Axillary lymph node metastasis in breast cancer is an important factor in assessing disease progression and prognosis, and there is an urgent need for non-invasive and accurate methods to assess axillary lymph node status. In recent years, the integration of artificial intelligence and medical imaging technology has shown great potential. Among them, S-Detect technology, with its powerful image analysis capability, combined with the accurate quantitative assessment of virtual touch tissue imaging quantification (VTIQ) technology, provides new possibilities for the prediction of axillary lymph node metastasis in breast cancer.

To explore the value of the conventional ultrasound-based artificial intelligence S-Detect combined with VTIQ technique to predict axillary lymph node metastasis in breast cancer.

Data of 148 female breast cancer patients (166 masses in total) who underwent surgery at the First Affiliated Hospital, Shihezi University from February 2022 to February 2024 were retrospectively collected and divided into metastatic group (n=61) and non-metastatic group (n=105) based on axillary lymph node pathology results. All patients underwent routine ultrasound, VTIQ and S-Detect examinations before surgery. Univariate and multivariate Logistic regression analyses were used to explore the influence of each observational index on axillary lymph node metastasis, screen meaningful indexes and establish a Logistic regression prediction model. The predictive value of the model was evaluated by the ROC curve.

The results of multivariate Logistic regression analysis showed that breast cancer mass border (OR=0.619, 95%CI=0.540-0.693), margin (OR=0.563, 95%CI=0.484-0.640), calcification (OR=0.559, 95%CI=0.480-0.636), aspect ratio (OR=0.540, 95%CI=0.461-0.617) and SWVmean (OR=0.794, 95%CI=0.725-0.853) were independent influences in predicting axillary lymph node metastasis in breast cancer (P<0.05). Logistic equations were constructed: Logistic (P) =-14.293+1.664×border+1.315×margin+1.757×calcification+1.341×aspect ratio+1.196×blood flow classification+0.736×SWVmax-3.942×SWVcentre+0.710×SWVmean. The AUC of this joint prediction model was 0.902 (95%CI=0.847-0.943), which was greater than the AUCs of each independent influencing factor (all P<0.05), and the AUC values of the joint prediction model were greater than the AUCs of the independent prediction models of conventional ultrasound (AUC=0.605, 95%CI=0.526-0.680), S-Detect (AUC=0.672, 95%CI=0.595-0.743), and VTIQ (AUC=0.794, 95%CI=0.725-0.853). The agreement between this joint prediction model and pathological results was good (Kappa=0.732, P<0.05) .

The prediction model constructed by combining S-Detect and VTIQ techniques based on conventional ultrasound has certain clinical predictive value for axillary lymph node metastasis in breast cancer.

Breast cancer is a hormone receptor-dependent malignant tumor, and the dynamical changes of estradiol (E2) play a critical role in the development of breast cancer. The classical case-cohort design completely ignores the information of non-selected samples, which could easily lead to biased estimating.

To explore the effect of dynamical changes of E2 levels on the survival prognosis in breast cancer patients, and evaluate the superiority of improved case-cohort design.

In this study, we selected 8 226 patients who were diagnosed as breast cancer by pathological examination at the Affiliated Cancer Hospital of Xinjiang Medical University from 2015 to 2019, by using the time of patient diagnosis as the follow-up start date, and defining the death of patients due to breast cancer as the outcome event. The follow-up end date was December 31, 2021. The demographic characteristics, immunohistochemical indicators, clinicopathological characteristics and survival status of patients were gathered, and their serum E2 levels were longitudinally monitored. Based on the classical case-cohort design, the improved case-cohort design was achieved by incorporating survival data from patients outside of the case-cohort sample. Under the classical and improved case-cohort designs, linear mixed effects model and Cox proportional risk model were used to fit the longitudinal data (longitudinal submodel) and survival data (survival submodel) of breast cancer patients, respectively, and two joint models for longitudinal and time-to-event data were further established. Moreover, Markov Chain Monte Carlo algorithm was used to estimate the parameters of two joint models. The area under the receiver operating characteristic curves (AUC) and prediction errors (PE) were further applied to compare the discrimination and calibration of two joint models under the classical and improved case-cohort designs.

Based on the inclusion and exclusion criteria, a total of 895 breast cancer patients were included in the full cohort, of which 53 patients died of breast cancer. The median follow-up time for patients was approximately 28 months. The samples of classical case-cohort design were concluded two parts: one was one quarter of the patients selected from the full cohort as a random subcohort, the other was patients who died during the follow-up period outside the random subcohort, of which included survival data from 236 patients and 1 062 measurements of E2 levels. Moreover, on the basis of the classical case-cohort design, the survival data of breast cancer patients who were outside of the classical case-cohort samples and survived during the follow-up period (G₄) were included as the samples of the improved case-cohort design that included survival data from 895 patients, 1 062 measurements of E2 levels from 236 patients (in which it was assumed that there were 2 958 longitudinally missing measurements of E2 levels) . The results of two joint models under classical and improved case-cohort designs both revealed that dynamical change of E2 levels was identified as the influencing prognostic factors for breast cancer patients. For one-unit longitudinal increment of lg (E2) , the mortality risks for patients would increase by about 23% (HR=1.23, =1.015) and 8% (HR=1.08, =1.020) , respectively. Moreover, the joint model under the improved case-cohort design showed better discrimination and calibration (AUC=0.706-0.962, PE=0.001 2-0.010 8) .

The longitudinal increment of E2 levels could cause a decrease of the survival probability for breast cancer patients. The joint model under case-cohort design could both analyze longitudinal and survival data, and the improved case-cohort design would be superior to that of the classical case-cohort design.

Postoperative upper extremity lymphedema is a common postoperative complication in breast cancer patients, which greatly affects patients' quality of life and confidence in treatment. Currently, western medicine has limited effect in treating postoperative upper extremity lymphedema after breast cancer, and acupuncture has better efficacy in treating this disease, however, there is no research on the choice of different acupuncture treatment modalities.

To compare the efficacy of different acupuncture modalities on upper extremity lymphedema after breast cancer surgery using reticulated meta-analysis, with a view to providing an evidence-based basis for the selection of clinical treatment options.

A computerized systematic search of the China national knowledge infrastructure, Wanfang Data, VIP, China Biomedical Literature Service, PubMed, Embase, Medline and Cochrane Library databases of randomized controlled trials (RCT) on the intervention of different acupuncture modalities in postoperative lymphedema after breast cancer was conducted from the time of database construction to October 31, 2023. The literature search was completed independently by two researchers, and the initial and re-screening were performed in strict accordance with the inclusion and exclusion criteria. After the final inclusion of the literature was categorized, the basic information and data were extracted and the risk of bias was assessed, and the data were analyzed using software such as R 3.6.2 and Stata 14.0.

Fourteen papers were finally included, containing a total of 915 patients with upper limb lymphedema after breast cancer surgery, including 459 cases in the treatment group and 456 cases in the control group. Eleven interventions were involved, including conventional treatment, ordinary acupuncture, warm acupuncture, millifire acupuncture, western medicine, acupuncture+moxa stick, conventional+abdominal acupuncture, conventional+warm acupuncture, conventional+acupuncture, conventional+guanxi, and conventional+forceful motion acupuncture. The results of the ranking of the cumulative probability plot area under the curve (SUCRA) of each intervention on the difference between the affected-patient side circumferential diameters showed that the results of routine + abdominal needling (100.0%) >milli-fire needling (66.4%) >routine + warm needling (58.2%) >regular needling (19.0%) >routine (6.5%) . The results of SUCRA ranking of each intervention on the total efficiency showed that milli-fire acupuncture (90.1%) >ordinary acupuncture (71.1%) >routine+force-activated acupuncture (67.7%) >warm acupuncture (62.1%) >routine + warm acupuncture (57.9%) >acupuncture+moxa sticks (50.7%) >routine +off-needling (48.2%) >routine+needling (47.7%) >routine + abdominal needling (38.6%) >western medicine (9.6%) >routine (6.3%) .

Among the 11 interventions, the combined total efficiency and the ranking of the difference between the affected-healthy side circumference showed that millipede acupuncture is the best choice for the treatment of upper extremity lymphedema after breast cancer surgery, but more high-quality RCTs are needed to confirm this.

Anthracyclines are fundamental in the chemotherapy treatment of breast cancer, but these treatments often lead to changes in physique, such as increased body fat and decreased cardiopulmonary function, alongside gastrointestinal reactions and bone marrow suppression, thereby impacting the patients' quality of life. Current studies on the ameliorative effects of exercise on these side effects yield inconsistent results, necessitating further research. Clinically, the efficacy and safety of exercise prescriptions in mitigating these chemotherapy side effects in breast cancer patients warrant further exploration.

This study aims to investigate the effectiveness and safety of aerobic exercise in improving the physique and quality of life of breast cancer patients during anthracycline-based chemotherapy.

This study is a randomized controlled trial involving 44 adult female breast cancer patients who received anthracycline-based chemotherapy at Beijing Chaoyang Sanhuan Cancer Hospital, from March 2022 to January 2023. They were randomly assigned to an exercise group (23 participants) and a control group (21 participants). The control group was informed about personalized exercise guidance after chemotherapy. The exercise group, under the supervision of rehabilitation therapists, engaged in workouts during their hospital stay and continued personalized exercise interventions at home with self-monitoring and remote supervision by researchers. Key outcome measures, including physique and quality of life, were collected before and after chemotherapy, along with the incidence and severity of gastrointestinal reactions, bone marrow suppression, and exercise-related adverse events. Covariance analysis, using pre-chemotherapy data as covariates, compared the physique and quality of life between the two groups.

Four participants were lost during the intervention and follow-up, leaving 40 participants (21 in the exercise group, 19 in the control group). No severe adverse events were observed during the exercise intervention. The average compliance with the exercise intervention was 81.8%; average compliance per exercise session was 91.9%, and average compliance with exercise intensity was 92.5%. Post-chemotherapy, the exercise group showed lower body fat weight, body fat percentage, visceral fat area, waist circumference, waist-to-hip ratio, and significantly higher grip strength of the dominant hand and relative peak oxygen uptake (VO₂peak) compared to the control group (P<0.05). The incidence of functional impairments post-chemotherapy in the exercise group (7/20) was significantly lower than in the control group (12/16) (χ²=5.707, P=0.017). Post-chemotherapy, the exercise group reported significantly lower scores in physical condition, emotional condition, and additional scores, and higher functional condition scores than the control group (P<0.05). Post-chemotherapy, the control group's physical condition scores (P<0.001) and the exercise group's functional condition scores (P=0.017) were higher than pre-chemotherapy. The control and exercise groups underwent 84 and 94 anthracycline chemotherapy sessions, respectively, with the control group experiencing 84 gastrointestinal reactions and 71 bone marrow suppressions, and the exercise group experiencing 54 gastrointestinal reactions and 45 bone marrow suppressions, showing statistically significant differences between the groups (P<0.05) .

Aerobic exercise during anthracycline chemotherapy can improve the physique and quality of life of breast cancer patients and is safe when supervised.

Cardiotoxicity is a leading cause of mortality among breast cancer patients treated with chemotherapy. Therefore, an early risk assessment is vital for the clinical prevention and treatment of cardiotoxicity in breast cancer patients treated with chemotherapy, although a recognized tool is scant in our country.

To develop a cardiotoxic risk assessment scale for breast cancer patients undergoing chemotherapy and to test its reliability and validity.

Through reviewing relevant domestic and international literatures, a pool involving items to assess the risk of cardiotoxicity in breast cancer patients treated with chemotherapy was created. Semi-structured interviews with healthcare providers at Jiangsu Cancer Hospital from September to October 2022 were performed by purposive sampling, thus primarily forming a tool of items for the cardiotoxic risk assessment scale. In addition, breast cancer patients treated with chemotherapy in Jiangsu Cancer Hospital were randomly selected for a pre-survey and validation of the reliability and validity of the scale. Ranked by the score of the cardiotoxic risk assessment scale, the top 27% of participants were assigned into the high-score group, and the remaining were in the low-score group. Cronbach's α coefficient was used to evaluate the internal consistency of the scale. Validity of the scale was verified by measuring the item-level content validity index (I-CVI) and scale-level content validity index (S-CVI). Exploratory factor analysis was performed to assess the structural validity. Receiver operating characteristic (ROC) curves were plotted, and the area under tcurve (AUC) was calculated to determine the predictive validity.

Twenty healthcare providers were included in the semi-structured interviews. After two rounds of expert consultations, a 19-item cardiotoxic risk assessment scale in breast cancer patients treated with chemotherapy was developed. In this study, there were 79 patients in the low-score group and 83 in the high-score group. No significant differences in the history of smoking, endocrine treatment and immunotherapy were detected between the two groups (P>0.05). Correlation analysis showed that the history of smoking and immunotherapy was not significantly correlated with the total scores (P>0.05). Eventually, three items of smoking history, history of endocrine treatment and history of immunotherapy were removed, forming a 16-item scale. The Cronbach's α coefficient, test-retest reliability and inter-rater reliability were 0.739, 0.983 and 0.984, respectively. Content validity results showed that I-CVI ranged from 0.83 to 1.00, and S-CVI was 0.98. Predictive validity results showed the AUC of 0.887 (95%CI=0.827-0.947, P<0.001), with a cut-off value of 32.50 points, Youden's index of 0.649, specificity of 89.1%, and sensitivity of 75.9%. Exploratory factor analysis results showed a Kaiser-Meyer-Olkin (KMO) value of 0.700. Bartlett's sphericity test showed the χ² value of 1 037.898 (df=120, P<0.001). Five common factors were extracted, with a cumulative variance contribution rate of 61.991%. Risk stratification results indicated a low risk at 32-38 points, medium risk at 39-56 points, and high risk at 57 points and above.

The cardiotoxic risk assessment scale for breast cancer patients undergoing chemotherapy has good reliability and validity. It can better predict the high-risk population of cardiotoxicity and provide an effective assessment tool for clinicians and nurses to effectively identify the high-risk population of breast cancer patients undergoing chemotherapy.

Community health service center is the main gatekeeper for breast cancer screening, while its efficacy of screening is difficult to guarantee for the re-striction of screening process by various factors.

To analyze the focus issue of breast cancer screening program in the real world and explore corresponding solutions.

A mixed-methods convergent design was used to collect quantitative and quali-tative data. In the quantitative study, typical sampling method was used to select one community health service center in each of the four districts of Tianjin as the investigation institution from April 2021 to November 2022, accidental sampling method was used to select age-eligible women within 3 km of the four institutions as resident survey respondents, so as to explore the issues existing in the on-site operation of breast cancer screening. In the qualitative study, 9 residents, 12 physicians participating in the screening and 4 leaders were selected through purposive sampling from June to November 2022 for semi-structured in-terviews. The grounded theory was used to analyze the interview content, and the grounded theory framework of the focus issues of breast cancer screening was plotted. Combined with literature and typical investigation data, a mixed methods study was conducted to determine the focus issues of breast cancer screening.

The quantitative study showed that in the advocacy work, the promotion method is traditional, the awareness rate and participation rate of residents was 46.3% (143/309) and 32.4% (100/309) , respectively; in the screening work, the institutions invested different human and material resources, and the average waiting time of screening residents accounted for 62.2% (40.5/65.1) of the total time; in the follow-up and referral work, the invested human and material resources were little, the mammography referral compliance of residents was 29.9% (59/197) . The qualitative study showed that a total of 38 comprehensive open codes were formed in the interview and converged into 10 axial codes and 3 core codes, including advocacy organization, screening organization, follow-up and referral. The mixed methods study showed that 3 focus issues were identified in final, including how to improve residents' participation rate, how to ensure adequate human and material resources in screening institutions, and how to improve residents' mammography referral compliance.

The efficacy of breast cancer screening is influenced by advocacy organization, screening organization, follow-up and referral. It is necessary to rationally allocate resources to ensure adequate human and material resources for screening institutions; innovate promotion methods, expand coverage of promotion and improve residents' health literacy, participation rates and mammography referral compliance, to ensure the substantial progress of breast cancer screening and provide reference for opti-mizing the efficacy of breast cancer screening.

Due to many barriers, it is difficult for primary medical institutions to ensure substantial achievements in breast cancer screening. So it is particularly important to establish a system for scientifically and effectively assessing the capacities of primary care institutions in conducting breast cancer screening.

To construct a system for assessing the capacities of primary care institutions for conducting breast cancer screening.

From September to October 2022, through literature review and group discussion, we developed an item pool of the initial version of Breast Cancer Screening Capacity Assessment System for Primary Care Institutions (BCSCASPCI) . Then we conducted an online Delphi survey between November and December 2022 using a self-developed questionnaire with a purposive sample of 21 experts for understanding their views regarding the initial version of BCSCASPCI, and the response coefficient, authority coefficient, and the Kendall's W of the survey were calculated. Finally, based on the results of the survey and a group discussion, the final version of the BCSCASPCI was determined. The Analytic Hierarchy Process was used to determine the weight coefficients of its indicators and to examine the logical consistency of indicators.

All the experts returned effective questionnaires, achieving a response rate of 100.0%, and the authority coefficient was 0.812, and the Kendall's W was 0.209 (P<0.001) . The final version of the BCSCASPCI consists of 3 primary indicators (structure, process, and outcome) , 10 secondary indicators, and 56 tertiary indicators. The weight coefficients of the 3 primary indicators were 0.310 8, 0.195 8 and 0.493 4, respectively. The consistency ratios of indicators at each level were <0.100.

Our BCSCASPCI has proven to be highly authoritative and scientific, and is expected to provide guidance and reference for studies related to breast cancer screening capacity assessment. But the applicability and application effects of the system still needs further verification.

The low coverage rate of breast cancer screening has affected the prevention and control effect of breast cancer in China. Factors related to the screening coverage rate include multiple aspects of the screening implementation process.

Based on the implementation process of breast cancer screening in China, this study aims to simulate the changes in the breast cancer screening coverage rate before and after the implement optimization measures to provide suggestions for optimizing the breast cancer screening coverage rate in China.

From July to September 2022, we systematically searched the journal literature on female breast cancer screening in four databases, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Data to collate and summarize the relevant influencing factors of women's screening behaviors. Collating and analysing the breast cancer screening pathways and systematic subjects of breast cancer screening in China based on the official documents of the relevant governmental websites on breast cancer screening. Based on China's breast cancer screening pathways, screening subjects and screening behavioral correlates, we constructed the causality diagram of the breast cancer screening coverage and the stock flow diagram of the system dynamics of the breast cancer screening coverage. Simulating the effects of some optimisation strategies for breast cancer screening coverage in China, 2010-2040.

The model simulates previous screening strategies and policy resource environment. Breast cancer screening coverage gradually increased to 40% between 2010 and 2013. From 2013 to 2040, it fluctuates between 40% and 45%, showing a trend of slow decline at first and then a slow rise. Policy intervention scenarios, based on the improved population's screening intention and screening accessibility strategy, respectively simulated five kinds of optimization measures of breast cancer screening coverage rate from 2024. The five measures are as follows: (1) focusing on publicity and education, (2) standardizing the quality of screening services, (3) controlling per-case screening costs, (4) doubling the number of special breast cancer screening slots, (5) standardizing the quality of screening services and controlling per-case screening costs. The measure of focusing on publicity and education will increase rapidly coverage rate during 2024-2030 to 60.38%, then increase slowly to 66.04% during 2031-2040. The screening coverage rate will rapidly increase to 60.27% before 2029, after standardizing the quality of screening services. Then it will slowly increase to 66.04% from 2030 to 2040. After controlling per-case screening costs, the screening coverage rate will increase from 46.95% to 54.17% in 2024-2026. Then the screening coverage rate up to 58.95% in 2027-2040. Compared with no optimization measures during 2024-2040, doubling the number of special breast cancer screening slots will only increase the screening coverage rate by 1%-2%. The screening coverage rate in 2024-2040 increased from 46.95% to 86.79%, after standardizing the quality of screening services and controlling per-case screening costs.

Breast cancer screening coverage is projected to fluctuate from 41.7% to 46.0% in China from 2024 to 2040. Improving screening intention or accessibility can improve screening coverage, but the two optimization measures have their own upper limits. Meanwhile, in the Chinese population, the optimization measures to improve screening intention are better than the optimization measures to improve screening accessibility. Combined optimization measures to improve population's screening intention and screening accessibility can break through the upper limit of their respective promotion and have a better effect on improving screening coverage.

Earlier studies have investigated the association between overweight/obesity and an elevated risk of breast cancer in women. However, some studies have found that it may not be scientifically accurate to solely analyze the association between overweight/obesity and breast cancer in women for overweight/obesity can be classified into different metabolic phenotypes. The current findings on the association of different metabolic phenotypes with breast cancer remain inconsistent.

To prospectively analyze the associations of different metabolic obesity phenotypes with the risk of breast cancer in women.

In this prospective cohort study, female employees (n=23 406) of Kailuan Group who participated in physical examinations for the first time in Kailuan General Hospital and its 11 affiliated hospitals from 2006 to 2008 were selected as the study subjects and received questionnaire investigation, physical examination and laboratory tests. The study subjects were divided into the four groups based on the types of metabolic syndrome and BMI, including metabolically healthy normal weight (MHNW) group (n=12 739), metabolically unhealthy normal weight (MUNW) group (n=1 060), metabolically healthy overweight/obese (MHO) group (n=6 394), and metabolically unhealthy overweight/obese (MUO) group (n=3 213). The subjects were followed up, with the first physical examination attended as the starting point, and new onset breast cancer, death, or the end of follow-up time (2020-12-31) as the endpoints. Multivariate Cox proportional hazard regression model was used to estimate the association of the four groups with the risk of breast cancer.

During an average follow-up of (13.26±1.85) years, with 353 new cases of breast cancer and an incidence density of 11.38 cases per 10 000 person-years in the total population. The incidence cases in the MHNW, MUNW, MHO, and MUO groups were 154, 21, 113, and 65, respectively, with the incidence density of 9.08, 15.37, 13.27, and 15.49 per 10 000 person-years, and the cumulative incidence of 1.22%, 2.01%, 1.67%, and 1.93%, respectively. Multivariate Cox proportional hazard regression model analysis, after adjusting for confounders, showed that compared with the MHNW group, the risk of breast cancer was increased by 42% (HR=1.42, 95%CI=1.11-1.82) and 59% (HR=1.59, 95%CI=1.17-2.17) in the MHO group and MUO group, respectively. Stratified analysis by menopausal status showed that compared to the MHNW group, the MUO group was associated with a 69% increase in risk of premenopausal breast cancer (HR=1.69, 95%CI=1.01-2.83). The risk of postmenopausal breast cancer was increased by 85% (HR=1.85, 95%CI=1.09-3.14), 50% (HR=1.50, 95%CI=1.06-2.13), and 55% (HR=1.55, 95%CI=1.05-2.28) for the MUNW, MHO, and MUO groups, respectively, compared to the MHNW group.

Overweight/obesity is a risk factor for female breast cancer, and overweight/obesity with metabolic abnormalities further increases the risk of breast cancer. Additionally, normal weight postmenopausal women who are metabolically unhealthy may be at an increased risk of postmenopausal breast cancer.

Breast cancer has become the most common malignant tumor threatening the health of Chinese women in recent years. The use of tamoxifen (TAM) has successfully reduced the recurrence and progression of estrogen receptor-positive breast cancer, however, it also increases the risk of endometrial lesions.

To explore the risk factors for endometrial lesions in breast cancer patients taking TAM, determine the optimal threshold value of endometrial thickness, and improve the positive detection rate of hysteroscopy.

Breast cancer patients taking TAM (20 mg/d) who underwent hysteroscopic endometrial biopsy admitted to the Department of Gynecology of the First Affiliated Hospital with Nanjing Medical University from January 2015 to January 2022 were retrospectively selected as the study objects and divided into the negative hysteroscopic endometrial biopsy group (normal endometrium) and positive hysteroscopic endometrial biopsy group (endometrial lesions including endometrial polyps, endometrial hyperplasia without atypia, endometrial atypical hyperplasia and endometrial carcinoma). Clinical data of the patients were collected, including age, BMI, history of hypertension and diabetes, delivery times, presence of menopause and abnormal uterine bleeding/postmenopausal bleeding (AUB/PMB), receiving of chemotherapy, duration of TAM treatment, use of gonadotropin-releasing hormone agonists (GnRH-a), endometrial thickness, echo features of intrauterine lesions. Multivariate Logistic regression analysis was used to explore the risk factors for endometrial lesions in breast cancer patients taking TAM. The receiver operating characteristic (ROC) curve of endometrial thickness for predicting endometrial lesions detected by hysteroscopy was plotted, and the area under the ROC curve (AUC) and its 95%CI were calculated to determine the optimal cut-off value of endometrial thickness for receiving hysteroscopic surgery.

The proportion of patients with AUB/PMB, duration of TAM treatment≥24 months, intrauterine hyperechoic lesions and endometrial thickness in the positive hysteroscopic endometrial biopsy group were higher than those in the negative hysteroscopic endometrial biopsy group (P<0.05). Multivariate Logistic regression analysis showed that AUB/PMB〔OR=7.731, 95%CI (1.949, 30.699), P=0.004〕, endometrial thickening〔OR=1.223, 95%CI (1.091, 1.371), P=0.001〕 and intrauterine hyperechoic lesions〔OR=13.383, 95%CI (2.751, 65.103), P=0.001〕were independent risk factors for endometrial lesions detected by hysteroscopy in breast cancer patients taking TAM. The AUC of endometrial thickness for predicting endometrial lesions detected by hysteroscopy in breast cancer patients taking TAM was 0.753〔95%CI (0.638, 0.868), P<0.001〕, with the Youden index of 0.54, optimal cut-off value of 9.15 mm, sensitivity and specificity of 0.755 and 0.786, respectively.

The risk of endometrial lesions is increased in breast cancer patients taking TAM with AUB/PMB, endometrial thickness≥9.15 mm suggested by ultrasound and intrauterine hyperechoic lesions, when the hysteroscopy and endometrial biopsy should be actively considered.

Breast cancer is the most prevalent malignancy in the world. Endocrine therapy reduces the level of estrogen in vivo, thus affecting the blood lipid level, which reduces the quality of life and the treatment compliance of patients.

To analyze the clinical characteristics and traditional Chinese medicine (TCM) prescription of hyperlipidemia in estrogen receptor (ER) positive breast cancer patients during endocrine therapy in real world.

Based on method of retrospective study, a total of 238 patients with ER positive breast cancer who received endocrine therapy in Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2012 to March 2022 were selected as the study subjects. The data including age, triglyceride, total cholesterol, low density lipoprotein, endocrine therapy drugs, TCM prescriptions of the patients were exported through the search platform of scientific research big data to establish a clinical data table of the patients. ER positive breast cancer patients with normal baseline blood lipid levels were divided into the normal group and dyslipidemia group according to the blood lipid levels during endocrine therapy, and hyperlipidemia was classified into hypercholesterolemia, hypertriglyceridemia and mixed hyperlipidemia. The exported prescriptions were analyzed for frequency, four properties, five flavors, channel tropism and medication regularity by using the "prescription analysis", an auxiliary platform for TCM inheritance, to obtain new prescriptions.

Among 238 ER positive breast cancer patients, 97 patients (40.8%) had normal baseline blood lipid levels, of whom 42 patients (205 person-time return visit) developed dyslipidemia during standardized endocrine therapy. Among the patients with dyslipidemia, 37.6% (77/205) occurred in the age group of 51 to 60 years as the highest number; 86 person-time with dyslipidemia received exemestane treatment, accounting for the highest proportion of 42.0%. Among the 42 patients with dyslipidemia (205 person-time return visit) , hyperlipidemia occurred in 99 person-time, and hypercholesterolemia occurred in 49.5% (49/99) . There was no statistically significance difference in the age of patients with three types of hyperlipidemia (P>0.05) . There were statistically significance differences in the proportion of endocrine therapy types among patients with three types of hyperlipidemia (P<0.05) . There were 189 kinds of TCM prescriptions for hyperlipidemia in ER positive breast cancer patients during endocrine treatment, licorice was the most frequently used medicine (408 times) , the highest frequency of use was tonifying qi drug (22.6%) . The channels of TCM collected by the big data platform were mainly distributed in the spleen, lung and liver channels. The properties of TCM were mainly cold, flat and warm, and the flavors were mainly sweet, bitter and pungent. The combination of "Astragalus and Licorice" had the highest frequency. Six core drug combinations and three new prescriptions were obtained through complex system entropy clustering analysis.

The highest incidence of hyperlipidemia in ER positive breast cancer patients during endocrine therapy is 51-60 years old, and hypercholesterolemia is the most common. The position of hyperlipidemia in ER positive breast cancer patients during endocrine therapy is in the spleen. The medication are maily used for invigorating spleen to remove dampness, tonifying qi and regulating stomach.

Breast cancer has become the most prevalent cancer worldwide, which leads to both physical symptom burden and psychological distress among patients. Although available literature has demonstrated the effect of physical activity in improving psychological health among breast cancer survivors, the underlying psychosocial mechanism is relatively understudied.

To investigate the association of walking with positive and negative affect among breast cancer patients, and examine the potential mediating effects of different dimensions of posttraumatic growth between them.

From April to July, 2019, 256 breast cancer patients receiving community-based management were recruited using convenience sampling from Shanghai Pengpuxincun Community Health Center to attend a household survey. Two hundred and thirty-five of them who completed the survey were included as final participants (achieving a response rate of 91.8%) . Levels of walking were measured using International Physical Activity Questionnaire-Long Form (IPAQ-long) , posttraumatic growth was assessed using Posttraumatic Growth Inventory-Short Form (PTGI-SF) , emotional health was assessed using the 20-item Positive and Negative Affect Scale (PANAS) . Structural equation modeling was conducted to test the parallel mediating effects of different dimensions of posttraumatic growth between walking and positive and negative affect.

The result of intermediary effect analysis show that, walking was associated with greater positive affect through facilitating the personal strength dimension of posttraumatic growth among breast cancer patients, with an indirect effect of 0.07〔95%CI (0.02, 0.13) 〕. Moreover, walking was associated with lower level of negative affect through facilitating the appreciation for life dimension of posttraumatic growth, with an effect size of -0.13〔95%CI (-0.21, -0.05) 〕. The result of the intermediary model show that, the level of walking activity promoted positive emotions (β=0.34, P<0.01) by promoting the personal strength dimension of post-traumatic growth (β=0.21, P<0.01) . In addition, walking activity decreased negative mood (β=-0.37, P<0.01) by promoting the life appreciation dimension of post-traumatic growth (β=0.35, P<0.01) .

Posttraumatic growth plays an important role as a mediator between walking and emotional health in breast cancer patients. In view of this, physicians from community health centers, the institutions responsible for long-term health management of cancer patients, should value walking as a potential intervention for improving psychological health of breast cancer patients in the future community health management. In addition, it is recommended to use both physical activity and psychological interventions to improve posttraumatic growth, in order to further enhance the intervention efficacy.

Worldwide, breast cancer has become the most common malignancy, and many breast cancer survivors struggle with psychological problems in treatment and recovery. The efficacy of mindfulness-based stress reduction (MBSR) in the psychological care of breast cancer patients has been confirmed in many systematic reviews (SRs) . However, due to inconsistent outcome measures used in various SRs, the review results cannot be directly applied to clinical practice.

To perform an overview of the SRs of the efficacy of MBSR in breast cancer patients, providing a reference for the making of psychological care interventions for these patients.

PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, JBI, CNKI, Wanfang Data, and CBM were searched from inception to July 2022 for SRs of patients with breast cancer treated with MBSR. Literature screening and data extraction were performed by two researchers independently. Methodological quality was assessed using the AMSTAR 2. The standardization of reporting quality was assessed using the PRISMA checklist. Quality of evidence and strength of recommendations were assessed using the GRADE approach. The confidence of evidence from qualitative SRs was assessed using the CERQual.

Fourteen SRs were included. The methodological quality of included SRs was generally low, with only one being of high quality and two fatally missing key items. The defects in reporting quality were mainly in study protocol registration, risk of bias assessment and funding sources. Fifteen outcomes and 73 evidence bodies (0, 31, 28 and 6 were classified as high, moderate, low, and very low quality, respectively, by the GRADE approach, and the other 8 were classified as low quality by the CERQual approach) were identified in the SRs in total. MBSR could relieve anxiety, depression, fatigue, and stress in breast cancer patients to varying degrees, whose efficacy has proven to be significant in a short-term, but is uncertain in a long-term.

Generally, SRs on MBSR improving psychological condition in breast cancer patients contain unsatisfactory quality of evidence, whose methodological quality and standardization level of reporting quality still need to be improved further. Moreover, the shorter-term effect of MBSR has been confirmed, but its long-term effect is uncertain, and requires to be evaluated by more high-quality, large-sample clinical studies.

Breast cancer is the leading cause of death among women worldwide, characterized by high incidence and heavy disease burden.

To assess the secular trend of breast cancer incidence and mortality in Chinese females from 1990 to 2019.

The data on breast cancer incidence and mortality in Chinese females aged ≥15 years from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019. The Bayesian age-period-cohort (APC) model was used to fit breast cancer incidence and mortality trends during 1990—2019 to assess the effects of age, period and cohort on breast cancer incidence and mortality.

The crude incidence of breast cancer among Chinese females increased from 14.14/100 000 to 52.81/100 000, and the crude mortality increased from 7.22/100 000 to 13.40/100 000 during 1990—2019.The standardized incidence of breast cancer showed an increasing trend in general (17.07/100 000 in 1990, 35.61/100 000 in 2019) , while the standardized breast cancer mortality was basically stable (9.16/100 000 in 1990, 8.98/100 000 in 2019) .The results of the APC model showed that the average net drift value of breast cancer incidence in females of all age groups was 2.58%〔95%CI (2.34%, 2.83%) 〕, and the highest value of local drift was 3.46%〔95%CI (3.11%, 3.80%) 〕 in the 65-69 years old group. The average net drift value of mortality was -0.75%〔95%CI (-1.09%, -0.41%) 〕. The local drift value was stable in 15-44-year-olds, and was above 0 in age groups above 60 years old. The incidence and mortality of breast cancer increased with age. The period effect of incidence showed an increasing trend (RR: 0.79-1.47) , while the period effect of mortality showed a decreasing trend (RR: 1.08-0.90) when the period of 2000—2004 was set as the control group. The cohort effect of breast cancer incidence increased (RR: 0.27-2.48) , and the cohort effect of breast cancer mortality risk increased firstly and decreased after then (RR: 0.78-1.06-0.44) when the cohort of 1955—1959 was set as the control group.

The incidence and mortality of breast cancer in Chinese females increased continuously from 1990 to 2019, which was dominantly influenced by age and cohort.

The overall incidence of breast cancer in Chinese women is on the rise, seriously threatening their physical and mental health. Breast cancer prevention and treatment behaviors are critical to the outcomes of affected women in the community. However, these behaviors vary across individuals. And measures should be explored to improve the efficacy of such behaviors.

To perform a latent class analysis of breast cancer prevention and treatment behaviors among community-living women, and to explore the associated factors, providing evidence for individualized prevention and management of female breast cancer in the community.

A total of 1 355 community-living women were selected from in 15 towns/subdistricts of 5 counties/districts in Yinchuan and Zhongwei cities of Ningxia, China by use of convenience sampling method from November 2019 to August 2020. They were surveyed using a questionnaire consisting of baseline characteristics, and breast cancer prevention and treatment behaviors (relevant questions used are belonging to the part of breast cancer prevention and treatment in the Knowledge, Attitude and Practice of Breast and Cervical Cancer Prevention and Treatment Among Women in Ningxia) . The latent classes of breast cancer prevention and treatment behaviors were presented, and their influencing factors were identified by multivariable logistic regression analysis.

The survey achieved a response rate of 97.93% (1 327/1 355) .By use of latent class analysis, breast cancer prevention and treatment behaviors of the respondents were classified into four latent classes, including positive prevention and treatment (n=522, 39.34%) , high-risk behaviors plus positive treatment (n=449, 33.83%) , high-risk behaviors plus negative treatment (n=229, 17.26%) , and general prevention and treatment (n=127, 9.57%) . The overall median score of breast cancer prevention and treatment behaviors was 9.00 (7.00, 11.00) points for all respondents. The median score of breast cancer prevention and treatment behaviors was 11.00 (11.00, 12.00) points for respondents with positive prevention and treatment behaviors, 9.00 (8.00, 10.00) points for those with high-risk behaviors plus positive treatment behaviors, 6.00 (5.00, 6.00) points for those with high-risk behaviors plus negative treatment behaviors, and 8.00 (6.00, 9.00) points for those with general prevention and treatment behaviors, with significant difference across the groups (H=1 008.493, P<0.001) . Multivariable Logistic regression analysis showed that, compared with general prevention and treatment behaviors, living in Zhongwei and having a history of childbirth were associated with increased possibility of being classified into positive prevention and treatment behaviors, having health insurance〔urban resident basic medical insurance (URBMI) , commercial health insurance, or other types〕, self-pay treatment, and a history of hormone replacement therapy were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) , having a history of childbirth were associated with increased possibility of being classified into high-risk behaviors plus positive treatment behaviors, having health insurance (URBMI or commercial health insurance) , as well as a history of hormone replacement therapy were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) , and primary education or below, household monthly income per person of 1 000-2 999 yuan were associated with increased possibility of being classified into high-risk behaviors plus negative treatment behaviors, and having URBMI were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) .

In general, breast cancer prevention and treatment behaviors in this group could be definitely classified, all being performed at a moderate level. To improve the level of breast cancer prevention and treatment behaviors of Ningxia's community-living women, focus should be on those who have high-risk behaviors and negatively seek for treatment. Moreover, the problems in positive breast cancer prevention and treatment behaviors in women with other three classes of behaviors should also be intervened and corrected to improve the outcomes of them.