Day 1 :
Keynote Forum
Shahla Masood
University of Florida College of Medicine-Jacksonville, USA
Keynote: Why the Term of “Low Grade Ductal Carcinoma In situ†should be changed to “Borderline Breast Diseaseâ€: Diagnostic and Clinical Implications
Time : 9.05 - 9-25
Biography:
Shahla Masood is a Persian born physician, who currently holds the positions of Professor and Chair of the Department of Pathology at University of Florida College ofrnMedicine – Jacksonville and Chief of Pathology and Laboratory Medicine at UF Health Jacksonville. In addition, Dr. Masood is the Medical Director of UF Health BreastrnCenter. An internationally recognized expert in breast cancer diagnosis and prognosis, Dr. Masood has fostered the concept of an integrated multidisciplinary approachrnin breast cancer care, research, and education. She is the founder and Editor-in-Chief of The Breast Journal, the founder and past president of the “International Societyrnof Breast Pathology,†the Director of the “Annual Multidisciplinary Symposium on Breast Diseaseâ€, and “The Breast Cancer Public Forumâ€. Dr. Masood is heavily involvedrnin the study of minimally invasive procedures such as fine needle aspiration biopsy and ductal lavage in providing diagnostic and prognostic information in high risk andrnbreast cancer patients. She defined the cytomorphology of high-risk proliferative breast disease in the early 1990s and has pioneered the concept of cytomorphology as arnbreast cancer predictor. Dr. Masood is the author of several textbooks, book chapters, and numerous publications. She is a frequent speaker at national and internationalrnsymposiums and consensus meetings. She is also a member of the board of trustees of several prestigious scientific societies and organizations at local, regional, nationalrnand international levels. Dr. Masood has received numerous awards and recognition for her scientific work, her contribution to advancing global breast health educationrnand her efforts to improve the quality of breast health care. She is the recipient of “The 2010 Breast Health Global Initiative Award,†“Courage to Teach Award†from NationalrnAccreditation Council for Graduate Medical Education, and Florida Times Union “Eve Award,†to name a few. She has been named as one of the Top Doctors in America,rnTop Doctors in Cancer and one of the 20 Top Most Influential Professors in Oncology at an international level. She was recently recognized at the 15 Year Anniversary ofrnRace for a Cure in Rome, Italy for her efforts in initiation of the Komen Italia, Race for the Cure. Dr. Masood is a patient advocate, a partner in community affairs and anrnaccomplished artist and gourmet chef.
Abstract:
During the last several years, increased public awareness, advances in breast imaging and enhanced screening programs have ledrnto early breast cancer detection and attention to cancer prevention. The numbers of image-detected biopsies have increasedrnand pathologists are expected to provide more information with smaller tissue samples. These biopsies have resulted in detectionrnof increasing numbers of high-risk proliferative breast disease and in situ cancers. The general hypothesis is that some forms ofrnbreast cancers may arise from established forms of ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH) andrnpossibly from more common forms of ductal hyperplasia. However, this is an oversimplification of a very complex process, givenrnthe fact that the majority of breast cancers appears to arise de-novo or from a yet unknown precursor lesion. Currently, ADHrnand DCIS are considered as morphologic risk factors and precursor lesions for breast cancer. However, morphologic distinctionrnbetween these two entities has remained a real issue that continues to lead to overdiagnoses and overtreatment. Aside fromrnmorphologic similarities between ADH and low grade DCIS, biomarker studies and molecular genetic testing’s have shown thatrnmorphologic overlaps are reflected at the molecular levels and raise questions about the validity of separating these two entities. Itrnis hoped that as we better understand the genetic basis of these entities in relation to ultimate patient outcome, the suggested usernof the term of “Borderline Breast Disease†can minimize the number of patients who are subject to over treatment.
Keynote Forum
Prof. Raj Kumar
Department of Basic Sciences, The Commonwealth Medical College, Scranton, PA, USA
Keynote: A novel therapeutic approach for triple-negative breast cancer
Time : 09:45-10:05
Biography:
Dr. Kumar received his Ph.D. degree in Neuro-toxicology and is currently a Professor of Biochemistry at The Commonwealth Medical College, Scranton, PA, USA. Dr. Kumar’s research area is focused on the therapeutic targeting of the steroid receptors (SRs) for endocrine-related cancers. Currently, his laboratory is working on a novel therapeutic strategy that could provide cell/tissue-specific target gene regulations in current SHR-based endocrine therapies. In addition to more than 100 publications to his credit, Dr. Kumar has also served as Editorial Board member of more than two-dozen scientific journals, and as expert reviewer on more than two-dozen grant review panels.
Abstract:
Triple–negative breast cancer (TNBC) is frequently diagnosed in younger women and is highly aggressive with early pattern of metastasis, limited treatment options, and poor prognosis. A recent study showed that blocking glucocorticoid receptor (GR) activity could potentiate chemotherapy-induced cytotoxicity in TNBC. However, due, in part, to mainly targeting GR’s activation function domain, AF2 and largely overlooking AF1 activity, cell/tissue-specific efficacy of GR antagonists has been low. It thus is axiomatic that attempts to precisely control GR activity in TNBCs without controlling AF1 activity will be of limited success. We recently showed that the antagonist-bound receptor, which blocks coactivator interactions with AF2, opens AF1 surfaces for such interactions with coactivators including SRC-1. We also reported that TBP-induced AF1 conformation suits for SRC-1 interaction and subsequent transcriptional activity. Our western blot data also showed that the level of TBP and SRC-1 are higher in MDA-MB-231, TNBC cells compared to MCF-7 cells. Increased Expression of TBP and SRC-1 have been suggested to contribute to oncogenesis in breast cancers. Interestingly, the level of GR expression is constitutively higher in the nucleus of MDA-MB-231 cells compared to MCF-7 suggesting that the GR in TNBC may be transcriptionally active even in the absence of an endogenous hormone. Therefore the role of TBP/SRC-1/AF1 in modulating GR-mediated specific gene regulation in TNBCs may be critical. We have identified a small peptide that can block GR AF1/TBP/SRC-1. It is expected that the results from these studies may provide a novel therapeutic strategy to inhibit TNBC tumor growth.
- Biology of Breast Cancer
Chair
Shahla Masood
University of Florida College of Medicine-Jacksonville, USA
Co-Chair
Christopher Busby
Environmental Research SIA, Latvian Academy of Sciences, Latvia
Session Introduction
Christopher Busby
Environmental Research SIA, Latvian Academy of Sciences, Latvia
Title: The breast cancer epidemic: Evidence for a radiogenic cause
Biography:
Christopher Busby obtained a 1st class degree in Chemistry from London University and a PhD Chemical Physics from the University of Kent. He worked in the physical chemistry of molecular cell interactions for Welcome and began research in the biological effects of internal radionuclides in 1989. He was a member of two UK government committees on internal radiation and has published more than 30 research papers, many articles and three books on this issue. He is a reviewer for several journals on the issue of radiation and health. He was visiting Professor at the University of Ulster until his retirement and is currently Director of Environmental Research SIA, based in Riga, Latvia. He has been Scientific Secretary of the European Committee on Radiation Risk based in Brussels since 1998.
Abstract:
The marked increase in rates of breast cancer, together with the reduction in the age of onset of the disease which began in the 1980s, point to some environmental cause. An early analysis of cohort effects in breast cancer mortality in England and Wales was presented at the 1998 World Breast Cancer Conference in Ontario. Cohort effects suggest that the principal cause was exposure to radionuclides in atmospheric test fallout. This provided a basis for epidemiological studies of breast cancer mortality near three nuclear sites in England and Wales, the results of which are presented here. Using small area data supplied by the Office for National Statistics we found a statistically significant doubling of the risk of dying of breast cancer in census wards close to the offshore coastal sediment contaminated by routine releases from the Hinkley Point nuclear site in Somerset between 1994 and 2004. In a separate study using the same data source we found a significant doubling of breast cancer mortality in small area census wards adjacent to coastal sediment contaminated by releases from the Bradwell nuclear power station in Essex. A third study employed an epidemiological questionnaire approach to examine breast cancer incidence downwind of the nuclear power station at Trawsfynydd in Wales. Results showed a statistically significant 4-fold excess incidence in the ten years prior to the survey. Taken together and with other evidence these results support the belief that the increases in breast cancer seen in the last 30 years are principally radiogenic in origin.
Vicente Marco
Hospital Quirón Barcelona, Spain
Title: Changes in breast cancer pathology reports after second opinion
Biography:
Vicente Marco graduated from the University of Barcelona Medical School. He underwent residency training in Anatomic Pathology at the State University of New York, Buffalo, NY, USA. He is certified by The American Board of Pathology. Currently, he is Director of the Department of Anatomic Pathology at Hospital Quirón Barcelona, Barcelona Spain. He has published more than 25 papers in reputed journals and has been serving as an Editorial Board Member of Diagnostic Pathology.
Abstract:
A second opinion in breast cancer pathology reports may be requested when a patient is referred from another institution for treatment. This may uncover significant discrepancies that impact on patient management and prognosis. These discrepancies are related to the histologic diagnosis, the presence or absence of invasion in carcinomas, and the results of predictive factors of response (hormone receptors and HER2). A significant improvement in the concordance among pathologists in the assessment of breast cancer lesions can be achieved by careful histologic study, following standardized criteria and using high quality techniques. Also, complete and accurate clinical information is needed for pathological assessment.
San Ming Wang
University of Nebraska Medical Center, USA
Title: The unknown predisposition can lie deep in the family tree
Biography:
San Ming Wang completed his graduate training from Swiss Institute for Experimental Cancer Research, and Postdoctoral studies from Northwestern University and University of Chicago. He is an Associate Professor in UNMC, specializing in cancer genetics and genomics. He has published over 60 papers in reputed journals.
Abstract:
Genetic predisposition is the primary risk factor for hereditary breast cancer. For the majority of familial breast cancer, however, the genetic predispositions remain unknown. Currently, detection of the unknown predispositions is largely through screening large numbers of pooled individual cases, and the newly identified predispositions occur in disease population. Considering that family unit is the basic structure of genetics and hereditary breast cancer is an autosomal dominant disease, the disease family must carry the same genetic predisposition across generations. Therefore, focusing on the cases in lineages of familial breast cancer, rather than pooled, genetically-unrelated cases in disease population, is expected to provide high probability to identify the genetic predisposition for each family. We tested this concept by studying the family-specific variants in hereditary breast cancer families. We used exome sequencing to analyze three disease families and 22 probands with BRCAx (BRCA-negative) hereditary breast cancer. We observed the presence of family-specific, novel, deleterious germline variants in each family. Certain variants are putative deleterious genetic predispositions damaging functionally important genes involved in DNA replication and damaging repair, tumor suppression, signal transduction, and phosphorylation. Our study demonstrates that the unknown predispositions for many BRCAx hereditary breast cancer families can lie in each disease family. The application of a family-focused approach has the potential to detect those unknown predispositions.
Biography:
Gaspar Banfalvi studied pharmacy and received doctorate in Szeged (1972), spent two years at the Institute for Drug Research (Budapest, 1972-1974). He obtained degrees (CSc, DSc, Med. Habil.) at the Department of Medical Chemistry, Budapest and Habil. Biol. at University of Szeged. He took a biology chair at University of Debrecen (2000 - 2005). Teaching obligations: chemistry, biochemistry, cell biology, genetics, physiology. Longer visits: > 4 years Boston, 5 months Leiden, 6 mo NCTR, 8 mo Weizmann Institute. Research interest: DNA structure and function, genotoxicity, metastasis.
Abstract:
Abdominal organs (liver, kidney, spleen) are frequent targets of cancer cell invasion, but less known for their metastatic potential to other organs (e.g. breast). In spite of the possible connection between the pathogenesis of liver and breast cancers the study of this relationship was neglected. The spread of abdominal tumors to internal mammary lymph nodes has not been reviewed earlier. The idea of breast cancer being a metastasis rather than a primary btumor is based on the metastatic spread of rat tumor cells released by abdominal primary tumors (He/De, Ne/De) and leukemia (My1/De, My2/De) cells. The metastatic process starts with the peripheral disruptions of primary tumors. Tumor cells released into the abdomen cross the apertures of the diaphragm and enter the thoracal lymph nodes. Tumor cells accumulate in parathymic lymph nodes. Abdominal colloidal carbon particles faithfully mimic the migration of tumor cells and deposit in parathymic lymph nodes. Explanation is provided why the connection between abdominal tumors and mammary tumors escaped attention, notably rodent parathymic lymph nodes in humans were referred to as internal mammary or parasternal lymph nodes. These developments will impact future breast cancer diagnosis and therapy.
Tibor Tot
European Society of Pathology Sweden
Title: Multiparameter characterization of breast carcinoma: subgross, microscopy, proteins, and genes
Biography:
Tibor Tot, associate professor of pathology at the University of Uppsala and head of Laboratory Medicine Dalarna, Sweden, is faculty member of the breast pathology arm of the European School of Pathology (ESP), and scientific director in the European School of Oncology Certificate of Competence in Breast Cancer program. Publications: 6 textbooks, 20 book chapters, and 80 journal articles mostly on radiological – pathological correlation of breast diseases. He is repeatedly invited speaker on international congresses, member of the European Working Group for Breast Cancer Screening Pathology and past chair of the Working Group for Breast Pathology of the ESP.
Abstract:
The morphology of breast carcinoma is often very complex. Tumor characteristics which are detectable at the low resolution level of radiology and those detectable only with high resolution of microscopy or even higher resolution of gene sequencing are seemingly very different, but a close relationship between them can be evidenced. As the subgross morphological parameters and molecular phenotypes have been studied separately, this relationship has not received the attention it deserves. Tumor size, lesion distribution, disease extent, and intratumoral and intertumoral heterogeneity are subgross morphological parameters of breast carcinomas that are essential for proper diagnostic characterization of the disease. If assessed adequately by modern multimodality radiology and large-format histopathology, these parameters individually provide significant prognostic information. The molecular phenotype categories for breast carcinomas were recently defined and their prognostic and predictive power is determined. Luminal A tumors are often small and stellate (star-like) at radiology and rarely associated with calcifications. Luminal B, basal-like and triple negative cancers are most often round/oval and are significantly larger at average at the time of detection compared to Luminal A tumors. HER2 expressing tumors are more often multifocal and associated with a high-grade in situ component (casting type microcalcifications) than cancers with other molecular phenotypes. Diffuse invasive carcinomas are rare but have an unfavorable prognosis, despite having luminal phenotype. The interrelation of subgross, microscopic and molecular parameters indicate the necessity of multiparameter characterization of breast carcinomas for proper diagnosis and therapy.
Werner Boecker
University of Münster, and Hamburg, Germany
Title: Syringomatous tumour of the nipple and low-grade adenosquamous carcinoma: Evidence for a common origin
Biography:
Werner Boecker completed his dissertation at the age of 25 years at the Intitute of Pathology, University of Hamburg where he studied pathology under his teacher Gerhard Seifert. At the age of 34 he was appointed as Professor at the same institution. In 1997 he was appointed as Director and Professor of the Gerhard-Domagk-Institute of the University of Muenster. He has published more than 200 papers in reputed journals, has been serving as an editorial board member and published the books â€Breast Preneoplasia: A New conceptual approach†and the German Book “Pathologieâ€. .
Abstract:
Syringomatous tumour of the nipple and low-grade adenosquamous carcinoma (LGAdSC) of the breast are regarded as distinct entities. To clear the nature of these two lesions, we compared the expression of different lineage/differentiation markers in 12 syringomatous tumours of the nipple, 10 syringomas of skin and 9 LGAdSC, and normal breast epithelium. Using triple immunofluorescence labelling and quantitative RT-PCR studies for different keratins, p63 and SMA, we demonstrated that syringomatous tumour of the nipple and LGAdSC are identical or nearly identical lesions. Both contain p63+/K5/K14+ tumour progenitors from which, based on the sequential expression of these markers, K10+ squamous and K8/18+glandular lineage arise. In contrast , syringoma of skin does not express K8/18. Identical p63+/K5/14+ cells were also found in the normal breast duct epithelium. Based on our findings, we suggest that physiological p63+/K5/14+ counterparts of the normal breast duct epithelium or early related cells might play a key role in neoplastic transformation of both syringomatous tumour and LGAdSC. We propose that the differentiation patterns found in both lesions reflect the early ontogenetic stages of the normal breast epithelium.
Elena Bonanno
University of Rome Tor Vergata, Italy
Title: Microcalcification as an active phenomenon mediated by epithelial cells with mesenchymal characteristics
Biography:
Elena Bonanno, MD, PhD; (medical school degree in 1984; PhD degree in 1990) aggregate professor of pathology at University of Rome Tor Vergata, actually in charge of Cytopathology and breast pathology at Tor Vergata University Hospital. She published more than 80 scientific papers, 4 chapters in book. She actively participate to the Italian group of breast pathology study (GIPAM).
Abstract:
Mammary microcalcifications have a crucial role in breast cancer detection, but the processes that induce their formation are unknown. Moreover, recent studies have described the occurrence of the epithelial–mesenchymal transition (EMT) in breast cancer, but its role is not defined. Elemental analysis of microcalcifications by EDX revealed that the complex formation of calcium hydroxyapatite was strictly associated with malignant lesions whereas calcium-oxalate is mainly reported in benign lesions. Morphological studies demonstrated that epithelial cells with mesenchymal characteristics were significantly increased in infiltrating carcinomas with microcalcifications and in cells with ultrastructural features typical of osteoblasts close to microcalcifications. These data were strengthened by the rate of cells expressing molecules typically involved during physiological mineralization (i.e. BMP-2, OPN) that discriminated infiltrating carcinomas with microcalcifications from those without microcalcifications. Although the phenomenon of breast microcalcifications could be sustained by several mechanisms, the finding of osteoblast-like cells led us to hypothesize that microcalcifications in breast lesions could represent an active process related to epithelial to mesenchymal transition. New insights into the complex phenomenon of breast microcalcification could better define the pathophysiology of different microcalcifications. The introduction of mesenchymal markers such as vimentin and elemental analysis of breast lesions with microcalcifications may add further data to complete the clinical setting in the diagnosis and care of patients. The finding of a specific elemental composition associated with microcalcifications in cancer could enhance imaging technologies to discriminate microcalcifications in vivo, and thus act as a helpful tool in breast cancer screening.
Mieke Van Hemelrijck
King’s College London, London UK
Title: A role for lipids and statins in breast cancer risk and prevention?
Biography:
Following an MSc in Biomedical Sciences (2001-2005) and an MSc in Statistical Analysis (2005-2006) at Ghent University, Dr Van Hemelrijck obtained an MSc in Population & International Health at the Harvard School of Public Health (2006-2008). In 2010 she finished her PhD in Cancer Epidemiology at King’s College London. Her study findings, published in over 600 news articles to date, had a significant impact on the US Food and Drug Administration safety guidelines for commonly used prostate cancer drugs. In 2012, she was appointed as a Lecturer in Cancer Epidemiology at King’s College London, where she now runs the Cancer Epidemiology Group and has several PhD students working on breast cancer using data from Guy’s Hospital (London) and Uppsala University (Sweden).
Abstract:
Epidemiological evidence suggests a link between obesity and breast cancer. The lipid and glucose metabolisms have been postulated as possible intermediary mechanisms. Moreover, recent research suggests that statins, a group of drugs commonly prescribed to help lower serum cholesterol levels, may simultaneously reduce risk of fatal cancer. Here, we report on studies conducted based on several large Swedish cancer databases. Links between serum glucose and lipids and breast cancer severity at time of diagnosis were investigated in 35,017 women from the Swedish AMORIS cohort. Proportional odds models, with adjustment for interval time between serum measurement and diagnosis, were conducted. Despite the size and detail of the data in AMORIS, we only found a modest positive association between serum levels of glucose, apoB/ApoA-1 and BC severity, suggesting that these factors are not the main players in the link between obesity and BC aggressiveness. The effect of statins on cancer-specific death was assessed using two Swedish cancer databases. Marginal structural models based on inverse probability weights were applied to a pooled logistic regression model to estimate the causal effect of statins on cancer-specific death. These findings show that well-defined clinical trials are needed before the effect of a(ny) drug on cancer-specific mortality can be claimed, and observational research into drugs in relation to diseases other than their intended purpose should be interpreted cautiously. Despite increasing observations about a role for obesity in breast cancer carcinogenesis, more population-based studies and randomized clinical trials incorporating information on several factors of the lipid metabolism are needed to disentangle how targeting the lipid metabolism may fight breast cancer.
- Symposium on “Implementing recent advances in breast cancer diagnosis and treatment: The University of Tennessee Medical Center at Knoxville experience"
Session Introduction
Amila Orucevic
University of Tennessee Medical Center, USA
Title: Prognostic value of ER, PR, and HER2 breast cancer biomarkers and AJCC’s TNM staging system on overall survival of Caucasian females with breast cancer: An institution’s 10 year experience
Biography:
Amila Orucevic obtained MD degree from Medical School of University of Sarajevo, Bosnia and Herzegovina (1983) and PhD from The University of Western Ontario, London, Ontario, Canada (1996). She is a board certified pathologist for Anatomic and Clinical Pathology by The American Board of Pathology (2002), and board certified pathologist for Anatomic Pathology by The Royal College of Physicians and Surgeons of Canada (2002). Currently, she is Attending/Staff pathologist, Associate Professor, and Director of Research at the Department of Pathology, The University of Tennessee Medical Center, Knoxville, TN, USA. She published 21 papers in reputed peer reviewed journals.
Abstract:
The Breast Cancer Task Force and many recently published studies questioned relevance of AJCC’s TNM staging system in predicting outcomes in breast cancer because of the increasing understanding of prognostic impact of breast cancer biomarkers (ER/PR/HER2). Inclusion of biomarkers into the TNM system (bTNM) with goal of improving the TNM staging accuracy was suggested. We tested whether any of three recently proposed bTNM systems could improve the prognostic accuracy of breast cancer staging in our institution’s breast cancer patient population (>90% are Caucasians). 1253 Caucasian women diagnosed with primary invasive breast carcinoma from 1/1998-7/2008 entered our study. Breast cancers were grouped according to their TNM stage, or recently proposed bTNM systems: #1-bTNM-triple negative ER/PR/HER2 phenotype (TNP) vs. non-TNP; #2-bTNM ER status/grade/TNM stage; #3-bTNM-five-group ER/PR/HER2 subtype classification system recommended by St. Gallen International Consensus Panel in 2011.Overall survival (OS) was measured. TNM stage was significant predictors of OS in any bTNM used (#1-#3). In #1-bTNM, TNP significantly worsened prognosis/survival only in higher TNM stages (III&IV). In #2-bTNM, ER/grade and in #3-bTNM, five-group ER/PR/HER2 subtype classification had no significant impact on OS. Our data support the traditional TNM staging as a continued relevant predictive tool for breast cancer outcomes and show that biomarkers may improve the accuracy of TNM staging in advanced stages of breast cancer, but are dependent on classification system used. We propose systematic analyses of proposed bTNM ER/PR/HER2 classification systems in different study environments (both nationally and internationally) before biomarkers are fully incorporated into the TNM staging system (bTNM).
Daniel H. Snyder
The University of Tennessee Medical Center, USA
Title: Breast cancer in young age (≤40 years): The University of Tennessee Medical Center at Knoxville 10 year experience
Biography:
Dr. Daniel Snyder received his Bachelor of Science degree in Biology at Tennessee Technological University in Cookeville, TN in 2010, and earned his medical degree from Lincoln Memorial University-DeBusk College of Osteopathic Medicine in Harrogate, TN in 2014. Currently, Dr. Snyder is a PGY-1 resident in the Anatomic and Clinical Pathology Residency Program at the University of Tennessee Medical Center in Knoxville, Tennessee. His research interests include breast cancer, biomarkers, and patient outcomes.
Abstract:
Young age at diagnosis of breast carcinoma (BC), triple negative ER/PR/HER2 phenotype, and non-Caucasian race have all been reported to have a negative impact on patient outcome. We evaluated the prognostic value of ER/PR/HER2 subtypes, pathologic tumor characteristics, and TNM stage on overall survival (OS) of young Caucasian female patients (≤40y/o) with invasive BC from our institution over a 10 year period (1/1/1998-7/1/2008), and analyzed the type of therapy received (last follow-up day 8/1/2013). Eighty ≤40y/o patients (6.3% of study population) had complete ER/PR/HER2 data and were divided into five-ER/PR/HER2 groups per 2011 St. Gallen International Consensus Panel classification system. The effect of ER/PR/HER2 subtype on OS was measured using a Kaplan-Meier curve. A multivariate Cox regression was used when ER/PR/HER2 subtype was controlled for grade and TNM stage. 41% of patients were ER+/PR+/HER2- subtype, 31% ER+/PR+/HER2+ or ER-/PR-/HER2+, and 28% ER-/PR-/HER2-. The majority presented with grade 3 invasive BC (67.5%) and TNM stage II (50%). Only 17% had negative lymph nodes. 50% underwent modified radical mastectomy, 29% had breast conserving surgery, 46% had radiation, 82% received adjuvant chemotherapy and 80% of ER+ patients received hormonal therapy. Patients with ER+/PR+/HER2- subtype had significantly better OS than ER-/PR-/HER2- or ER+/PR+/HER2+ (p=.035) in a univariate analysis. However, when ER/PR/HER2 subtype was controlled for TNM stage and grade, only TNM stage was a significant predictor of OS (p<.001). These results are in concordance with our previously published data on the effects of ER/PR/HER2 on OS, and will be compared/contrasted to results from literature.
James M. McLoughlin
University of Tennessee Medical Center, USA
Title: The role of intraoperative fluoroscopy to improve negative margin resection of partial mastectomies: a single institution experience
Biography:
James McLoughlin earned his MD from Rush University in Chicago, IL and completed a general surgery residency at Baylor University Medical Center in Dallas, TX. He completed a surgical oncology fellowship at the H. Lee Moffitt Cancer in Tampa, FL. His practice is primarily focused on the care of breast cancer patients. His research interest is in improving clinical and surgical outcomes and identifying disparities in cancer outcomes.
Abstract:
The estimated positive margin rate for partial mastectomies for in situ or invasive breast cancer is between 15% - 24% though reported rates widely vary. In an attempt to decrease the positive margin rate for partial mastectomies, intraoperative fluoroscopy was added to the pre-incision operative planning as an additional tool to improve intraoperative accuracy. Beginning in January 2011 – December 2014, 220 women underwent a wire guided partial mastectomy with the pre-incision aid of intraoperative fluoroscopy. Surgical planning was based on the fluoroscopic images as well as the mammographic images taken post wire placement. All excised specimens were immediately evaluated with a specimen radiograph. Final margin status was assessed on permanent section. Positive margins were defined as tumor on ink. Close margins were considered negative if no tumor was seen on the inked margin. Margin status was compared to national rates as well as institutional rates prior to the addition of fluoroscopy. Despite vigorous fluoroscopic mapping, the overall positive margin rate did not decrease compared to the historic rates. It specifically had no impact on margins for DCIS or invasive lobular carcinoma. Overall, intraoperative fluoroscopy did not improve the negative margin rate compared to standard techniques for a partial mastectomy. The role for intraoperative fluoroscopy was most beneficial for planning surgery in difficult locations such as deep tumors in large breasts. It was also a useful teaching tool for junior residents learning three dimensional surgical planning. The role of intraoperative fluoroscopy should be determined on an individual patient basis.
Heather Gage
The University of Tennessee Medical Center, USA
Title: HER2+ breast cancer: Pre and post adjuvant anti-HER2 therapy era - the University of Tennessee Medical Center at Knoxville 11 year experience
Biography:
Dr. Heather Gage received a Bachelor of Arts degree in Physics from Bryn Mawr College, Pennsylvania in 2008, and received her medical degree from University College Cork, Ireland in 2013. Currently, Dr. Gage is a PGY 1 resident in the Anatomic and Clinical Pathology Residency Program at the University of Tennessee Medical Center in Knoxville, Tennessee. Research interests include breast cancer, biomarkers, and outcomes.
Abstract:
Large randomized trials have shown that adjuvant anti-HER2 therapy is efficient in reducing the risk of recurrence and improving the survival in patients with HER2+ breast cancer (BC). We evaluated whether the introduction of adjuvant anti-HER2 therapy for treatment of HER2+ BC patients in an academic institution settings outside of clinical trials had similar effect on overall survival (OS). Two-hundred-fifteen of 309 Caucasian females diagnosed with HER2+ invasive BC at our academic institution from 1998-2009 were studied. They were divided into 2 groups based on the time of diagnosis (before or after 11/2005, the start date of adjuvant anti-HER2 therapy administration as standard practice for operable HER2+ BC at our institution). Group 0 (G0) included 119 HER2+ patients diagnosed before 11/2005; Group 1 (G1) included 95 HER2+ patients diagnosed after 11/2005. Both groups were further subdivided based on ER/PR/HER2 subtype: G0 had 72 ER+/PR+/HER2+ and 48 ER-/PR-/HER2- patients. G1 had 56 ER+ PR+/HER2+ and 39 ER-/PR-/HER2+ patients. Ninety-four patients from G0 followed for >120 months were excluded from the study, to balance the G0 and G1 groups’ follow-up time. OS was measured by Kaplan-Meier curve. Although only 2/3 of G1 patients received anti-HER2 therapy, OS significantly improved (p<.003), largely due to an effect on the ER-/PR-/HER2+ group. This was also reflected in five-year survival (G0:ER-/PR-/HER2+=68.8%, G1:ER-/PR-/HER2+=84.6%; G0:ER+/PR+/HER2+=83.3%, G1:ER+/PR+/HER2+=85.7%). Our results are comparable to results from the clinical trials for anti-HER2 therapy in adjuvant settings. Similarities and differences will be discussed including the role of ER/PR positivity in HER2+ BC.
John L. Bell
University of Tennessee Graduate School of Medicine, USA
Title: Using USA guidelines and standards of breast cancer care in an academic medical center: screening to survivorship
Biography:
Dr. John L. Bell, received his medical degree from the University of Alabama/Birmingham, where he stayed to do his general surgical training, completed in 1986. A surgical oncology fellowship was completed in 1988 at the MD Anderson Cancer Center. Dr. Bell was recruited by the University of Tennessee to develop a Division of Surgical Oncology and an oncology program. He belongs to organizations such as the Southern Surgical Association, the American College of Surgeons, and the American Society of Breast Surgeons. He is the immediate past-president of the National Consortium of Breast Centers 2011-2013. He is certified by the American Board of Surgery, a Professor in the Department of Surgery, and Director of the UT Medical Center Cancer Institute.
Abstract:
The cost of healthcare in the United States is higher than all other developed countries. Despite these expenditures, outcomes lag behind others especially the United Kingdom, when looking at variables such as quality, access, efficiency, equity and healthy lives. The National Comprehensive Cancer Network, The American Society of Clinical Oncology, The United States Preventive Services Task Force, The National Cancer Institute, along with other organizations are increasing their focus on value-based, evidence-based cancer care as the United States transitions to the era of the Affordable Care Act (ACA). The ACA in some ways mimics the successful program now in place for many years in the United Kingdom which ranks number 1 in three of the five categories noted above. The full discussion of this abstract will review the latest cancer facts and figures in the United States and contrast those to other developed countries such as the United Kingdom. Appropriate risk reduction and prevention strategies, cancer screening controversies, diagnostic testing, treatment options, surveillance and survivorship data will be tabulated, reviewed, and discussed with an economic focus.
Matthew Curzon, M.D.
The University of Tennessee Medical Center, USA
Title: Breast cancer in elderly patients (70 years and older): The University of Tennessee Medical Center at Knoxville 10 year experience
Biography:
Dr. Curzon received a BSc degree in Physiological Science from the University of California, Los Angeles in 2008, and his Medical degree from the American University of the Caribbean in 2012. Currently, Dr. Curzon is a Chief Resident and a PGY-3 resident in Anatomic and Clinical Pathology Residency Program at the University of Tennessee Medical Center in Knoxville, Tennessee. He has research interest in breast cancer, biomarkers and improving patient outcomes.
Abstract:
Breast cancer (BC) incidence increases with age, however, there is still a paucity of data on cancer biology, standardized treatment, and outcomes in elderly (≥70 y/o) patients. We evaluated whether ER/PR/HER2 subtype and TNM stage of invasive BC had significant impact on overall survival (OS) in a study population of 232 elderly Caucasian female patients (≥70 y/o) from our institution at the 10 year interval (01/1998-7/2008), and analyzed treatments that they received (last follow-up date 8/1/2013). Patients were grouped according to TNM stage and ER/PR/HER2 subtype using 5-group classification system per 2011 St. Gallen International Consensus Panel recommendations. OS was measured comparing these categories using Kaplan Meier curves and Cox regression analysis. The majority of patients (178/232=76.7%) were in the traditionally considered “favorable†BC subtype (ER+/PR+/HER2-); 23.3% were in “unfavorable†subtype [HER2+=12% (28/232) and triple negative (TNP) =11.3% (26/232)]. Interestingly, a trend for better survival was noted in HER2+ patients, the group that is only nowadays considered worth reclassifying to “favorable†due to advantageous effects of anti-HER2 treatment (HER2+ OS=68%; ER+/PR+/HER2- OS=56% and TNP OS=58%). However, no ER/PR/HER2 subtype was significantly predictive of better OS (p=.73). TNM stage was predictive of OS (p<.001). Our previously published data on non-significant effects of ER/PR/HER2 on OS in our Caucasian BC patient population are concordant to results obtained in our elderly patient subgroup. Discussion of this abstract will include the treatments that our patients received and compare/contrast them to the literature data in an attempt to reconcile and stratify given therapy with outcomes.
- Breast Cancer Tests: Screening, Diagnosis and Monitoring
HER2 Positive and Other Types of Breast Cancers
Session Introduction
Diptendra K Sarkar
President Elect, Association Breast Surgeons of India, India
Title: Role of NFKB as a prognostic marker in breast cancer: a new tool in the horizon
Biography:
Professor Sarkar is the Chief of the Breast Service and Research Unit at IPGMER, Kolkata, India. He is a Founder member and presently the Honorary Secretary of The Association of Breast Surgeons of India. He has delivered more than 150 lectures and orations in various national and international conferences. He has published more than 30 articles and has contributed as author to two different text books. He is the Associate Editor of Indian Journal of Surgery and Surgical Oncology. He is part of the esteemed Governing Council of Association of Surgeons of India.He is the one of the pioneers of Breast Surgery in Eastern India.
Abstract:
The nuclear factor kB (NFkB) is a superfamily of transcription factors. Activation of the signaling pathway leads to induction of target genes that inhibits apoptosis, dysregulates cell cycle, promotes cellular invasion. It regulates tumorogenesis , inflammation and metastasis. It is hypothesized that study of a single factor, instead of multiple proliferative genes, can prognosticate breast cancer to same extent. A prospective study was conducted at the Comprehensive breast service and Breast cancer research Unit, IPGME&R,Kolkata, India. The patients were divided into two groups, first group (Group A) comprised of 57 patients with primary breast cancer and second group (Group B) comprised of 54 patients of fibroadenomas. NFkB was measured in both groups by Western Blot and RT-PCR technique using p65 protein of NFkB family.ER , PR and Her2 neu were measured by immunohistochemistry methods. NF-kB was expressed in 71.8% of breast cancer patients while none of the Group B patients expressed it.NF-kB / p65 expression is significantly associated with large tumor size(>5 cm.)(p-value 0.012),Grade III tumors(p=0.002),ER and PR negative tumors(p=0.002 and 0.001 respectively) and Her2 neu positive tumors(p=<0.001).Correlation is poor with lymph node status(p0.393) and menopausal status(p=0.973).The results were correlated with NPI.(higher NPI of more than 5.4 was statistically significant with p=0.002). The study puts forward the fact that NF-kB is a valid prognostic marker. Being a transcription factor, it controls multiple pathways and thus has the potential to replace costly multigene prognostication models. This can have a major impact in developing countries in prognosticating breast cancer.
Syeda Zakia Hossain
Faculty of Health Sciences, University of Sydney, Australia
Title: What factors affect breast screening practices among Muslim women living in Sydney metropolitan area?
Biography:
Dr Syeda Zakia Hossain has completed her PhD from the University of Queensland, Australia. She is a health sociologist and a demographer, expert in women’s health. She has worked extensively on women’s health and wellbeing. Her research focuses on health inequalities, chronic disease and disability, i.e., breast cancer, diabetes, health inequalities, South East Asia and Middle East. Dr Hossain has presented her research in national and international conferences and published more than 30 papers in reputed journals. Dr Hossain has been serving as an Executive editor of the Journal of Community Medicine and Health Education.
Abstract:
Breast cancer is one of the most commonly occurring malignant neoplasms among women. Survival from breast cancer has improved steadily over time in many developed countries. Ethnic differences in survival of breast cancer were reported in the USA. Limited evidence suggests that people from culturally and linguistically diverse (CALD) background have lower than average rates of population in cancer screening in Australia. The aim of this research is to understand breast cancer knowledge and screening practices among Muslim migrant women (MMW) living in Sydney metropolitan area. Participants of the study are Muslim migrant women (N=101), over the age of 35 living in metropolitan Sydney; were recruited using convenient and snowball techniques. Survey instrument was used to gather data. Results show that the mean age of the participants’ was 44.9 years, 54% had tertiary education, 57% were unemployed and mostly married (84%). Bivariate results show that education, employment and religious priority are significantly associated with breast cancer knowledge (P<0.05). Breast screening participation was significantly associated with age, residency, English ability, refusal to see male practitioners and breast cancer knowledge (P<0.05). Notable barriers of screening include pain, unnecessary radiation, lack of GP recommendation and something negative may be discovered, suggesting policy implications.
Medhat Faris
King Fahad Specialist Hospital, Dammam, KSA
Title: Patient advocacy program for breast cancer patients in the eastern province
Biography:
Prof. Medhat Faris is a professor of Medical Oncology, King Fahad Specialist Hospital, Dammam KSA. Trained in Medical Oncology at the Beatson Oncology Center, Glasgow, UK. He worked at Velindre Hospital, Maidstone Hospital, and Addenbrooke’s Hospital UK. He was offered the opportunity to establish the Oncology service in the sultanate of Oman (1998-2008). He is the founder of the patient’s advocacy program “We Careâ€. His work focusing on breast cancer research and patient’s care. Prof. Medhat Faris is also certified by the European Society for Medical Oncology (ESMO) since Sept. 1999. Moreover, he participated in international, regional and national clinical trials and has more than 70 publications & Reviewer of several Indexed Journals.
Abstract:
Patient advocate is a person who helps a patient work with others who have an effect on the patient's health, including doctors, nurses, insurance companies, employers, case managers, and lawyers. A patient advocate helps resolve issues about health care, and job discrimination related to a patient's medical condition. Cancer advocacy groups try to raise public awareness about important cancer issues. The following important points will be discussed including: Why Is being an advocate Important now?, Why you should be an advocate? And What are the obstacles of patient advocacy? Explanation of the Goals of the Advocate to Inform, enhance autonomy and respect the decisions of others, even if we don’t agree with it will be addressed. I will highlight the Efforts by physicians, cancer foundations, cancer survivors, patients and their families to improve cancer management and provide comprehensive evidence based treatment, education, early detection and support to patients and their relatives in our region. Details of our advocacy group “we care†to communicate with the patients and their relatives will be explained. It is now well recognized the important role that patients, patient advocates, and other members outside of the traditional science community play in advancing cancer care and research.
Caigang Liu
The Second Hospital of Dalian Medical University, China
Title: FSIP1: A new potential early screening marker for breast cancer
Biography:
Caigang Liu has completed his Doctor’s degree at the age of 33 years from China Medical University. He is the Director of the Breast Disease and Reconstruction Center and Breast Cancer Key Lab of Dalian of the Second Hospital of Dalian Medical University. He has published more than 100 papers, 39 of those were included in SCI.
Abstract:
This study is aimed at investigating the expression status of FISP1 in breast cancer. Wound fluid and serum samples from 122 female primary breast cancer patients and 112 recrudescent and metastatic breast cancer patients and 38 female benign cases were enrolled for the protein concentration analysis. 496 paraffin-embedded tissues with 5-year follow-up were enrolled for prognosis analysis. It was observed that FSIP1 protein was expressed significantly higher in breast cancer tissues compared to benign tissues. The cases with high FSIP1 expression intended to develop into better postoperative disease-specific survival (P<0.001). FSIP1 expression levels were significantly higher in primary breast cancer patients compared to benign group (4713±3065 pg/ml vs. 1798±1943 pg/ml, p<0.0001), in recrudescent and metastatic breast cancer compared to primary breast cancer group (7713±3065 vs. 4713±3065 pg/ml, p=0.003), in DCIS compared to IDCgroup (6172±2432 pg/ml vs. 4381±3019 pg/ml, p=0.0493), in lymphonodus negative group compared to positive group (5132±3216 pg/ml vs. 3943±2630 pg/ml, p=0.0401), in ER, PR positive breast cancer compared to negative group (5286±3152pg/ml vs. 3445±2458pg/ml, p=0.0018), and in luminal B breast cancer patients compared to triple-negative group (5383±3170pg/ml vs. 3697±2683pg/ml, p=0.0268). Similarly, FSIP1 in wound fluid of lymphonodus negative patients was significantly higher than those of positive group (4937±2914 pg/ml vs. 3273±2647 pg/ml, p=0.0384).
Biography:
I was born in 1985 in Konya. I graduated from Istanbul University, Cerrahpasa Medical Faculty (English Program). Between 2007-2009 I served on the student representative council. I began my General Surgery residency at the same faculty in 2011. In 2014, I was elected as President of the Turkish Surgical Society’s Resident Committee. I’m currently listed as an editor in the journal Medicine. In addition, I’m one of the founding members of the Turkish Young Doctors’ Platform and Association and currently their vice President. My research interests are endocrine surgery new technologies in medicine in terms of diagnostics and treatment modalities.
Abstract:
Breast cancer is the most common malignancy in women. Most effective method for treatment is early removal of cancer tissue. Widely used modalities in detection of breast cancer are mammography, magnetic resonance imaging (MRI), and ultrasonography. An alternative technique, which is in clinical trials phase, is microwave breast tomography (MMT). MMT is specific for cancer tissues. It relays on high contrast of dielectric coefficient between healthy and cancer tissue. This study aims to compare MRI and MMT with histopathology (HP) reports. Methods To evaluate the MMT in clinical settings, pre-operative MMT measurements are obtained from patients who has planned surgery and have a breast MRI, after informed consent was obtained. By using MMT outcomes, images were drawn using jet color mapping. A group of doctors blind to MRI and HP results were evaluated MMT images. MMT and MRI measurements of each patient is compared with HP reports of specimen. Results: When dimensions of lesions detected in MMT compared with MRI and HP reports, MMT dimensions were more congruent with HP results. Median (minimum-maximum) lesion dimensions of MMT, HP, and MRI respectively are: 28.05 (11 – 35.7), 24 (10 - 35), and 25 (8 - 44). Median MMT/HP and MRI/HP ratios are 103% and 91%. Conclusion: MMT results are more congruent with HP results than MRI, but larger series are required for further analysis.
Domenico Samorani
Santarcangelo Hospital, Italy
Title: Screening of Breast Cancer from Mammography to MR Imaging
Biography:
Dr. Domenico Samorani, Medical Doctor, now is Chief of General and Breast Surgery at Santarcangelo Hospital (RN) AUSL Romagna, Italy, Degree in Medicine and Surgery, Specialist in General Surgery at Bologna University. Expert in oncoplastic breast surgery. Author of several publications in particolar regarding the use of indocyanine green to detect the sentinel lymph node . He was a speaker at the 14th annual meeting of the American Society of Breast Surgeons ( Chicago 1 to 5 May 2013).
Abstract:
The use of Indocyanine Green (ICG) to detect the Sentinel Lymph Node (SLN) in breast cancer (BC) has been widely discussed in literature. As compared with Technetium (Tc) , ICG has different possible advantages: 1) Organisational: involvement of a nuclear medicine department is not necessary; 2) Social: patients no longer need to have Tc or other radioactive material injected at a nuclear medicine department). Further, the ICG technique can be performed in the operating room immediately after the induction of general anaesthesia and without any discomfort to the patient. 3) Operative: when radio-guided occult lesion localisation (ROLL) is combined with SN biopsy, SN detection with ICG avoids the superposition of 2 radioactive tracings at the injection site, favouring tumour detection. Some studies pointed out that the SLN detected via ICG coincides with that detected via Tc. After more than 300 surgeries during which we detected the SLN via ICG associated with Tc, thus refining our technique, in the last 4 months we have been using only ICG without combining it with any other tracers. So far, in 112 surgery cases, we have had 100% detection of the SLN with a median of 2 lymph nodes per patient (range: from 1 to 4). We inject a variable quantity of ICG that spans from 0.4 to 0.7 ml depending on the breast volume and on the distance between neoplasia and axilla or between areola and axilla. The time between the injection of the ICG and the incision varies from patient to patient (from 2 to 8 minutes), with a median of 4 minutes. Therefore, it is necessary to follow the subcutaneous migration of the tracer using an infrared torch and make the incision only when the tracer has visibly reached the axilla, not before, otherwise, by interrupting the vessels too soon, the detection of SLNs becomes much more difficult. As we have already reported, ICG increases the average number of detected SLNs as compared to Tc, without increasing complications. This fact does not seem to be a limit, rather, in certain cases – and according to what Giuliano also stated – it allows us to avoid axillary dissections when, out of three harvested lymph nodes, only a metastatic lymph node is detected. Our experience in using only ICG to detect the SLN demonstrates the use of ICG only, once the technique is mastered, allows, always and in every case, the removal of the SLN in BC
Lubna Mushtaque Vohra
Ziauddin University Hospital, Pakistan
Title: Metaplastic carcinoma of the breast and p16 positivity: What does it mean?
Biography:
Lubna Mushtaque Vohra is an Assistant professor in Ziauddin University Hospital, Karachi Pakistan. She is a dedicated qualified breast surgeon with special interest in oncoplastic, aesthetic and reconstructive breast surgery. She did her post graduation in general surgery followed by fellowship in breast surgery from Aga Khan University Hospital. She also did European board in breast surgery. Recently, did fellowship in Oncoplastic, aesthetic and reconstructive breast surgery under supervision of Prof. Werner Audretsch. She has also been actively participating in research and so many research articles published as authors.
Abstract:
Metaplastic breast cancer are a group of breast cancer subsets which display the coexistence of breast cancer of the usual varieties along with other components such as squamous, sarcomatoid ,chondroid or other tissue types in the same specimen. The presence of p16 positivity by immunohistochemistry as a surrogate marker in HPV related oropharangeal cancer is now well accepted. Whether this is related to other such cancers of the HPV spectrum needs more research. It is with this background that five sequential cases of meta plastic breast cancer were tested for p16 positivity by IHC.
Jose Roberto Piato
University of São Paulo, Brazil
Title: Improved frozen section examination of the retroareolar margin for prediction of nipple involvement in breast cancer
Biography:
Shyng-Shiou F. Yuan received M.D. degree from Kaohsiung Medical University, Taiwan and has completed his PhD and postdoctoral training from University of Texas Health Science Center at San Antonio, USA. He is currently the director of Translational Research Center, Kaohsiung Medical University Hospital. He has published more than 60 papers in reputed journals and has been serving as an editorial board member of Cancer Letters since 2007.
Abstract:
Introduction: Development of the nipple-sparing mastectomy (NSM) technique has constituted a significant advance in the surgical treatment of selected cases of breast cancer. The most important aspect of areolar complex preservation is the exclusion of carcinoma involving the nipple. The retroareolar surgical margin is usually sampled and subjected to an intraoperative evaluation by frozen section examination in order to avoid a second procedure. However, this method is not standardized resulting in variable rates of false-negative results.Here, a new technique is proposed for the intraoperative study of the retroareolar margin. This ex vivo study was conducted by performing a simulated NSM procedure for patients undergoing total mastectomy to assess the impact of these measures on the accuracy of retroareolar frozen section examination. Materials and Methods: Between September 2012 and April 2014, we studied 158 mastectomy specimens from patients undergoing total mastectomy for breast cancer at the Cancer Institute of the State of São Paulo. Inclusion criteria were stage Tis-T3 tumors, multifocal and multicentric breast carcinoma, unicentric carcinoma not suitable to quadrantectomy. Patients submitted to neoadjuvant chemotherapy were also included. To obtain the entire sample area, the terminal retroareolar milk duct bunch was isolated. Fragments approximately 1.5 cm in length were excised and sectioned in parallel at the base of the nipple using a cold bistoury. Three transverse histological sections (4 mm each) at 200 mm intervals that included the entire isolated fragments were subjected to frozen section examination. The sections were stained with hematoxylin-eosin (H&E) and were evaluated. The remainder of each fragment was embedded in paraffin and 4 mm sections were subsequently stained with H&E and examined. Results: A total of 158 mastectomy specimens involving mammary carcinoma of no special type were examined. These included 15 (9.5%) in situ stage tumors, 36 (22.8%) stage I tumors, 71 (44.9%) stage II tumors, and 36 (22.8%) stage IIIA tumors. Paraffin examinations identified 25 retroareolar fragments compromised by carcinoma, resulting in 16.1% prevalence. Of the frozen sections examined, 2/158 (1.3%) had false-negative results and 5/158 (3.1%) had false-positive results. For the former two cases, the corresponding paraffin examinations detected low-grade carcinoma in situ and a residual cell cluster with a diameter less than 1 mm. The latter was found in a mastectomy specimen from a patient that underwent neoadjuvant chemotherapy. For the three cases involving false-positive results, the corresponding paraffin examinations revealed no atypical ductal hyperplasia present, one sclerosingintraductal papilloma and one nipple syringomatous adenoma. Statistical analysis revealed that the frozen section examinations performed had a sensitivity rate of 92.0% and a specificity rate of 96.2%. In addition, the positive predictive value (PPV) was 82.1%, the negative predictive value (NPV) was 98.4%, and the accuracy was 95.4%. Conclusion: The frozen section examination technique described here detected nipple involvement in breast cancer with greater accuracy than the frozen section usually performed by most surgeons.
Yi-Cheng Hu
National Yang-Ming University, Taiwan
Title: Detection of a negative correlation between prescription of Chinese herbal products containing coumestrol, genistein or daidzein and risk of subsequent endometrial cancer among tamoxifentreated female breast cancer survivors in Taiwan between 1998 and 2008: A population-based study
Biography:
Yi-Cheng Hu completed his double majoring in traditional Chinese medicine and modern medicine in Taiwan and later with his residency in department of acupuncture in Chang Gung Memorial Hospital. Currently, he is the attending physician in China Medical University Hospital, Taipei branch and doing researches in the field of traditional Chinese medicine utilization on cancer patients.
Abstract:
Tamoxifen users sometimes seek complementary and alternative medicine advice for treatment of a variety of illness and co-administer with phytoestrogen-containing herbs, resulting in an increasing concern of its influence in subsequent endometrial cancer risk. Our study aims to determine the prevalence of Chinese herbal products containing coumestrol, genistein, or daidzein and their association with subsequent endometrial cancer risk among tamoxifen-treated breast cancer survivors in Taiwan. We selected all patients who were newly diagnosed with invasive breast cancer and received tamoxifen treatment between January 1, 1998, and December 31, 2008, from the National Health Insurance Research Database. Among the 26,656 tamoxifen-treated breast cancer survivors, we evaluated the usage, frequency of service, and prescription of Chinese herbal products containing coumestrol, genistein, or daidzein. The logistic regression method was employed to calculate the odds ratios for utilization of those herbal products. Cox proportional hazard regression was set to calculate the hazard ratios of endometrial cancer associated with such usage. Of the patients surveyed, 36.2% (n = 9,652) of the tamoxifen-treated breast cancer survivors examined in the study had consumed Chinese herbal products containing coumestrol, genistein, or daidzein during the study period. Among those tamoxifen-treated female breast cancer survivors in Taiwan, consumption of Chinese herbal products containing coumestrol, genistein, or daidzein is negatively correlated with subsequent endometrial cancer risk.