World Congress on Breast Cancer August 03-05, 2015 Birmingham, UK

Aurora Lasso Varela has completed her Ph.D. at the age of 25 years from Cantabria University (Spain) and she became specialist in Radiation Oncology from San Sebastian Oncologic Institute (Spain). She has worked as specialist in Radiation Oncology being in charge of treating breast cancer patients for more of ten years in Txagorritxu Hospital in Vitoria, Alava, Spain. At the present she works as radiation oncologist in Cruces Hospital, Vasque Country, Spain

Radiotherapy is used to complement conservative surgery in early stages of breast cancer and this combination achieves the same results in local control and survival as radical surgery. An important factor for local control is the time between surgery and starting RT. Evidence suggest that delays in the start of RT may have negative effects on treatment outcome [3] and negative implications for local control [4], however, there is no consensus on how long the starting of RT can be delayed after surgery without undesirable effects. We conducted a retrospective study including women with a primary diagnosis of breast cancer stage 0, I or II who underwent breast conserving surgery or mastectomy and treatment with radiotherapy, and we evaluated the appearance of recurrences and mortality 5 years after diagnosis. Patients were separated into two groups as a function of delay of radiotherapy beginning (≤6 weeks or more than 6 weeks). The mean age of women were 54 years (SD=9.5), the stage was I or II in 81.7% of them, and all of these received chemotherapy. 5.8% (n=16) of patients had a recurrence (n=16) and 2.9% (n=8) died within 5 years after diagnosis, half of them 4 (50%) due to neoplasm. 12 recurrences (75%) appeared in patients who began radiotherapy after 6 weeks of last treatment (surgery or chemotherapy). No significant differences were found in the probability of recurrence between two groups (p=0.233; OR 2.546 [0.548-11.837]). No significant differences were found either in the risk of dying p=0.680; OR 1.432 [0.260-7.896].

Maram completed her Radiologic Technology degree at Jordan University of Science and Technology (JUST) in 2005. After working two years as a teaching assistant, she received a Masters degree scholarship in Medical Imaging Science at Curtin University, Australia. Then she served another two years as a full-time lecturer at JUST. Maram is currently a Medical Radiation Sciences PhD student at the University of Sydney. She participated in many local and international conferences and she published several papers including a literature review “Digital tomosynthesis: A new future for breast imaging?” which was the most downloaded paper in Clinical Radiology in 2013.

Digital breast tomosynthesis (DBT) is a three-dimensional imaging technology that aims to reduce tissue superimposition encountered in digital mammography (DM). This study provides an evaluation of DBT in conjunction with DM in terms of localisation performance and the radiologists’ ability to identify lesion type compared with DM alone. Human ethics approval was obtained. Fifty cases (27 cancer and 23 non-cancer), each containing 2-view DM and 2-view DBT images, were reviewed by 23 experienced radiologists in two modes, DM alone and DM+DBT. Radiologists marked the location of the cancers, if present, gave it a score of 1-5 where 1 = “normal” and 5 = “malignant”, and reported its type (stellate mass, round mass, non specific density, architectural disturbance or microcalcifications). The radiologists’ performance in DM was compared with that using DM+DBT in terms of location sensitivity and Jackknife free-response receiver-operator characteristics (JAFROC) figure of metric (FOM). Use of DM+DBT resulted in significantly improved location sensitivity (0.563 vs 0.469, p< 0.00l) and JAFROC FOM (0.745 vs 0.621, p< 0.001) compared with DM alone. Adding DBT to DM increased the number of correctly identified stellate breast lesions (20.3% of stellate masses were missed on DM while correctly marked on DM+DBT compared with only 1.2% missed on DM+DBT and correctly marked on DM alone). This study suggests that adding DBT to DM significantly improves diagnostic performance for breast cancer detection and localisation as well as identification of stellate masses. Further research involving a higher numbers of specific lesion types is required.

Yunping Qiu has completed his PhD from Shanghai Jiao Tong University in China, and Postdoctoral studies from University of North Carolina at Greensboro in the USA. He is a Research Assistant Professor at Diabetes Research Center in Albert Einstein College of Medicine. He has co-authored more than 60 papers in reputed journals and has been serving as an Editorial Board Member of International Scholarly Research Notices.

Breast cancer is the most common invasive cancers for females. It caused more than 39,000 deaths in the U.S. in the year of 2012. About 20% of breast cancer cases cannot be detected by mammography. New diagnostic biomarkers or technologies for breast cancer are necessary. Here, we coupled mass-spectrometry based quantitative metabolites analysis with multivariate statistical technology to identify potential metabolites patternfor breast cancer diagnosis. We analyzed 146 lipid metabolites in the plasma samples from 55 female breast cancer patients and 25 healthy female controls. A number of 30 patients and 20 age-matched healthy controls were selected as the training dataset to identify potential biomarkers and to build the diagnostic model. The rest of the subjects were used as validation samples. Distinct separation between breast cancer patients and controls was achieved from an orthogonal partial least squares-discriminant analysis (OPLS-DA) model. A number of 39 metabolites were selected as differentially expressed metabolites based on the VIP (variable importance in the projection) values and the adjusted q values. We observed significantly lower levels of lysophosphatidylcholines and higher levels of sphingomyelins in the plasma samples obtained from breast cancer patients. Three metabolites were selected to build the diagnostic function (lysoPC a C16:0, PC ae C42:5 and PC aa C34:2), which successfully differentiated breast cancer patients from healthy controls, with a sensitivity of 98.1% and a specificity of 96.0% for the overall samples in this study. This result showed great potential of metabolomics in breast cancer diagnosis.

Fadia Gujam has completed her MSc of Surgical Oncology with Merit degree at the age of 32 years from University of Glasgow and now is at the end line of her PhD research (An investigation of breast cancer microenvironment) at the same institution. She has worked at the Institute of Cancer Research, Glasgow. She has published three papers in reputed journals.

Purpose: Tumour budding has previously been reported to predict survival in several solid organ tumours including breast; however, whether this is independent of other aspects of the tumour microenvironment is unknown. In the present study, the relationship between tumour budding, the tumour microenvironment and survival was examined in patients with invasive ductal breast cancer. Material and methods: Patients presenting between 1995 and 1998 were studied (n = 474). Tumour budding was measured utilising routine pathological slides at the invasive margin and its association with cancer specific survival (CSS) and clinicopathological characteristics examined. Results: Tumour budding was associated with CSS (hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.38–3.19, P = 0.001), independent of PR status, involved lymph node, necrosis, lymph (LVI) and blood (BVI) vessel invasion, and tumour stroma percentage (TSP). Further, tumour budding was independently associated with reduced CSS in node-negative disease (HR 3.06, 95% CI 1.41–6.67, P = 0.005), and those who have low TSP (HR 2.39, 95% CI 1.34–4.25, P = 0.003) and high grade local inflammatory infiltrative (HR 2.67, 95% CI 1.27–5.57, P = 0.009). Tumour budding was associated with several adverse pathological characteristics, including lymph node involvement, LVI, increased TSP and weaker local inflammatory infiltrative. Conclusions: The tumour budding was a significant predictor of survival in patients with invasive ductal breast cancer, independent of adverse pathological characteristics and components of tumour microenvironment. The present study further confirms the clinical utility of both tumour and host-based factors of tumour microenvironment.

Breast cancer is the most frequently diagnosed cancer and is the leading cause of death due to cancer among women worldwide. GLOBOCAN 2012 worldwide estimates showed that India had the highest breast cancer mortality, with 70,218 deaths. It has been seen that Indian women have a higher frequency of occurrence of breast cancer than Caucasians, particularly in the age group of <40 years. Studies worldwide have shown that young women diagnosed with breast cancer have a poor prognosis when compared to older women. However, the question remains as to whether the same trends are seen in India as well. OBJECTIVE: To study the patterns of breast cancer in young women. MATERIALS AND METHODS: Case records of all female patients diagnosed with breast cancer in Kasturba Medical College Hospital, Attavar, Mangalore between 2008-2011 were reviewed. Patients were divided into two groups – cases (≤40 years) and controls (>40 years). Clinical and histopathological data were recorded. The relationship between age and various histopathological and clinical parameters were analyzed using the Chisquare test. RESULTS: A total of 71 cases were evaluated out of which 18 were aged 40 and below (25%), and 53 were older than 40 years. The median age of presentation was 48 years, with the median age among the cases being 35 years and among the controls, 53 years. The frequency of T3 and T4 was greater among the younger patients. Younger patients had significantly less positive nodes than the older ones (p=0.047). None of the younger patients had presented with metastasis. Younger patients presented more often with Stage III cancer. ER and HER-2/neu negativity was more among the younger patients. Triple negative breast cancer (TNBC) was seen more frequently among the younger patients. The median survival for patients ≤40 years was 62 months and > 40 years was 50 months (p=0.157). The rate of recurrence of cancer was higher among the younger patients, with cancer in the lungs and liver showing significant association (p=0.019 for each). CONCLUSION: Young women diagnosed with breast cancer tend to present at later stages, have larger tumors, greater ER and HER2/neu receptor negativity, higher incidence of TNBC and a greater recurrence of cancer when compared to their older counterparts. These factors have been shown to be associated with a poor prognosis, and hence, breast cancer arising in young women should be treated aggressively to increase the overall survival of the patients.

Background Breast cancer is the leading cause of cancer deaths in the Maltese female population (Malta National Cancer Registry, 2014). Ensuring timeliness in its management is of utmost importance as it impacts prognosis. Aim To determine timeliness of care in the management of breast cancer patients in Malta, identify any delays and make recommendations for change. Methods Data Protection Unit permission was obtained. 100 cases were randomly selected from breast cancer surgeries carried out in 2014. Case files were accessed and service dates were audited. Cases were assigned to either Group A (n=16; referred from screening unit) or Group B (n= 78; all other referrals). 6 files were unavailable. Standard Used The breast cancer management pathway of the Central South Coast Cancer Network (UK) was used as standard. It advocates a maximum of 62 days from first contact to definitive treatment. Results For Group A there was a mean 41 day wait from initial imaging to referral to breast clinic. A mean of 74 days from first contact to surgery for Group A was found, in contrast with 53 days for Group B. The mean wait from first referral to first review at Breast Clinic stood at 7 and 6 days for Group A and B respectively. The triple assessment completion mean was 15 days for Group A and 14 for Group B. Histology reporting showed a mean of 8 days for both groups. Key messages The long wait experienced by patients seen first at breast screening unit needs to be addressed. Further information on waiting times depending on referral source is required.

Amplification or over-expression of the HER2 gene occurs in approximately 30% of breast cancers. HER2 proteins have been shown to form clusters in cell membranes that may play a role in tumorigenesis. It has been found that patients with ER+ (Estrogen receptor positive)/HER2+ compared with ER-/HER2+ breast cancers may actually benefit more from drugs that inhibit the PI3K/AKT molecular pathway. The PI3K/AKT/mTOR pathway is an intracellular signalling pathway important in apoptosis and hence cancer. In case of ER+/HER2+ breast cancer this pathway is overactive, thus reducing apoptosis and allowing proliferation. Various natural compounds, including epigallocatechin gallate(EGCG), caffeine, curcumin, resveratrol and Taxol, has been found to inhibit PI3K pathway. Also, synthetic inhibitors like Wortmanin and LY294002 has been found in inhibiting the PI3K pathway. Our study is based on designing natural inhibitors including epigallocatechin gallate(EGCG), caffeine, curcumin, resveratrol, taxol as well as for artificial inhibitors Wortmanin and LY294002; using ChemBioDraw Ultra 12.0 and ChemBio3D Ultra 12.0. Further we have done docking calculations using AutoDock 4.2 where Phosphoinositide 3-kinase was used as a receptor and was docked by all the seven ligands including the natural and the artificial. Screening was done using PyRx Virtual screening tool to find out the best Ligand (inhibitor) among the natural versus the synthetic, which binds and blocks the enzyme Phosphoinositide 3-kinase, which is part of this pathway and therefore, through inhibition, often results in tumour suppression. For docking the Lamarckian Genetic Algorithm has been followed. Based on the Gbindng value based on the scoring function designed it has been seen that Curcumin (Gbindng -679.46) has the best inhibitory effect followed by Taxol (Gbindng -638).