engleski

Breast cancer and immunosuppression in kidney transplant recipients: a literature review

Breast cancer is the most common neoplasm and the fifth cause of death among females. The etiology and pathogenesis of this malignancy are multifactorial. The occurrence of neoplasms in solid organ recipients treated with immunosuppressive drugs is 2 to 3 times higher than in the general population. Females with kidney transplants are also in the at-risk population. The aim of this article is to review recent literature on immunosuppression and the effect it has on breast cancer prevalence in kidney transplant recipients ; to discuss the proposed pathologic mechanisms of breast cancer owing to concurrent immunosuppressive treatments ; and to review breast cancer screening recommendations for kidney transplant recipients. To attain relevant literature, we conducted literature search using PubMed databases, see PRISMA Diagram (Figure 1). The following MeSH Terms were used in the search: “breast cancer” ; “risk factors” ; “cancer screening” ; “kidney transplantation” ; “immunosuppression” ; and “cancer”. We reviewed a total of 409 articles after having applied exclusion criteria. These articles included randomized controlled trials, reviews, and systematic reviews. Importantly, we also utilized references from other review/primary research articles to attain additional relevant information previously not captured from our initial research. Breast cancer is the third leading malignant cause of death in Croatia, preceding lung and colorectal carcinoma. Generally, breast cancer develops due to a combination of hormonal, genetic and age-related factors. However, a signifi cant risk factor and critical motif in carcinogenesis is immunosuppression. Carcinogenic environmental factors, disturbed function of the immune system due to chronic use of immunosuppressive drugs, and genetic make-up infl uence the process of carcinogenesis in transplant patients. Immunosuppression reduces immunosurveillance that predisposes patients to increased viral oncogenesis and general carcinogenesis causing cancer to be the second most frequent cause of death in post-kidney transplant patients. Particularly, kidney transplant recipients are prone to carcinogenesis due to lifelong immunosuppressive regimens. Importantly, differences in cancer risk depend on the kidney recipient's cancer type. Certain malignancies, such as breast cancer, are not affected by immunosuppression as their relative risk is comparable to that of the general population. Due to the limited number of articles addressing post- transplant breast cancer (PTBC), we present here a comprehensive review of the topic, current understanding of its pathophysiology, and the role of screening in its diagnosis, treatment and overall management. The risk of developing PTBC in kidney transplant recipients is not increased when compared to the general population. It appears that the development of breast cancer in kidney transplant recipients is unrelated to transplantation immunosuppressive regimen and is mostly associated with aging and independent risk factors that can lead by themselves to kidney transplantation such as diabetes mellitus. Due to screening programs, PTBC is usually diagnosed early. However, if PTBC is diagnosed in advanced grades, it is associated with signifi cantly increased mortality risk. Therefore, it is recommended that patients be screened periodically compared to their age- and gender- matched counterparts from the general population. Notably, this is an area of ongoing research and requires further investigation. Due to the rarity of PTBC and scarce resources on the topic, most guidelines are extrapolated from the general population and are not corresponding to the minimal risk of developing PTBC. Similarly, treatment guidelines are inferred from the general population and do not account for the particular considerations in these patients such as graft survival, graft rejection, nephrotoxic chemotherapeutic drugs, and concurrent administration of immunosuppression. It is worth mentioning that the heterogeneity of results discussed in our review is perhaps due to differing immunosuppressive regimens, type of organ transplantation, concomitant comorbidities, length of follow-up, and screening protocols used. To draw clear guidelines tailored for this population, further investigation into the mechanisms of disease is warranted, with prolonged follow- up time in patients on differing immunosuppressive regimens to allow for subsequent comparison.

breast cancer ; risk factors ; cancer screening ; kidney transplantation ; immunosuppression

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