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Breast Cancer: Molecular Mechanisms, Diagnosis, and Treatment

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International Manual of Oncology Practice

Abstract

Breast cancer continues to be a significant health problem, with an annual incidence of over 1.7 million and annual mortality of 500,000 world-wide. Breast cancer remains one of the most common causes of cancer death in developed countries and its incidence in developing countries has been trending upward, becoming a major health burden in these countries, as well.

A tremendous amount of research has been devoted to understanding the causes of breast cancer and to developing new therapies for this disease. This broad-based effort has resulted in definition of multiple molecular pathways that contribute to the development of breast cancer. This body of information is being used to develop new assessments and therapies that are improving both the survival and the quality of life of breast cancer patients. In this chapter we review the molecular biology of breast cancer, its pathological assessment and diagnosis, and methods for risk stratification. The current methods for local and systemic treatment, incluing surgical management and adjuvant therapy are discussed.

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References

  1. International Agency for Research on Cancer. GLOBOCAN (2008) Estimated cancer incidence, mortality, prevalence and disability-adjusted life years (DALYs) worldwide in 2008. Available from: http://globocan.iarc.fr/

  2. Forouzanfar MH et al (2011) Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet 378(9801):1461–1484

    Article  PubMed  Google Scholar 

  3. Cancer Facts and Figures (2013) Available from: http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2013/index

  4. Leong SL et al (2010) Is breast cancer the same disease in Asian and Western countries? World J Surg 34(10):2308–2324

    Article  PubMed Central  PubMed  Google Scholar 

  5. Abdulrahman GO, Rahman GA (2012) Epidemiology of breast cancer in Europe and Africa. J Cancer Epidemiol 2012:5

    Article  Google Scholar 

  6. Ferlay J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer (Oxford, England: 1990) 49(6):1374–1403

    Article  CAS  Google Scholar 

  7. Chen WQ et al (2013) Incidence and mortality of breast cancer in China, 2008. Thorac Cancer 4(1):59–65

    Article  Google Scholar 

  8. Radford DM, Zehnbauer BA (1996) Inherited breast cancer. Surg Clin North Am 76(2):205–220

    Article  PubMed  CAS  Google Scholar 

  9. Maxwell KN, Nathanson KL (2013) Common breast cancer risk variants in the post-COGS era: a comprehensive review. Breast Cancer Res 15(6):212

    Article  PubMed Central  PubMed  Google Scholar 

  10. CGAN (2012) Comprehensive molecular portraits of human breast tumours. Nature 490(7418):61–70

    Article  Google Scholar 

  11. Curtis C et al (2012) The genomic and transcriptomic architecture of 2,000 breast tumours reveals novel subgroups. Nature 486(7403):346–352

    PubMed Central  PubMed  CAS  Google Scholar 

  12. Zheng S et al (2012) The pathologic characteristics of breast cancer in China and its shift during 1999–2008: a national-wide multicenter cross-sectional image over 10 years. Int J Cancer 131(11):2622–2631

    Article  PubMed  CAS  Google Scholar 

  13. Alexander DD et al (2010) Summary and meta-analysis of prospective studies of animal fat intake and breast cancer. Nutr Res Rev 23(1):169–179

    Article  PubMed  CAS  Google Scholar 

  14. Chlebowski RT et al (2003) Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative randomized trial. JAMA 289(24):3243–3253

    Article  PubMed  CAS  Google Scholar 

  15. Bernstein L, Ross RK (1993) Endogenous hormones and breast cancer risk. Epidemiol Rev 15(1):48–65

    PubMed  CAS  Google Scholar 

  16. Rosner B, Colditz GA, Willett WC (1994) Reproductive risk factors in a prospective study of breast cancer: the Nurses’ Health Study. Am J Epidemiol 139(8):819–835

    PubMed  CAS  Google Scholar 

  17. Love RR, Philips J (2002) Oophorectomy for breast cancer: history revisited. J Natl Cancer Inst 94(19):1433–1434

    Article  PubMed  Google Scholar 

  18. Hall JM, Couse JF, Korach KS (2001) The multifaceted mechanisms of estradiol and estrogen receptor signaling. J Biol Chem 276(40):36869–36872

    Article  PubMed  CAS  Google Scholar 

  19. Slamon D et al (1987) Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene. Science 235(4785):177–182

    Article  PubMed  CAS  Google Scholar 

  20. Slamon DJ et al (2001) Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med 344(11):783–792

    Article  PubMed  CAS  Google Scholar 

  21. Thery JC et al (2014) Resistance to human epidermal growth factor receptor type 2-targeted therapies. Eur J Cancer 50(5):892–901

    Article  PubMed  CAS  Google Scholar 

  22. Baselga J et al (2012) Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med 366(2):109–119

    Article  PubMed  CAS  Google Scholar 

  23. Venkitaraman AR (2002) Cancer susceptibility and the functions of BRCA1 and BRCA2. Cell 108(2):171–182

    Article  PubMed  CAS  Google Scholar 

  24. Fong PC et al (2009) Inhibition of poly(ADP-ribose) polymerase in tumors from BRCA mutation carriers. N Engl J Med 361(2):123–134

    Article  PubMed  CAS  Google Scholar 

  25. Weinberg RA (2007) The biology of cancer. Garland Science, New York

    Google Scholar 

  26. Luo J, Solimini NL, Elledge SJ (2009) Principles of cancer therapy: oncogene and non-oncogene addiction. Cell 136(5):823–837

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  27. Wood LD et al (2007) The genomic landscapes of human breast and colorectal cancers. Science 318(5853):1108–1113

    Article  PubMed  CAS  Google Scholar 

  28. Magbanua MJ et al (2012) Isolation and genomic analysis of circulating tumor cells from castration resistant metastatic prostate cancer. BMC Cancer 12(1):78

    Article  PubMed Central  PubMed  Google Scholar 

  29. Copeland NG, Jenkins NA (2009) Deciphering the genetic landscape of cancer – from genes to pathways. Trends Genet 25(10):455–462

    Article  PubMed  CAS  Google Scholar 

  30. Kreeger PK, Lauffenburger DA (2010) Cancer systems biology: a network modeling perspective. Carcinogenesis 31(1):2–8

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  31. Veeck J, Esteller M (2010) Breast cancer epigenetics: from DNA methylation to microRNAs. J Mammary Gland Biol Neoplasia 15(1):5–17

    Article  PubMed Central  PubMed  Google Scholar 

  32. Fiskus W et al (2007) Hydroxamic acid analogue histone deacetylase inhibitors attenuate estrogen receptor-alpha levels and transcriptional activity: a result of hyperacetylation and inhibition of chaperone function of heat shock protein 90. Clin Cancer Res 13(16):4882–4890

    Article  PubMed  CAS  Google Scholar 

  33. Perou CM et al (1999) Distinctive gene expression patterns in human mammary epithelial cells and breast cancers. Proc Natl Acad Sci U S A 96(16):9212–9217

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  34. Perou CM et al (2000) Molecular portraits of human breast tumours. Nature 406(6797):747–752

    Article  PubMed  CAS  Google Scholar 

  35. Sorlie T et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A 98(19):10869–10874

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  36. Esserman LJ et al (2012) Chemotherapy response and recurrence-free survival in neoadjuvant breast cancer depends on biomarker profiles: results from the I-SPY 1 TRIAL (CALGB 150007/150012; ACRIN 6657). Breast Cancer Res Treat 132(3):1049–1062

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  37. Paik S (2011) Is gene array testing to be considered routine now? Breast 20(Suppl 3):S87–S91

    Article  PubMed  Google Scholar 

  38. Bartlett JMS et al (2012) Mammostrat as an immunohistochemical multigene assay for prediction of early relapse risk in the tamoxifen versus exemestane adjuvant multicenter trial pathology study. J Clin Oncol 30(36):4477–4484

    Article  PubMed  CAS  Google Scholar 

  39. Zou H et al (2007) Highly methylated genes in colorectal neoplasia: implications for screening. Cancer Epidemiol Biomarkers Prev 16(12):2686–2696

    Article  PubMed  CAS  Google Scholar 

  40. Bergers G, Benjamin LE (2003) Tumorigenesis and the angiogenic switch. Nat Rev Cancer 3(6):401–410

    Article  PubMed  CAS  Google Scholar 

  41. Relf M et al (1997) Expression of the angiogenic factors vascular endothelial cell growth factor, acidic and basic fibroblast growth factor, tumor growth factor β-1, platelet-derived endothelial cell growth factor, placenta growth factor, and pleiotrophin in human primary breast cancer and its relation to angiogenesis. Cancer Res 57(5):963–969

    PubMed  CAS  Google Scholar 

  42. Fang H, DeClerck YA (2013) Targeting the tumor microenvironment: from understanding pathways to effective clinical trials. Cancer Res 73(16):4965–4977

    Article  PubMed  CAS  Google Scholar 

  43. Qian B-Z, Pollard JW (2010) Macrophage diversity enhances tumor progression and metastasis. Cell 141(1):39–51

    Article  PubMed  CAS  Google Scholar 

  44. Janakiram M et al (2012) T cell coinhibition and immunotherapy in human breast cancer. Discov Med 14(77):229–236

    PubMed Central  PubMed  Google Scholar 

  45. Stagg J, Allard B (2013) Immunotherapeutic approaches in triple-negative breast cancer: latest research and clinical prospects. Ther Adv Med Oncol 5(3):169–181

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  46. Onishi T et al (2010) Future directions of bone-targeted therapy for metastatic breast cancer. Nat Rev Clin Oncol 7(11):641–651

    Article  PubMed  CAS  Google Scholar 

  47. Kösters JP, Gøtzsche PC (2003) Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev. doi:10.1002/14651858.CD003373

    PubMed  Google Scholar 

  48. U.S.P.S.T.F. (2009) Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 151(10):716–726, W-236

    Article  Google Scholar 

  49. Tabar L et al (2001) Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality. Cancer 91(9):1724–1731

    Article  PubMed  CAS  Google Scholar 

  50. Nelson HD et al (2009) Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med 151(10):727–737, W237-42

    Article  PubMed Central  PubMed  Google Scholar 

  51. Bruening W et al (2012) Noninvasive diagnostic tests for breast abnomalities, vol 47, Comparative effectiveness reviews. Agency for Healthcare Research and Quality (US), Rockville

    Google Scholar 

  52. Burstein HJ, Harris JR, Morrow M (2011) Malignant tumors of the breast. In: De Vita VT, Lawrence TS, Roseberg SA (eds) Cancer: principles and practice of oncology. Lippincott Williams and Wilkins, Philadelphia, pp 1401–1446

    Google Scholar 

  53. Hindle WH (1999) Development and growth of the breast. In: Hindle WH, MD (eds) Breast care. Springer, New York, pp 28–39

    Google Scholar 

  54. Lester S, Cotran R (1999) The breast. In: Cotran R, Kumar V, Collins T (eds) Pathologic basis of disease. W.B. Saunders Company, Philadelphia, pp 1093–1119

    Google Scholar 

  55. Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19(5):403–410

    Article  PubMed  CAS  Google Scholar 

  56. Guidance for Industry and Food and Drug Administration Staff – In Vitro Companion Diagnostic Devices (2011) [cited 2014 January 21]; Draft guidance on companion diagnostic development]

    Google Scholar 

  57. Allred DC (2010) Issues and updates: evaluating estrogen receptor-[alpha], progesterone receptor, and HER2 in breast cancer. Mod Pathol 23(S2):S52–S59

    Article  PubMed  CAS  Google Scholar 

  58. Wolff AC et al (2013) Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol 31(31):3997–4013

    Article  PubMed  Google Scholar 

  59. Edge S et al (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  60. Gradishar WJ et al (2014) NCCN clinical practice guidelines in oncology: breast cancer. Version 2.2014

    Google Scholar 

  61. Fisher B et al (1985) Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 312(11):674–681

    Article  PubMed  CAS  Google Scholar 

  62. Suyoi A et al (2014) When is a completion axillary lymph node dissection necessary in the presence of a positive sentinel lymph node? Eur J Cancer 50(4):690–697

    Article  PubMed  CAS  Google Scholar 

  63. Giuliano AE et al (2011) Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 305(6):569–575

    Article  PubMed  CAS  Google Scholar 

  64. Tokin C et al (2012) Oncologic safety of skin-sparing and nipple-sparing mastectomy: a discussion and review of the literature. Int J Surg Oncol 2012:921821

    PubMed Central  PubMed  Google Scholar 

  65. EBCTCG (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378(9804):1707–1716

    Article  Google Scholar 

  66. Moran MS et al (2014) Society of Surgical Oncology-American Society for radiation oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol 21(3):704–716

    Article  PubMed  Google Scholar 

  67. Akyurek S, Yavas G (2013) Role of postmastectomy radiation therapy after neoadjuvant chemotherapy in locally advanced breast cancer. Exp Oncol 35(4):267–271

    PubMed  CAS  Google Scholar 

  68. Yang TJ, Ho AY (2013) Radiation therapy in the management of breast cancer. Surg Clin North Am 93(2):455–471

    Article  PubMed  Google Scholar 

  69. Whelan TJ et al (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362(6):513–520

    Article  PubMed  CAS  Google Scholar 

  70. Badwe R, Parmar V, Hawaldar R (2013) Surgical removal of primary tumor and axillary lymph nodes in women metastatic breast cancer at first presentation: a randomized controlled trial. In San Antonio breast cancer symposium, San Antonio, Abstract, pp S2–02

    Google Scholar 

  71. Virnig BA et al (2009) Diagnosis and management of ductal carcinoma in situ (DCIS). Evid Rep Technol Assess (Full Rep) 185:1–549

    Google Scholar 

  72. McLaughlin SA (2013) Surgical management of the breast: breast conservation therapy and mastectomy. Surg Clin North Am 93(2):411–428

    Article  PubMed  Google Scholar 

  73. Wapnir IL et al (2011) Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 103(6):478–488

    Article  PubMed Central  PubMed  Google Scholar 

  74. Masannat YA et al (2013) Challenges in the management of pleomorphic lobular carcinoma in situ of the breast. Breast 22(2):194–196

    Article  PubMed  Google Scholar 

  75. O’Malley FP (2010) Lobular neoplasia: morphology, biological potential and management in core biopsies. Mod Pathol 23(Suppl 2):S14–S25

    Article  PubMed  Google Scholar 

  76. Bramati A et al (2014) Efficacy of biological agents in metastatic triple-negative breast cancer. Cancer Treat Rev 40(5):605–613

    Article  PubMed  CAS  Google Scholar 

  77. Clark O et al (2014) Targeted therapy in triple-negative metastatic breast cancer: a systematic review and meta-analysis. Core Evid 9:1–11

    Article  PubMed Central  PubMed  Google Scholar 

  78. André F, Zielinski CC (2012) Optimal strategies for the treatment of metastatic triple-negative breast cancer with currently approved agents. Ann Oncol 23(suppl 6):vi46–vi51

    Article  PubMed  Google Scholar 

  79. Yang LH et al (2012) Survival benefit of tamoxifen in estrogen receptor-negative and progesterone receptor-positive low grade breast cancer patients. J Breast Cancer 15(3):288–295

    Article  PubMed Central  PubMed  Google Scholar 

  80. Fisher B et al (1998) Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 90(18):1371–1388

    Article  PubMed  CAS  Google Scholar 

  81. Visvanathan K et al (2013) Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 31(23):2942–2962

    Article  PubMed  Google Scholar 

  82. Dickler MN, Norton L (2001) The MORE trial: multiple outcomes for raloxifene evaluation – breast cancer as a secondary end point: implications for prevention. Ann N Y Acad Sci 949:134–142

    Article  PubMed  CAS  Google Scholar 

  83. Barrett-Connor E et al (2006) Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med 355(2):125–137

    Article  PubMed  CAS  Google Scholar 

  84. Siris ES et al (2005) Skeletal effects of raloxifene after 8 years: results from the continuing outcomes relevant to Evista (CORE) study. J Bone Miner Res 20(9):1514–1524

    Article  PubMed  CAS  Google Scholar 

  85. Vogel VG (2009) The NSABP Study of Tamoxifen and Raloxifene (STAR) trial. Expert Rev Anticancer Ther 9(1):51–60

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  86. den Hollander P, Savage MI, Brown PH (2013) Targeted therapy for breast cancer prevention. Front Oncol 3:250

    Google Scholar 

  87. Swaby RF, Sharma CG, Jordan VC (2007) SERMs for the treatment and prevention of breast cancer. Rev Endocr Metab Disord 8(3):229–239

    Article  PubMed  CAS  Google Scholar 

  88. Burstein HJ et al (2010) American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 28(23):3784–3796

    Article  PubMed  Google Scholar 

  89. Chia S et al (2008) Double-blind, randomized placebo controlled trial of fulvestrant compared with exemestane after prior nonsteroidal aromatase inhibitor therapy in postmenopausal women with hormone receptor-positive, advanced breast cancer: results from EFECT. J Clin Oncol 26(10):1664–1670

    Article  PubMed  CAS  Google Scholar 

  90. Johnston SR et al (2013) Fulvestrant plus anastrozole or placebo versus exemestane alone after progression on non-steroidal aromatase inhibitors in postmenopausal patients with hormone-receptor-positive locally advanced or metastatic breast cancer (SoFEA): a composite, multicentre, phase 3 randomised trial. Lancet Oncol 14(10):989–998

    Article  PubMed  CAS  Google Scholar 

  91. Piccart-Gebhart MJ et al (2005) Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 353(16):1659–1672

    Article  PubMed  CAS  Google Scholar 

  92. Romond EH et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 353(16):1673–1684

    Article  PubMed  CAS  Google Scholar 

  93. Pivot X et al (2013) 6 months versus 12 months of adjuvant trastuzumab for patients with HER2-positive early breast cancer (PHARE): a randomised phase 3 trial. Lancet Oncol 14(8):741–748

    Article  PubMed  CAS  Google Scholar 

  94. Pogue-Geile KL et al (2013) Predicting degree of benefit from adjuvant trastuzumab in NSABP trial B-31. J Natl Cancer Inst 105(23):1782–1788

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  95. Freedman RA, Muss HB (2014) Managing metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer in the older patient. J Geriatr Oncol 5(1):2–7

    Article  PubMed  Google Scholar 

  96. Goldhirsch A et al (2013) 2 years versus 1 year of adjuvant trastuzumab for HER2-positive breast cancer (HERA): an open-label, randomised controlled trial. Lancet 382(9897):1021–1028

    Article  PubMed  CAS  Google Scholar 

  97. Rayson D et al (2008) Anthracycline-trastuzumab regimens for HER2/neu-overexpressing breast cancer: current experience and future strategies. Ann Oncol 19(9):1530–1539

    Article  PubMed  CAS  Google Scholar 

  98. Buzdar AU et al (2013) Fluorouracil, epirubicin, and cyclophosphamide (FEC-75) followed by paclitaxel plus trastuzumab versus paclitaxel plus trastuzumab followed by FEC-75 plus trastuzumab as neoadjuvant treatment for patients with HER2-positive breast cancer (Z1041): a randomised, controlled, phase 3 trial. Lancet Oncol 14(13):1317–1325

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  99. Robidoux A et al (2013) Lapatinib as a component of neoadjuvant therapy for HER2-positive operable breast cancer (NSABP protocol B-41): an open-label, randomised phase 3 trial. Lancet Oncol 14(12):1183–1192

    Article  PubMed  CAS  Google Scholar 

  100. Geyer CE et al (2006) Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med 355(26):2733–2743

    Article  PubMed  CAS  Google Scholar 

  101. Incorvati JA et al (2013) Targeted therapy for HER2 positive breast cancer. J Hematol Oncol 6:38

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  102. Swain SM et al (2013) Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA study): overall survival results from a randomised, double-blind, placebo-controlled, phase 3 study. Lancet Oncol 14(6):461–471

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  103. Verma S et al (2012) Trastuzumab emtansine for HER2-positive advanced breast cancer. N Engl J Med 367(19):1783–1791

    Article  PubMed  CAS  Google Scholar 

  104. Sendur MA, Aksoy S, Altundag K (2013) Cardiotoxicity of novel HER2-targeted therapies. Curr Med Res Opin 29(8):1015–1024

    Article  PubMed  CAS  Google Scholar 

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Schuur, E.R., DeAndrade, J.P. (2015). Breast Cancer: Molecular Mechanisms, Diagnosis, and Treatment. In: de Mello, R., Tavares, Á., Mountzios, G. (eds) International Manual of Oncology Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-21683-6_9

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