissue, expression is restricted to the myoepithelium while in breast cancer the expression pattern is similar to smooth muscle actin and vimentin. I have demonstrated that silencing of this protein in breast tumor cells reduces migration by over 50 percent. Furthermore, I have identified this β-catenin binding protein as a target of the Snail EMT network and have demonstrated this protein to be a marker of basal-like carcinomas. These results define a role for this novel protein in EMT, as a marker for the basal subtype, and a promising therapeutic target for metastasis inhibition.

Fatty acid synthase (FAS), an enzyme that is over-expressed in many cancers, is necessary for cancer cell proliferation. Previously, we have shown that FAS in cancer cells is regulated at least in part, by Sp1. Indole-3-carbinol (I3C) and its acid condensation product, 3,3’-diindolylmethane (DIM) modulate various transcription factors involved in regulating cellular proliferation and apoptosis. The objective of this study was to determine whether reductions in breast cancer cell proliferation caused by I3C and/or DIM occur as a result of reductions in FAS. DIM and, in some cases, I3C reduced FAS expression in three breast cancer cell lines. However, addition of palmitate or oleate to DIM-treated MCF-7 cells did not restore proliferation. DIM-associated reduction in proliferation of MCF-7 cells also results in a reduction of Sp1 expression, and down-regulation of FAS occurs after inhibition of proliferation. Thus, the anti-proliferative effect of I3C and DIM may be due to their effect on down-regulating Sp1, which in turn could modify several Sp1-associated genes, including FAS.

A feature of neoplastic cells is that mutations in the key intermediates of TGF-β signaling contribute to the loss of sensitivity to its anti-tumor effects. The role of SMAD3 and SMAD4 germline mutations in breast cancer predisposition is currently unclear. To address this, mutation analysis of the Mad-Homology 2 domains in 408 breast cancer cases and 710 controls recruited by the Breast Cancer Family Registry (BCFR) was performed using Denaturing High-Pressure Liquid Chromatography. This study identified 23 distinct intronic variants, and three coding variants c.1214T>C, c.1478G>A, and c.1701A>G in SMAD4. No aberrant splicing was observed, but qPCR analysis and tissue expression data showed significantly elevated SMAD3 expression relative to controls (p<0.05). For SMAD4, c.1478G>A from a familial breast cancer case showed a 5-fold expression change. Taken together, inactivating alterations are not driving tumorigenesis. Rather, aberrant germline expression provides novel insight into SMAD3 and SMAD4’s roles in breast cancer predisposition.

Folate intake in North America has drastically increased over the past decade due to folic acid fortification and widespread supplemental use. The role of folate in breast cancer is highly controversial and the effects of folic acid supplementation on breast cancer patients are currently unknown. An animal study was performed to determine the effects of folic acid supplementation on the progression of the mammary tumors in the DMBA-carcinogen model. Folic acid supplementation was associated with more rapid sentinel tumor progression and with higher sentinel tumor weight, volume, and area, although no clear dose-responsive relationship was observed. Folic acid supplementation was associated with an increased expression of proapoptotic protein PARP and decreased expression of proliferation protein PCNA. These data suggest that folic acid supplementation may promote the progression of established mammary tumors. Whether or not folic acid supplementation may adversely affect the outcome of patients with breast cancer warrants further studies.

Fatty acid synthase (FAS), an enzyme that is over-expressed in many cancers, is necessary for cancer cell proliferation. Previously, we have shown that FAS in cancer cells is regulated at least in part, by Sp1. Indole-3-carbinol (I3C) and its acid condensation product, 3,3’-diindolylmethane (DIM) modulate various transcription factors involved in regulating cellular proliferation and apoptosis. The objective of this study was to determine whether reductions in breast cancer cell proliferation caused by I3C and/or DIM occur as a result of reductions in FAS. DIM and, in some cases, I3C reduced FAS expression in three breast cancer cell lines. However, addition of palmitate or oleate to DIM-treated MCF-7 cells did not restore proliferation. DIM-associated reduction in proliferation of MCF-7 cells also results in a reduction of Sp1 expression, and down-regulation of FAS occurs after inhibition of proliferation. Thus, the anti-proliferative effect of I3C and DIM may be due to their effect on down-regulating Sp1, which in turn could modify several Sp1-associated genes, including FAS.