Breast Cancer

Ivan Terziev was born in 1961. He graduated in Medicine in 1987 from the Medical University of Sofia and obtained a specialty in Pathology and Cytology in 1991. Dr Terziev has been working at Tsaritsa Yoanna ISUL University Hospital since 1988, and he is also an Assistant professor of Pathology at the Medical University of Sofia, Bulgaria. Dr Terziev is a member of Bulgarian and European Society of Pathology and Bulgarian-Turkish group on Diseases of Thyroid and Breast. He has numerous publications in Bulgarian scientific journals, as well as more than 20 papers in reputed international ones. Dr Terziev is working in the area of histopathology of head of neck, thyroid gland, gastrointestinal, breast and surgical pathology.

Introduction: The incidence of breast cancer (BC) in Bulgaria is lower than the average in Europe (76.3 out of 100 000 females to average in Europe 94.2/100 000 females). The data from Bulgarian National Cancer Registry for the last 40 years shows continuous growth in the number of newly diagnosed cases – from 1632 patients in 1976 to 4000 in 2014. The staging distribution for 2013 is the

following: stage I (A, B) – 29%, stage II (A, B) – 42 %, stage III (A, B, C) – 20 %, stage IV – 5 %, unclassified – 4 %1.

Purpose: The purpose of this study is to analyze the choice of therapeutic management in patients with BC, diagnosed and treated at the Breast Unit, University Hospital ''Tzaritza Joanna – ISUL'', Medical University (MU) of Sofia in 2016 according to the stage of the disease.

Materials and method: All patients, diagnosed with BC were staged according to the TNM- classification (8th edition). The University

of Southern California/Van Nuys Prognostic Index (USC/VNPI), the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Medical University Sofia (MUS) prognostic model for evaluating the probability of local recurrence were used in determining the treatment options for patients with non-invasive form of BC (DCIS)2. The selection of patients with early breast cancer, suitable for breast-conserving surgery (BCS) with simultaneous intraoperative radiotherapy (IORT), was accomplished according to The Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) Breast Cancer Working Group (2009) criteria3. SPECT/CT was the preferred method for a preoperative maping of sentinel lymph nodes, followed by intraoperative detection with Europad Gamma Probe camera. We used the INTRABEAM® system (Carl Zeiss Surgical Gmbh, Oberkochen, Germany) to complete the process.

Results: In 2016 386 BC patients were treated at our Breast Unit. The mean age of the group of 136 newly diagnosed cases (132 females and 5 males) is 59,2 (29-91). Invasive ductal carcinoma was the most frequent finding (76%) and invasive lobular carcinoma occurs in 16 % of all cases. We had one male patient with malignant fibrous histiocytoma of the breast.

Conclusion: Important factors for successful results are the modern complex treatment, which requires individualized approach, and the consequtive modules in standard limits that we provide. The role and advantages of the specialized structures (Breast Units) are undeniable, since they ensure the highest level of diagnosis and treatment, i.e. for the past year at our Breast Unit newly-diagnosed patients were 33% without a single patient with unclear stage. Nationally these numbers are 29% and 4%, respectively.

Ns Rika Fatmadona, MKep, Sp.Kep MB, has her expertise in oncology nursing and passion in improving nursing education and health. She has get master and nursing specialist in Oncology at University of Indonesia. Now she works as a lecturer in Nursing Faculty at Andalas University Padang. Her concerned on nursning education, and doing research on cancer patient. Not only that, she is also as a clinical instructor in educational hospital, RSP Andalas Padang and also takes a role in caring patient as a clinical care manager. As a researcher, she is concerned on caring of cancer patient and its impact on family.trying to arrange develop research on her way to get PhD. Her vision in updating knowledge and skill is one way to develop herself. Being good and useful to everyone, is her motto.

Minangnese, community in west sumatera, is the largest matrilineal society in the world, with property, family name and land passing down from mother to daughter. Being diagnosed by Breast cancer (BC) has impact on family integrity, which is a very stressful event for patients and their families. Moreover, The role of the family as significant person and very important in supporting the patient. The research design used was cross sectional with sampling purposive sampling technique. Data collection was conducted from 7 to 16 of December 2015, with 40 people sampled in population of BC patients in public hospital Solok. The aim of this study was to determine the relationship between family support with the quality of life of breast cancer patients in public hospital Solok. Methodology & Theoretical Orientation: This research using corelatic anlysis that discusses the degree of relationship between two variables vary consistently;independent variables (family support) and dependent variable (QoL) in patients with BC in cross-sectional approach. Data were collected through interview using a questionnaire which is processed and analyzed by chisquare test. Findings :The result showed more than half of respondents had negative quality of life in highly support in family. There is a relationship between family support and quality of life.Being diagnosis has been shown to evoke a state of shock, fear and disbelief, thus creating not only a psychological crisis but an existential one as well. Most Minangnese women experience at least some psychosocial distress during the course of their breast cancer diagnosis, but they try to struggle by their own power, keep doing their daily task, until the stadium of BC or its complication make them suffering, and these maketheirqualityof life negative.The level of distress varies from woman to woman and can vary for the individual patient over the course of diagnosis. Recommendations are made for health service to promote early detection of BC and give health education to patient and family of BC

Background: Breast cancer is the most common cancer among Iranian women. Breast cancer screening methods have led to earlier diagnosis and improvement in the survival of breast cancer patients. However, Iranian women with a family history of breast cancer are less likely to participate in breast cancer screening programs. In this study we have evaluated the effectiveness of peer group based intervention in promoting breast cancer screening participation in women with a family history of breast cancer.

Method: Women with a family history of breast cancer who were 20 years or older and in pre contemplation, contemplation, or relapse stage of breast cancer screening according to Trans Theoretical Model (TTM) were included. A computerized randomization was performed to allocate participants to the intervention or the control group. In order to prepare peer group leaders, an educational program was held for volunteer women by a health expert. Afterwards, three sessions were held in three weeks for the intervention

group. A questionnaire was filled out for participants in both groups at baseline one and three months after the intervention.

Results: Overall 98 women completed the study. ANOVA showed that one and three months after the intervention, women in the intervention group had a significantly higher level of knowledge, perceived sensitivity, perceived severity, health motivation, CBE and mammography benefits and lower barriers toward CBE and mammography.

Discussion: A structured intervention based on peer group can successfully improve participants’ knowledge, beliefs and participation in breast cancer screening programs in high risk women for breast cancer.

Ziba Farajzadegan has completed her MD from Tabriz University and specialy studies from Isfahan University School of Medicine. She is working as a preventive Medicine Specialist in Isfahan Medical Sciences for 15 years. Her research interest is women health, focusing on supportive care of women with breast cancer.

Background: Breast cancer is the most common cancer among Iranian women. Breast cancer screening methods have led to earlier diagnosis and improvement in the survival of breast cancer patients. However, Iranian women with a family history of breast cancer are less likely to participate in breast cancer screening programs. In this study we have evaluated the effectiveness of peer group based intervention in promoting breast cancer screening participation in women with a family history of breast cancer.

Method: Women with a family history of breast cancer who were 20 years or older and in pre contemplation, contemplation, or relapse stage of breast cancer screening according to Trans Theoretical Model (TTM) were included. A computerized randomization was performed to allocate participants to the intervention or the control group. In order to prepare peer group leaders, an educational program was held for volunteer women by a health expert. Afterwards, three sessions were held in three weeks for the intervention

group. A questionnaire was filled out for participants in both groups at baseline one and three months after the intervention.

Results: Overall 98 women completed the study. ANOVA showed that one and three months after the intervention, women in the intervention group had a significantly higher level of knowledge, perceived sensitivity, perceived severity, health motivation, CBE and mammography benefits and lower barriers toward CBE and mammography.

Discussion: A structured intervention based on peer group can successfully improve participants’ knowledge, beliefs and participation in breast cancer screening programs in high risk women for breast cancer.

Fu Zhuo-Han Marc : After a Master in biomedical engineering at UCL. He is currently Business Developer at OncoDNA. It is an exciting challenge to combine

scientific and sales knowledge to further develop OncoDNA’s activities in South East Asian Regions.

Statement of the Problem: Breast cancer (BC) is the most common cancer amongst women in Europe, with one out of eight developing this disease during her lifetime. In the last few decades, surgical excision followed by adjuvant radiotherapy, sentinel lymph node dissection, and adjuvant systemic therapy in the form of chemotherapy, hormonal therapy and Trastuzumab have improved the quality of life and long‐term survival of women diagnosed with early disease. However, BC remains the leading cause of female cancer-related death worldwide. Thanks to the NGS and other tests (like IHCs, methylation), it is now possible to perform a profiling of the tumor to identify either treatments that might be associated with some clinical benefit or resistance to approved treatment.

Methodology: Biopsies of women affected by different breast cancer type have been analysed by sequencing and some specific tests (methylation, IHCs).

Findings: Overall, the NGS provided the oncologist with no use in 50% to 90% of the cases whereas the IHCs/specific tests increase this number by a factor 2 with the caviar of the combination of both. These results were prospectively compared to the decision of the oncologists in an automated way. 23.2% of the patients passed away before the oncologist’s decision. Among the 76.8% remaining, 59.7% followed our recommendations, 27.5% didn’t and 3.1% went against. Only in 6.6% of the cases, the decision was taken according to the NGS only, and 95.4% remaining concerned chemotherapies only. And in 100% of the cases, the treatment chosen was either a drug approved for the cancer type analysed or approved for another cancer type. None of the drugs in development in clinical trial was chosen and only 1% went into a clinical trial.

Conclusion & Significance: This study demonstrated how simple strategies based on the NGS only have a limited impact on the oncologist’s final decision confronted to the reality where only chemotherapies are available in their countries and clinical trials are either not recruiting or really difficult to get into.

Lai Oi Ling has done her professional Doctorate in the year 2012 from the University of the West of England. She is the Registered Nurse in Hospital Authority and a member of the Hong Kong Soka Gakkai International. She is actively participating in the Hong Kong Cancer Fund as a Volunteer Lecturer in patient education.

Aim: To be or not to be a breast cancer survivor? This study aimed to explore the spiritual impact of the Buddhist beliefs as a lived experience on breast cancer survivorship in Hong Kong culture.

Method: A phenomenological research design guided in data collection. A purposive sample of ten breast cancer survivors coming from the Soka Gakkai International, Fo Guang Shan was interviewed two times. Twenty semi structured, in-depth and face to face interviews are conducted in the community. All of them recites the Buddhist Sutra and perform different meditation practices every day. Their unique lifeworld stories reflected on the Hong Kong healthcare context. Two layers data reduction included the thematic analysis and the van Manen's method. The researcher conceptualized themes under the lived space, lived body, lived time, and lived human relations. The hermeneutics approach elaborated the participant's life including being, being-with-others, and being-in-the-world.

Result: These women expressed that the Buddhist mindfulness and chanting meditation have led them to be open and to accept all experiences in their way. The survivors perceived breast cancer as an opportunity to discover their own Buddhahood no matter what difficulties they encountered. Two significant stresses came from the suffering during the treatment and fulfilling the role as a mother. Four Buddhist coping themes were (a) transforming their negative karma, (b) opening up own Buddhahood, (c) fulfilling the Bodhisattvas identity, and (d) hope and future. All of them had performed two patterns including "to actualize their essence of life" and "to study and practice their Buddhist faith." Body and mind changed from passive, "being help by others" to active, "to empower and encourage other people."

Conclusion: Searching the meaning of life is important to help them cope with the adversity in living with cancer. The author suggests the cancer survivors define the ultimate goal in life and explore the significance of faith which empowers them to achieve happiness in their unique way.