To investigate the impact of anxiety sensitivity (AS) on regional spontaneous neural activity in patients with breast cancer and to explore the interplay among brain activity, AS, and health anxiety-related metacognition (MC). Sixty-four breast cancer patients (33 with high AS[HAS-BC], 31 with low AS[LAS-BC]) and 42 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging(rs-fMRI). Regional homogeneity (ReHo) was calculated and analyzed using one-way analysis of variance (ANOVA), followed by post hoc analysis (Gaussian random field correction, voxel-level p < 0.001, cluster-level p < 0.05). Correlations between ReHo values and clinical scores (Anxiety Sensitivity Index-3 [ASI-3], Metacognitions Questionnaire-Health Anxiety [MCQ-HA], and Generalized Anxiety Disorder 7-item scale [GAD-7]) were examined. A mediation model was constructed to investigate relationships among neural activity, AS and health anxiety-related MC. Eight brain regions exhibited significant ReHo differences among the three groups: left pons, right inferior temporal gyrus (ITG), left middle temporal gyrus, right cerebellum lobule 4 and 5, right insula, right superior frontal gyrus, left postcentral gyrus, and right supplementary motor area. In breast cancer patients, ReHo in the right ITG was negatively correlated with MCQ-HA scores (r = -0.395, p = 0.0012). Mediation analyses revealed that ReHo in the right ITG mediated the relationship between ASI-3 and MCQ-HA scores (indirect effects = 0.111, 95 % CI [0.027, 0.238]). Altered spontaneous brain activity characterizes breast cancer patients with different levels of AS. Specifically, decreased ReHo in the right ITG mediates the relationship between AS and health anxiety-related MC in breast cancer patients.

Background: This study aimed to quantify the frequency and imaging features of new CT-detected pulmonary abnormalities during breast cancer chemotherapy and examine their associations with cumulative cyclophosphamide and paclitaxel exposure. Methods: This single-center retrospective study included 223 patients who underwent an on-treatment chest CT under an early-pandemic infection-control policy. New CT-detected pulmonary abnormalities were defined as new findings on this on-treatment CT that were absent on the pretreatment staging CT. Cumulative cyclophosphamide (C) and paclitaxel (T) doses (mg/m²) were calculated from treatment cycles before the on-treatment CT and dichotomized at 1800 and 960 mg/m², respectively. Associations were assessed using Firth-penalized logistic regression. Results: New CT-detected pulmonary abnormalities were identified in 34/223 patients (15.2%). Among 25 CT-positive cases with sufficiently detailed CT reports, patchy opacities (14/25, 56.0%) and ground-glass opacities (11/25, 44.0%) were the most frequent findings. Compared with patients with low cyclophosphamide and paclitaxel-equivalent exposure, combined exposure categories showed higher odds of the CT-detected outcome. In the Firth model, cyclophosphamide > 1800 mg/m² was associated with the CT-detected outcome (adjusted odds ratio (OR) 2.38, 95% CI 1.06–5.71; p = 0.036), whereas paclitaxel-equivalent exposure > 960 mg/m² (OR 2.46, 95% CI 0.86–6.80; p = 0.092) and age ≥ 60 years (OR 2.08, 95% CI 0.91–4.62; p = 0.083) were not statistically significant. Conclusions: New CT-detected pulmonary abnormalities were common during breast cancer chemotherapy (15.2%). Higher cumulative cyclophosphamide exposure was associated with the CT-detected outcome in multivariable analysis. Prospective longitudinal studies are needed to clarify the clinical significance of these abnormalities and their causality.

Anxiety sensitivity (AS) significantly impacts treatment outcomes and quality of life in breast cancer patients, yet the neural mechanisms underlying AS-related brain structural changes remain poorly understood. To investigate brain structural alterations associated with AS and their temporal evolution in patients with breast cancer. Eighty-five patients with breast cancer (42 with high AS and 43 with low AS) and 42 healthy controls (HCs) were recruited. Voxel-based morphometry analysis was conducted to examine gray matter volume (GMV) differences between the high and low AS patient groups and the HCs. Causal structural covariance network (CaSCN) analysis was employed to investigate the inferred temporal evolution of GMV alterations in relation to AS levels and disease duration using cross-sectional data. AS levels showed a marked decline within the first two months post-diagnosis before stabilizing. Both patient groups exhibited GMV reduction compared with HCs, with low AS patients showing more widespread atrophy. The left middle cingulum (MCC.L) GMV negatively correlated with AS scores in high AS patients (r = -0.448, P = 0.0029). CaSCN analysis revealed a directional influence pathway from the MCC.L to the right thalamus (THA.R), with the THA.R showing positive self-feedback. Conjunction analysis identified shared effects of decreasing AS and increasing illness duration mediated by the THA.R, resulting in concordant atrophy in regions such as the left cerebellum (lobule VI) and discordant changes in temporal, parietal, and limbic areas. THA.R plays a central role in mediating AS-related brain structural alterations in breast cancer patients, offering potential therapeutic targets for managing AS.