Royal Perth Hospital, Western Australia, Australia.
University of Western Australia, Western Australia, Australia.
Breast. 2021 Oct;59:279-285. doi: 10.1016/j.breast.2021.07.014. Epub 2021 Jul 21.
High prevalence, unreliable risk discrimination and poor clinical outcomes are observed in malignant and benign breast diseases (BD). The involvement of microbial communities in the development of BD has become topical, and distal influences of microbial dysregulation in the breast have been well established. Despite advances, the role of the breast skin microbiota in BD remains unclear. Interactions between the skin microbiota and the underlying mucosal immune system are complex. In homeostasis, the skin offers a physical barrier protecting underlying breast tissue from skin commensals and noxious environmental triggers. Our review aims to illuminate the role of the skin microbiota in the development of BD.
Adhering to the PRISMA protocol, a systematic review was conducted utilising the Medline and Embase search engines.
Through a comprehensive search of the last ten years, twenty-two studies satisfied the inclusion criteria. Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes were identified as the most prevalent phyla of both breast tissue and skin in healthy controls and BD. High abundance of skin commensals, specifically some species of Staphylococcus, have been linked in breast cancer and metastases. Similarly, dysregulated microbial abundance is also seen in inflammatory and implant-associated BD. These findings raise the hypothesis that the skin microbiota plays a role in tissue homeostasis and may contribute to a range of breast pathologies. Several mechanisms of microbial transfer to underlying tissue have been proposed, including retrograde transfer through ductal systems, breakdown of the skin barrier, and migration through nipple-aspirate fluid.
Our review provides preliminary insights into the skin microbiota as a modifiable risk factor for BD. This raises opportunities for future studies in antimicrobials/probiotics as an adjunct to, or replacement of surgery; a diagnostic and/or prognostic tool for BD; and the possibility of conditioning the microbiota to manage BD.
恶性和良性乳腺疾病（BD）中存在高发病率、不可靠的风险鉴别能力和较差的临床结局。微生物群落参与 BD 的发展已经成为一个热门话题，并且已经充分证实了乳腺中微生物失调的远端影响。尽管取得了进展，但乳腺皮肤微生物群在 BD 中的作用仍不清楚。皮肤微生物群与潜在黏膜免疫系统之间的相互作用很复杂。在体内平衡中，皮肤提供了一个物理屏障，保护下方的乳腺组织免受皮肤共生菌和有害的环境触发因素的侵害。我们的综述旨在阐明皮肤微生物群在 BD 发展中的作用。
根据 PRISMA 方案，利用 Medline 和 Embase 搜索引擎进行了系统评价。
通过对过去十年的全面搜索，有 22 项研究符合纳入标准。在健康对照组和 BD 中，均鉴定出变形菌门、厚壁菌门、放线菌门和拟杆菌门为最常见的皮肤和乳腺组织菌群。皮肤共生菌，特别是某些葡萄球菌属物种的高丰度与乳腺癌和转移有关。同样，在炎症性和植入相关的 BD 中也观察到微生物丰度的失调。这些发现提出了一个假设，即皮肤微生物群在组织体内平衡中发挥作用，并可能导致一系列乳腺病理。已经提出了几种微生物向下方组织转移的机制，包括通过导管系统逆行转移、皮肤屏障破坏以及通过乳头抽吸液迁移。
我们的综述初步探讨了皮肤微生物群作为 BD 的可改变风险因素。这为未来的研究提供了机会，包括将抗生素/益生菌作为手术的辅助手段或替代品；BD 的诊断和/或预后工具；以及对微生物群进行调理以管理 BD 的可能性。
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