Day 2 :
The University of Texas MD Anderson Cancer Center, USA
Keynote: MicroRNA expression profiling to identify potential biomarkers in inflammatory breast cancer
Time : 09:00-09:30
Dr. Lei Huo received her Bachelor of Medicine degree at Beijing Medical University and her PhD in Molecular Biology and Genetics at Northwestern University, Chicago. A practicing breast pathologist in MD Anderson Cancer Center, she is actively involved in clinical and translational research in the field of breast cancer. Her research interests include molecular and immunohistochemical markers in the diagnosis and treatment of breast cancer, among others.
Inflammatory breast cancer is characterized by clinical hallmarks of diffuse erythema and edema (peau d’orange) involving one third or more of the breast skin caused by tumor emboli blocking dermal lymphatics, and rapid progression from the onset of the disease. It is the most aggressive form of breast cancer, comprising 1-5% of newly diagnosed breast cancer in the United States. The survival outcomes of patients with inflammatory breast cancer are poor with standard therapy. There is an urgent need for new therapeutic targets. At the molecular level, the few published mRNA expression profiling studies have indicated that transcriptional heterogeneity exists in inflammatory breast cancer as extensively as in non-inflammatory breast cancer. Recent advances have implicated the role of microRNA as oncogenes or tumor suppressor genes in tumorigenesis, metastasis and response to treatment in various cancer types including breast cancer. In our recent study, the microRNA expression profiles of 23 inflammatory breast cancer, 24 non-inflammatory advanced breast cancer and 12 normal breast tissue fresh frozen samples were generated using a previously validated microRNA microarray assay. Among the differentially expressed microRNAs, microRNA-205 expression was decreased not only in tumor compared with normal breast tissue, but also in inflammatory breast cancer compared with non-inflammatory breast cancer. Lower expression of microRNA-205 correlated with worse distant metastasis-free survival and overall survival in our cohort. Thus, microRNA-205 may serve as a therapeutic target in advanced breast cancer including inflammatory breast cancer.
Vardhman Mahavir Medical College, India
Time : 09:55-10:20
Dr. Chintamani specialises in oncosurgery. He is the President of Association of Breast Surgeons of India and the Governing council member of Association of Surgeons of India.He is a tutor and examiner at Royal College of Surgeons of Edinburgh, UK.
Management of breast cancer ,arguably the commonest cancer of mankind has indeed undergone a tremendous evolution in the last few decades. While there are variations in the presentation and behaviour of this cancer, there are few accepted common management strategies that have been adopted world over. Till such time that we have completely reliable and rock solid guidelines there would be regional variations in the management and outcome of this dreaded but curable cancer. The management approaches would also vary depending on the availability of healthcare resources and proper investigational and management facilities. The management would therefore need to be tailored to the centre, the patient and also the expertise available.
While there are no issues with these modalities being available in the developed world, there are problems in the developing world, although one can find some of these countries as healthcare paradoxes i.e at one end there are centres of excellence and at the other end there are issues relating to providing primary health care and management of certain basic health problems like communicable diseases. There is thus no uniformity in the management of breast cancer across centres and countries. Quality assurance has to be ensured in order to achieve acceptable and reproducible outcomes in the management of breast cancer across the globe.
Location: Hall B
The University of Texas MD Anderson Cancer Center, USA
Vardhman Mahavir Medical College, India
University of Tennessee Medical Center, USA
Title: Predictive and prognostic multigene breast cancer assays used in the clinical practice in the United States: Analysis of the national cancer data base
Time : 10:00-10:20
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). Dr. Orucevic 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 Dr. Orucevic 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 26 papers in peer reviewed journals.
The newest version of NCCN guidelines (1.2016) and recently published American Society of Clinical Oncology Clinical Practice Guideline on use of biomarkers to guide decisions on adjuvant systemic therapy for women with early stage invasive breast cancer give guidelines for use of multigene assays for breast cancer patients. Nation-wide data on current clinical practice across the United States regarding utilization of multigene assays in clinical practice is lacking, as well as data on the impact of the assays on chemotherapy administration (ChemoA).
Retrospective observational study of National Cancer Data Base (NCDB) patients from 2010-2012 was used to investigate utilization and impact of multigene assays in breast cancer patients across the United States. NCDB depicts ~70% of all newly diagnosed malignancies in the USA annually. De-identified data of patients that had multigene assay results were analyzed.
513,080 patients had BC; 406,525 were estrogen receptor-positive (ER+). 91,651 patients had OncotypeDX 21-gene assay, 2,518 had MammaPrint 70-gene assay, 2,321 had other (unspecified) multigene assay, and 1,020 had test performed but unknown type.
Results addressing impact of race, socioeconomic status, geographic location and adherence to the guidelines applicable at the time of the study on utilization of multigene assays will be discussed as well as compliance with treatment recommendations based on the multigene assay test results.
University of Tennessee Medical Center, USA
Title: Outcomes disparities for invasive breast cancer in rural communities are not related to delays in treatment
Time : 10:20-10.40
Dr. McLoughlin is a surgical oncologist and an associate professor of surgery at the University of Tennessee – Knoxville. He has been in clinical practice for 9 years with a research interest in cancer outcomes research, epidemiology, and health policy issues.
Introduction: Rural communities in the Southeast, defined as counties with a population of 2,500 or less, are often in disparate regions based on socioeconomic status and cancer outcomes. National data was analyzed to determine the factors most responsible for poor cancer outcomes in these rural counties.
Methods: The NCDB (National Cancer Data Base) was analyzed for breast cancer outcomes from 1998 – 2012. The analysis was primarily focused on rural counties in the South Atlantic and East South Central Regions which include the majority of the counties in Appalachia. Multivariate analyses were performed to evaluate the clinical and economic factors in breast cancer outcomes in these regions.
Results: From 1998 – 2012, over 2.8 million patients with invasive breast cancer were evaluated with 581,514 in the Southeast region. Of those, 12,515 (2.2%) are from rural counties. Those in rural counties were 15% more likely to die than those in urban and metro counties. The median survival for rural counties was 162 months (95% CI 156 – 168) vs. urban counties which was 178.5 months (95% CI 177 – 179). When comparing the time of diagnosis to the time treatment began and was completed, there were more delays in initiating and completing treatment in those from rural counties. However, the delays resulted in a 0.01% increase in dying per day of delay. In other words, for every 100 days of delay there is a 1% increase in the chance of dying. The greatest impact on mortality appeared to be related to socioeconomic factors including median household income and highest education level achieved (see Table 1).
Conclusion: Despite concerns of lack of access to healthcare in rural communities, moderate delays in initiating and completing treatment for breast cancer do not appear to contribute to the observed disparate outcomes. Improvements in breast cancer outcomes may be best focused on secondary school graduation rates and improved regional economics.
The University of Tennessee Medical Center, USA
Title: Influencing factors and evolving trends for contralateral prophylactic mastectomy in breast cancer patients
Time : 10:55-11:15
Dr. Sneha Bhat received her undergraduate degree in Biochemistry from Mary Baldwin College in Staunton, VA, in 2008, and her Medical Degree from University of TN Health Science Center in Memphis, TN, in 2013. Currently, Dr. Bhat is a PGY-3 General Surgery at the University of Tennessee Medical Center in Knoxville, TN.
While mastectomy has no survival advantage over conservation management in breast cancer (BC) patients who undergo surgical treatment, the number of bilateral mastectomies (BM) in the United States is increasing.
We investigated socio-economic factors and clinicopathologic characteristics of 508 BC patients from our institution with unilateral BC who underwent mastectomy between 2000 and 2009 and analyzed which of these factors influenced patients’ decision with unilateral cancer to undergo BM. From 508 patients with unilateral BC, 397 underwent unilateral mastectomy (UM) and 111 BM.
Our study showed that BM was more likely to be chosen by younger patients (less than 50 years old, p<0.001); patients with private insurance (p<0.05); residence in urban settings (p<0.05) and plans for subsequent reconstruction (p<0.05). Marital status, smoking history, family cancer history, BC stage and grade did not significantly impact patient’s choice of BM vs UM.
Our results showed that patients with unilateral BC who are younger (< 50 years), have private insurance, reside in urban settings, or plan for subsequent reconstruction are more likely to undergo BM for unilateral BC. Influencing factors and evolving trends for contralateral prophylactic mastectomy in BC patients with unilateral breast cancer in the United States will be compared and contrasted to our findings.
The University of Tennessee Medical Center, USA
Title: Valid statistical approaches for data driven analysis in breast cancer: Research avenues under patient protection and affordable care act (PPACA)
Time : 11:15-11:35
R. Eric Heidel completed his Ph.D. at the University of Tennessee in 2012 and was immediately hired as the first Assistant Professor of Biostatistics ever at the University of Tennessee Graduate School of Medicine. He has published over 40 peer-reviewed papers in top-tier journals and has led workshops at numerous national and international conferences on research design, statistics, epidemiology, and psychometrics. He started his own statistical consulting company in 2014, Scale, LLC, and published the world’s first online decision engine for applied research and statistics, Research Engineer. It has been accessed in 229 countries and territories around the world.
Secondary data analysis is becoming a popular method for analyzing population data related to cancer outcomes. Large data repositories like the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Result (SEER) provide researchers with a vast wealth of pertinent clinical, prognostic, demographic, confounding, and outcome variables in real patient populations. Subgroup and sensitivity analyses are also easier to conduct with large datasets because they are more likely to represent underserved and at-risk populations. The Patient Protection and Affordable Care Act (PPACA) put forth a call to compare established treatments on their clinical efficacy using comparative effectiveness research (CER). CER was defined in the PPACA as “research evaluation and comparing health outcomes and clinical effectiveness, risks, and benefits of two or more medical treatments, services, and items.” With access to millions of breast cancer outcomes and a reinvigorated focus on comparing treatments, services, and items, researchers are uniquely positioned to produce extensive CER evidence related to the diagnosis and treatment of breast cancer. Going further, these large databases allow for CER evidence to be generated for many underserved and vulnerable populations that are not represented in the current literature. The objective of generating evidence for these types of subgroups is written right into the legislation (PPACA) itself. Another beneficial aspect of the CER and secondary data is that the PPACA defines retrospective cohort designs as perfectly acceptable when generating evidence. These types of observational studies are very easy to conduct and are an excellent fit for large secondary databases.
North Carolina State University , USA
Title: Factors influencing decisions of breast cancer patients to follow-up on recommendations for genetic counselling – The University of Tennessee Medical Center experience
Time : 11:35-11:55
Ms. Megan McNeil is currently pursuing her Bachelor’s Degree in Biological Sciences at North Carolina State University, where she is a Park Scholar. She participated as an Outside Learner, assisting in research for the Pathology Department at University of Tennessee Medical Center in Knoxville, TN. She plans to attend medical school after graduating from NC State.
Referrals of patients to the genetic center at the University of Tennessee Medical Center Cancer Institute (UTMC-CI) follow the NCCN Clinical Practice Guidelines in Oncology for Genetic/Familial High-Risk Assessment for Breast and Ovarian Cancer, developed to identify individuals who may benefit from cancer risk assessment and genetic counselling. Referrals for genetic counselling at UTMC-CI are given to patients by nurse navigators, and patient’s information is forwarded to the hospital’s genetic center.
We investigated factors influencing decisions of breast cancer patients in UTMC to follow-up on recommendations for genetic counselling in 2012-2014 time period. These included age, rural-vs-urban living, benign-vs-malignant breast diagnosis and effect of Angelina Jolie’s announcement on 5-14-2013 of undergoing prophylactic mastectomies for being a carrier of BRCA1-gene for breast cancer. Her statement apparently caused an increase of genetic counselling referrals in a big referral center in Canada and few in the United Kingdom.
From 412 UTMC-CI’s referred patients, 139=33.7% scheduled, 105=25.5% attended the appointment; 30=7.3% sought testing and 5=1.2% were found with genetic mutation. Malignant breast diagnosis, urban living and age<50 significantly increased scheduling of the appointment by referred patients (p<.05), but Angelina Jolie’s announcement had no effect (p=.07).
While attending of the appointment and seeking of genetic testing when recommended was underpowered by number of patients in our study, we noted that each step of the process was challenged by stepwise decline of show of referred patients. UTMC-CI’s employment of a genetic counsellor for cancer patients only (summer-2016), housed-in Cancer Institute, might help in alleviating this problem.
The University of Tennessee Medical Center, USA
Time : 11:55-12:15
Dr. Garnetta Morin-Ducote, received her medical degree from the LSU Health Science Center (formerly LSUMC-NO) in New Orleans, Louisiana where she stayed for internship training. She completed a radiology residency at the University of Tennessee Medical Center, Knoxville, Tennessee. She is board certified by the American Board of Radiology. Dr. Morin-Ducote belongs to the Society of Breast Imaging, American College of Radiology, American Roentgen Ray Society and is an associate professor of radiology. She is currently the director of the University Breast Center.
Preoperative planning for breast conservation including imaging and correlative pathology help to accurately stage the patients with early stage 1 and stage 2 breast cancer. Preoperative breast MR for early breast cancer staging has been compared with mammography and ultrasound for accuracy of staging. Accuracy of staging by imaging is reported to be dependent on the presence or absence of an in situ component as well as ductal verse lobular pathology. At our institution preoperative breast MR is performed following percutaneous needle biopsy for patients with high grade DCIS, invasive ductal or lobular carcinoma, and with no extenuating co-morbidities. This practice has become standard for patients diagnosed in our breast center as well as outside referrals since 2008. This now allows for 5 and 7 year retrospective evaluations for the use of preoperative breast MR and its accuracy for staging. Other factors to be discussed for staging accuracy will include effect of percutaneous needle biopsy on lesion size prior to breast MR or following breast MR, and the accuracy of lesion size measurement depending on breast density.
The University of Tennessee Medical Center, USA
Time : 12:15-12:35
Dr. Jillian Lloyd, MD, MPH is a Board Certified General Surgeon, fellowship-trained in Breast Surgery. She was educated at Emory University for undergraduate, medical school, and public health. She completed General Surgery residency at The Mayo Clinic in Jacksonville, FL, and went on to complete a fellowship in Breast Surgery at The Bryn Mawr Hospital in Phildelphia, PA. She joined the faculty at the University of Tennessee Knoxville in September 2016. Her research interests include health disparities and cancer biology as it relates to outcomes.
The use of fine wires for the localization of non-palpable breast lesions has been used for decades and remains the gold standard. However, this procedure has its limitations, including patient discomfort, surgical timing, dislodgement, and accuracy. Newer techniques have developed over time, which offer solutions to these inherent drawbacks of the wire. Radioactive seed localization (RSL) has been used for approximately 10 years, and allows surgeons to localize non-palpable breast lesions utilizing a gamma detection system akin to sentinel lymph node biopsy. RSL can be placed up to 5 days prior to operation, and studies have shown improved accuracy. Another, newer technique involves ultrasound visible clip placement at the time of biopsy, which can then be identified intra-operatively. This technique eliminates a second localization procedure altogether, though results are less robust than with the RSL. Even newer and more novel techniques involve the use of an infrared reflector placed up to 30 days prior to surgery, and intraoperative use of an infrared beam to localize this reflector. These techniques offer novel solutions to the age-old limitations of wires and will be discussed
- Screening & Diagnosis for Breast Cancer
Breast Cancer Immunotherapy & Radiation Therapy
Innovative Therapeutic Apporaches in Breast Cancer
Location: Hall B
University of Tennessee Medical Center
University of Tennessee Medical Center
The University of Texas MD Anderson Cancer Center, USA
Time : 12:35-12:55
Dr. Hui Chen, Assistant professor at Department of Pathology, The University of Texas MD Anderson Cancer Center. She received her M.D. from Peking Union Medical College and Ph.D. in Biochemistry and Molecular Biology from Colorado State University. She had postdoctoral research training from John Hopkins Medical School and clinical fellowship training in Oncological Surgical Pathology and Molecular and Genetic Pathology from Memorial Sloan Kettering Cancer Center. She is practicing pathologist specialized diagnostic molecular pathology and breast pathology at MD Anderson Cancer Center.
Current advances in single nucleotide polymorphism (SNP) microarray have enabled genome-wide analysis of copy number aberrations and allelic imbalances of oncogenes and tumor suppressor genes in malignant neoplasms. The molecular inversion probe (MIP) technology allows SNP microarray testing on solid tumors with limited (20-80ng) and fragmented DNA from formalin-fixed paraffin-embedded tissue (FFPE). One of the MIP microarray platforms used in OncoScan (Affymetrix) provides genome wide coverage with 220,000 SNP probes and high resolution coverage for approximately 900 cancer genes commonly seen in solid tumors. Cross-laboratory validation has demonstrated reproducibility of OncoScan FFPE assay. In addition, OncoScan shows promise as a quantitative measure of targetable oncogenes such as HER2 in breast cancer. SNP microarray demonstrates potential utility to provide diagnostic, prognostic and therapeutic information beyond conventional biomarker analysis for breast cancer.
University of Southern California, USA
Time : 12:55:13:15
Dr. Salhia received her Honors Bachelor of Science Degree (1998) in Biological Sciences from the University of Toronto. She earned a Master of Health Sciences (2001) and a Ph.D. (2006) in Cellular and Molecular Biology from the Arthur and Sonia Labatt Brain Tumor Research Center, Department of Laboratory Medicine and Pathobiology, University of Toronto. She completed a postdoctoral fellowship from 2006-2011 at the Translational Genomics Research Institute (Phoenix, Arizona) in Cancer Genetics and Epigenetics. Currently she is an Assistant Professor in the Integrated Cancer Genomics Division at the Translational Genomics Research Institute
A number of clinico-pathological criteria and molecular profiles have been used to stratify patients into high and low risk groups. Currently, there are still no effective methods to determine which patients harbor micrometastatic disease after standard breast cancer therapy and who will eventually develop local or distant recurrence. In the last few years, circulating cell-free (cf)DNA has attracted attention for clinical use in the context of risk prediction, prognostication and prediction of response to chemotherapy in human cancer. Various types of DNA alterations have been reported in cfDNA including, point mutations, microsatellite instabilities, loss of heterozygosity and DNA methylation. Specifically, aberrant DNA methylation is among the earliest and most chemically stable molecular alterations in cancer, making it a potentially useful biomarker for early detection or risk prediction. The purpose of our study was to identify circulating DNA methylation changes that can be used for prediction of metastatic breast cancer (MBC). Plasma cell-free (cf)DNA from 40 MBC patients, 40 disease free survivors (DFS), and 40 healthy individuals (H) was analyzed by whole-genome bisulfite sequencing (WGBS) and differential analysis performed between groups. Targeted bisulfite amplicon sequencing was used as a validation strategy. Differential methylation analysis revealed ~5.0x106 differentially methylated CpG loci in MBC compared with H or DFS. In contrast, there was a strong degree of similarity between H and DFS. Overall, MBC demonstrated global hypomethylation and focal CpG island hypermethylation. Data analysis identified 21 novel hotspots, within CpG islands, that differed most dramatically in MBC compared with H or DFS. This first unbiased analysis of cfDNA identified 21 DNA hypermethylation hotspots associated with MBC, and demonstrated the ability to distinguish tumor-specific changes from normal-derived signals at the whole genome level. This signature is a potential blood-based biomarker that could be advantageous at the time of surgery and/or after the completion of chemotherapy to indicate patients with residual micrometastatic disease at high-risk of recurrence, and who could benefit from additional therapy.
A Man’s Pink – Male Breast Cancer Advocacy Organization, USA
Time : 14:40-15:00
I am 72 year old, eleven year male breast cancer (MBC) survivor. Since launching our website in 2008, I am now in continual contact with 48 MBC survivors globally. This number continues to grow. Ten of these men have posted their story on our website in support of men who have and will, in the future, be diagnosed with breast cancer. I have participated in numerous TV documentaries, newspaper articles and scientific conferences in order to overcome some of the stigmatisms by opening the platform for men to discuss and start talking about MBC. Together we can make a difference.
I am an eleven-year male breast cancer (MBC) survivor and founder and CEO of A Man’s Pink. A Man’s Pink is an advocacy organization that promotes MBC awareness through our website www.malebreastcancer.ca. Our mission is to promote MBC awareness, improve early MBC detection methods and increase survival rate for men diagnosed with breast cancer. Until the early 1980’s, many MBC patients diagnosed with estrogen receptor-positive tumors (80-90% of MBC patients) with metastatic or inoperable cancer underwent removal of their testicles in order to prevent further growth of the tumor (20% of estrogen in men is produced in the testicles). This treatment approach strongly discouraged men from talking about MBC. Thankfully, the identification of the “estrogen receptor” eliminated this treatment option. Today’s talk will discuss MBC occurrence data, prognosis and treatment options, myths about MBC, overcoming some of the MBC stigmatisms by creating a website for men to discuss and start talking about MBC, as well as difficulties encountered by patients and survivors during their treatment and recovery. Working closely with world-renowned Australian breast cancer oncologist and author of “Male Breast Cancer – Taking Control” Professor John Boyages, our mission has evolved to include MBC sessions as part of breast cancer and oncology conferences and symposia globally. Feedback and suggestions from medial professionals will be solicited, in a survey form, to obtain their ideas and suggestions on how to best increase MBC awareness, early detection, increasing survival rates and to facilitate the journey for men in their battle with breast cancer globally.
Albany State University, USA
Title: Understanding the epigenetic role of phytochemicals in suppressing the PhIP induced cytotoxicity in breast epithelial cells
Time : 15:00-15.20
Dr. Ashok Jain is a professor of biology at Albany State University, Albany, GA and program coordinator for Biotechnology program. Dr. Jain has received research funding from NIH, DOD and USDA. Dr. Jain is also serving as MARC U*STAR project director. His research focuses on prevention of breast cancer. He has published more than 35 papers in reputed journals and has been serving as reviewer for six journals of international repute.
Cooking of meat at high temperature such as frying or barbeque causes production of heterocyclic amines (HCAs). At least a dozen of HCAs are found in cooked meat. The 2-amino-1-methyl-6-phenylimidazo[4-5-b]pyridine (PhIP) is abundant and most potent HCA. Several studies have shown that PhIP can induce tumors in breast, prostate and colon cells and in rodent models. It is shown that PhIP causes DNA mutation, promote tumor growth and promote invasiveness of cancer cells. Metabolism of PhIP results in the formation of free radicals (ROS) and PhIP metabolites are known to produce DNA adduct and DNA strand breaks. Phytochemicals are known to inhibit cytotoxic and genotoxic effects. Therefore, we hypothesized that the right combination of antioxidants and or phytochemical (naturally present in fruits, vegetables and spices) along with grilled meat should be capable of suppressing the PhIP induced cytotoxicity and breast cancer. Therefore, a model system using human breast epithelial cells (MCF 10A) was developed to test various antioxidants in presence or absence of PhIP. We have tested four vitamin (C, K3, D3, and E), Gingerol (6 and 10), N-acetyl cysteine, glutathione and curcumin at varying concentrations. The protective effect of these compounds was evaluated using cell viability assay, DCF assay to quantify ROS production, Comet assay to quantify the DNA damage and DNA adduct formation by immunofluorescence method. Results indicate that presence of these compounds improves cell viability as compared to PhIP treated group. However, curcumin co-treated cells showed significant differences and PhIP induced cell cytotoxicity was consistently reverted to normal. Gene expression analysis indicates that curcumin interact via multiple molecular targets, suggesting that curcumin appears to be an effective anti-PhIP food additive.
UTMB Galveston, USA
Melissa Joyner is a professor at UTMB Galveston, USA
One of the greatest challenges that we currently face in overcoming breast cancer is not related to technology or available
drug regimens to treat breast cancer but rather to barriers to obtaining the care itself based on different ethnic and
cultural issues. Billions of dollars have and will continue to be spent in an effort to cure breast cancer. But women from varying
ethnicities face genetic, cultural, socioeconomic barriers, dietary standards, lack of awareness, and access to care which appear
to represent the greatest hurdles to treatment.
Based on research data, genetics clearly plays a significant role in breast cancer. The National Cancer Institute data shows
that white, non-Hispanic women are most likely to be diagnosed with breast cancer but black women of African descent tend
to develop cancer at a younger age, have more aggressive tumor characteristics (3x more likely to have triple negative disease),
and have decreased survival rates with advanced cancer based on retrospective data. Hispanic females in the U.S. with a
family history have double the risk for triple negative disease and they present with cancer at a younger age. The amount of
estrogen levels also appears to vary by race in analysis of data on postmenopausal females. Many studies have shown that
African American ancestry are less likely to get breast cancer, they have an almost 40% risk of dying from their disease versus
a Caucasian female and their risk is higher than any other ethnic group. Asian American women is the United States have a
lower risk of breast cancer but are more likely to present with advanced disease largely in part felt to be associated with fact that
they obtain mammograms less often. Likewise, only 1/3 of Hispanic females age 40 and older obtain regular mammograms.
Furthermore, Hispanic females will often wait to seek care even when they have self-palpated a mass, resulting in not only a
delay in diagnosis but also resulting in more advanced disease at presentation.
Hasselt University, Belgium
Title: Influence of lifestyle factors on mammographic density and prevention of breast cancer: An overview
Time : 14:15-14:35
Drs Magda Johanna Vandeloo obtained degree of ‘Graduate in Dietetics’ from the University of Leuven, Belgium. After obtaining Bachelor’s degree in Management, she completed in 2006 her Master’s degree Natural Sciences, ‘Environmental Sciences’ with emphasis in Nutrition and Toxicology, both at the Open University of the Netherlands. For 30 years she has been in a management position at the Department of Nutrition, Jessa Hospital Hasselt Belgium. Since a few years, she is doctoral researcher in the field of breast cancer prevention. Currently she is working on a new study about lifestyle, mammographic breast density and molecular types of breast cancer.
High mammographic breast density is considered to be a strong risk factor for breast cancer. Women who have breast density of 75% or greater have an almost fivefold increased risk of breast cancer compared to women with absence of density. These effects are noted for both premenopausal and postmenopausal women of all ages. Higher mammographic density is associated with more aggressive cancers and with ‘in situ’ tumors.
Recent studies highlight the possible relationship between lifestyle, dietary and environmental factors on one side and increased breast density on the other side. The effect of energy intake and dietary patterns in childhood and throughout adulthood on subsequent mammographic density has recently been investigated. Data from observational studies suggest that the strongest associations are among vitamin D, calcium, dietary fat and alcohol. The relation between body mass index and breast density is very complex. Some studies examined influence of lifestyle factors as physical activity and smoking habits on mammographic density. Findings of recent studies investigating the influence of Mediterranean diet on breast density suggest decrease in mammographic density.
Implementation of corrections in nutrition and lifestyle can be guided to reduce mammographic breast density. As breast cancer risk is nearly impossible to influence in adult age, preventive strategies should be applied as early in life as feasible. In children, changes in nutritional habits and lifestyle might be possible because social attitudes are in full development. Better control of these factors during lifetime might reduce mammographic density and hence breast cancer risk later in life.
Central Lisbon Hospital , Portugal
Time : 15:20-15:40
Vasco Carvalho Lourenço da Fonseca is 41 years old and he practices medicine for 16 years, following a family tradition of medical doctors. He is currently an oncologist. Along his career, he had the privilege to work on some health reference units, as well as in a renewed research center. He is married and father of 3 children. He was a high competition athlete in equestrian sports. His interest in his community and in societal issues, lead him to integrate the list that is currently in functions at Câmara Municipal de Lisboa (City hall).
Breast Cancer is a public health issue worldwide. The time from diagnosis to treatment initiation varies from country to country and regionally within a country, mainly due to differences in the healthcare infrastructure. Early diagnosis and prompt treatment initiation are key factors in patients’ survival rates. When treatment starts late it has a negative impact on survival rates. Most of the times these situations can be foreseen by understanding how the health infrastructure in particularly works.
Currently there is a rising trend, with a high percentage of patients with “Luminal” like breast cancer who only undergo adjuvant endocrine therapy. It is beneficial for the patients to start this treatment as earlier as possible after diagnosis. It seems that no major risks are associated with the interruption of endocrine therapy to start afterwards adjuvant chemotherapy and later reintroduction of the endocrine therapy as an adjuvant treatment. This is only applicable to patients with indication to adjuvant chemotherapy and not to neoadjuvant chemotherapy that should start as promptly as possible.
The safety of interrupting hormone therapy to later reintroduce it has not been fully clarified, although this strategy is usually used in clinical practice, namely when patients wish to get pregnant. On the other hand several data from neoadjuvant setting show that primary endocrine therapy is efficacious and safe. In “luminal A” like early breast cancer, particularly in the subgroup of elderly patients that refuse surgery, the maintenance of endocrine therapy as the unique oncologic treatment has shown promising results.
Based on current medical practice, the authors argue that introducing early endocrine therapy is a valid option and should be considered under clinical guidelines. Nevertheless, the authors highlight that care should be taken avoiding generalizing this strategy before the obtainment of more robust data.
It is noteworthy that the most globally used clinical guidelines (from ESMO and NCCN) do not support the therapeutic strategy herein described. The authors argue that such strategy should be evaluated by those entities because the early introduction of hormone therapy may increase the survival time of breast cancer patients. The reduction of the mortality rate is expected to be more obvious in countries where a longer time-span from diagnosis to adjuvant treatment is noted.
The authors thus propose that medical community and oncologists analyse this strategy for the treatment of breast cancer and hope that global studies can be accomplished under this strategy. A clear positive impact in the life of thousands of breast cancer patients is expected.
Dr. Alexis Bousamra, Division of Pathology and LaboratoryMedicine, Allegheny Health Network, Allegheny General Hospital, Pittsburgh,Pennsylvania, USA
Background: Molecular inversion probe (MIP) technology has proven successful inovercoming the challenges of generating high-quality copy number (CN) data fromformalin-fixed paraffin-embedded (FFPE) samples, requiring a minimal amount of DNA.HER2 status is currently assessed by a variety of qualitative and semi-quantitative methods, including immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). We hypothesized that MIP technology can provide accurate and quantitative HER2 assessment, which is especially important with emerging novel anti-HER2 therapies. Applying MIP technology on FFPE breast cancer (BC) tissue, we generated HER2 and pericentromeric 17 CN data by MIP and correlated them with HER2 and chromosome 17 centromere (CEP17) CN data by FISH.
Methods: We selected 27 tumor blocks from 26 female patients with invasive BCs (17 with, 8 without and 2 equivocal for HER2 amplification by FISH). For each tumor, we had cut 5-μm sections from a representative FFPE tissue block for IHC, FISH, and MIP array studies. We performed IHC with monoclonal HER2/neu Ab-8 antibody and FISH with PathVysion HER2/CEP17 dual-probe. After manual microdissection, we extracted genomic DNA and subjected DNA samples to genome-wide CN analysis with focus on HER2 and chromosome 17's pericentromeric region. Data were analyzed by Nexus Express for OncoScan.
Results: With a designated cut-off of 4.0 for CN gains, 15 of 17 HER2+ BC by FISH had HER2 CN gains (4.0- 28.0) on MIP analysis. Two of 17 HER2+ BC by FISH had a HER2 CN of 2.5 and 2.3 by MIP, likely due to tumor heterogeneity. All 8 HER2- BC by FISH also had a HER2 CN <4.0 by MIP. All 27 samples displayed excellent correlation between CEP17 CN by FISH and pericentromeric 17 CN by MIP.
Conclusion: Our findings show a robust correlation between MIP and FISH results, with 25 of 27 samples showing similar CN data by both methods. With minimal DNA requirements using FFPE tissue, MIP array technology shows promise as a quantitative measure of HER2 CN. A larger prospective study is required to assess whether MIP array is a more accurate representation of the tumor’s HER2 status than FISH. By allowing genome-wide CN profiling, MIP technology may improve our understanding of BC biology and behavior and potentially be critical in guiding clinical decisions regarding targeted therapy.
Cruces Universitary Hospital, Spain
He was Born in 1956, in Barakaldo-Bizkaia (Basque Country), SPAIN.Doctor in Medicine, Basque Country University. Radiologist. Accredited university Professor
in Health Sciencies, Basque Country University.Founding member and past President of the “Spanish Society of Breast Imaging” (SEDIM).Founding member of the
“European Society of Breast Imaging” (EUSOBI). Founding member and Past-Vicepresident of the “Iberoamerican Society of Breast Imaging” (SIBIM). Founding
member and President of the “Basque Society of Breast Diseases”. Author of numerous articles and book chapters about breast diseases.
According to the International stage system (TNM) in Breast Cancer, there is a direct relationship between tumor size
and axillary lymph node status since T1 tumors (usually diagnosed in screening campaigns) are infrequently associated
with axillary lymph node metastases and the selective sentinel node biopsy is commonly indicated. On the other hand, and
due to the utilization of genetic platforms, now is known that approximately 32% of the small tumors detected in screening
campaigns present a “high risk” profile. May be observed cases in which, at the time of diagnosis, predominate the metastatic
axillary lymph node components over the tumor size. We present two cases in 47 and 70-year-old patients respectively, with
prominent axillary disease and clinically occult “small” tumors (T1), along with their molecular/genetic profile. In both cases,
the molecular/genetic profile was “aggressive” or “high risk”, which reinforces both the “genomic paradigm” for the spread of
breast cancer and call into question the TNM system validity at the time of planning a therapy and establishing a prognosis.