3^rd World Conference on Breast and Cervical Cancer September 24-25, 2018 Abu Dhabi, UAE

Hazem Khout has completed his Fellowship in Breast Oncoplastic Surgery at Edinburgh Breast Unit. He is a Fellow of the Royal College of Surgeons of Edinburgh and the European Board of Breast Surgery. He is currently a Consultant Breast Oncoplastic Surgeon at the Nottingham Breast Institute and an Affiliate Member at the Nottingham Breast Cancer Research Centre. He was appointed as a Professional Clinical Advisor for Surgery in East Midlands by the Public Health of England. He has a special interest in empowering breast cancer patients in making the decision and maximizing breast oncoplastic options.

Variations in oncoplastic and reconstructive practice are well-known and studied in the United Kingdom and worldwide. Some variations are due to services geographical fragmentation, patient and cancer-related factors and differences in breast unit’s infrastructure. However, it is evident that the lack of collaboration between local expertise is one the main factors affecting immediate total and partial breast reconstruction. A multi-phased project to re-design the reconstruction pathway was initiated at the Nottingham Breast Institute in March 2016. A new weekly Oncoplastic Forum (OPF) was introduced to improve patients’ outcome and enhance training and educational opportunities for trainees. We undertook a study to explore the impact of introducing an innovative multidisciplinary Oncoplastic Forum (OPF) on utilizing the diversity within the breast team to minimize inequality in accessing reconstructive options and to improve the patient experience. A prospective, inductive single-centered study was conducted using mixed research method. Qualitative data from semi-structured individual and focused group interviews were analyzed. The quantitative data were collected from electronic surveys. The outcome suggested that the oncoplastic forum has improved patient experience from professionals’ point of view. The use of a multidisciplinary approach minimized inter-surgeon variations and streamlined patient pathway. There are opportunities and challenges associated with modern technology and leadership h to impact on implementing safe healthcare changes. This oncoplastic forum might be the solution to address inequality and surgeon’s code discrepancy in oncoplastic practice.

Mohamad Al-Gailani is a Consultant Breast and General and Surgeon and In-Charge of Department of Surgery at Al Hammadi Hospital Al-Suwaidi, Nuzha Riyadh, KSA. He has also worked with NHS Foundation Trust, Rotherham, United Kingdom. He was the Member of British Association of Surgical Oncology and also the Member of the Association of Breast Surgery.

Breast cancer is the commonest female malignancy accounting for about 22% of all new female cancers. It is expected to affect 1:8 (12%) of women during their lifetime. The incidence in the Gulf and Arab world is approaching that in the West. Many women are anxious about their family history of breast cancer and what if anything they can do about it. In this presentation we will discuss breast cancer susceptibility and how to reduce the risk in general, the relevance of the individual’s family history, the objective assessment and risk stratification of family history and whether the Oral Contraceptive Pill (OCP) and Hormone Replacement Therapy (HRT) could increase the risk? Finally, what are the modern options available for a woman with a significant family history of breast cancer? It includes a review of the latest NICE UK guidelines on breast screening, chemoprevention and risk-reducing bilateral skin sparing mastectomy with immediate reconstruction.

George Farha has obtained General Medicine Diploma from St Joseph University. He has worked as Resident Radiation Oncologist at Hotel-Dieu de France-Beirut

and Gustave Roussy Cancer Campus Paris, France. He had done his Fellowship in Head and Neck and CNS Radiation Oncology from the University of Toronto. He has also served as an Assistant Professor of Radiation Oncology at University of Balamand, Beirut, Lebanon.

Aim: Aim is to dosimetrically compare two techniques of Accelerated Partial Breast Irradiation (APBI): Arc therapy by RapidArc (RA) and 3D conformal external beam irradiation (3D-CRT) by two mini-tangents and an “en face” electron beam.

 

Method: A retrospective dosimetric comparison of RA and 3D-CRT was performed. 22 le -sided breast cancer patients treated by 3D-CRT APBI were included for a dosimetric comparison of the dose received to the ipsilateral breast, heart, Non-Target Breast Tissue Volume (NTBTV), ipsilateral lung. All patients were treated with 38.5 Gy in 10 fractions twice daily using two mini-tangents and an “en face” electron beam, the dosimetric constraints were respected. The lumpectomy cavities (CTV) were contoured based on surgical clips. The PVT was constructed as a uniform expansion of 1.8 cm for all patients and was limited to 5 mm below the skin. Normal structures including ipsilateral lung, breast, and heart were delineated on each scan. The same contoured simulation CT was used for treatment planning and dosimetry with both techniques (RA and 3D-CRT) for each patient. To evaluate dose to the ipsilateral breast, heart, ipsilateral lung, NTBTV, and PTV, Dose-Volume Histogram

(DVH) an analysis was performed.

 

Result: The average percentage of the breast volume receiving 30 and 20 Gy was higher in the 3D-CRT group (23.8% and 25.4 %, respectively) compared with RA (20.7% and 23.1%, respectively). Improved coverage of the PTV was noted in the 3D-CRT plans compared with RA plans. With the 3D-CRT technique, 98.1% of the PTV received 36.5 Gy compared with 96.7% with RA technique. The average of the mean and maximal doses to PTV was higher by 2.1% and 5.9%, respectively in RA compared with 3D-CRT (p=0.001). Homogeneity index was lower with 3D-CRT (0.087) than RA (0.104). V5 Gy and mean dose to the heart were not significantly improved in RA (0.6 % and 0.58 Gy, respectively compared to 0.92 % and 0.82 Gy, respectively;p=0.78 for V5 Gy; p=0.95 for mean dose). V5 Gy and mean dose to the ipsilateral lung were not significantly higher in RA (5.7% and 1.2 Gy, respectively compared to 5.2 %and 1.10 Gy, respectively; p=0.35 for V5 Gy; p=0.27 for mean dose). V10 Gy and

mean dose to the NTBTV were not significantly improved in RA (35 % and 11.3 Gy, respectively compared to 38.1 % and 15.9 Gy, respectively; p=0.63 for V10 Gy; p=0.98 for mean dose).

 

Conclusion: In patients treated with 3D-CRT, coverage of the PTV was not significantly better and the mean dose to the ipsilateral lung was not significantly lower. As we did observe a trend in favor of RA, we think it would be useful to do the dosimetric comparison on a larger number of patients because a better PTV coverage with 3D-CRT might come at the cost of a higher integral dose to the remaining normal breast. RA might give a better sparing of the heart with lower doses to NTBTV but higher maximal dose to PTV.

Carcinoma of the uterine cervix is the second most common cancer of women worldwide. The available literature on the treatment of patients with advanced/recurrent and metastatic cervix cancer is discussed in the presentation. Single-agent chemotherapy for patients with advanced cervix cancer can be divided into those who received platin-based therapy and those

who received nonplatin-based therapy. The concept of combination chemotherapy requires the establishment of a standard single agent and then the addition of drugs that have demonstrated single-agent activity, no-overlapping toxicity and additive or synergistic antineoplastic activity in an e ort to develop a combination with improved efficacy and minimal or no increase in toxicity. Doublets that were selected for further investigation in phase III clinical trials include Bleomycin plus Cisplatin, 66 Fluorouracil plus Cisplatin, Paclitaxel plus Cisplatin, Ifosfamide plus Cisplatin, Gemcitabine plus Cisplatin, Vinorelbine plus Cisplatin, and Topotecan plus Cisplatin. When compared with single-agent Cisplatin, most doublets demonstrate a response

advantage over cisplatin alone. The role of chemotherapy in patients with advanced, recurrent or metastatic cervix cancer has been directed at improved objective response rates and palliation of symptoms while trying to maintain an acceptable level of toxicity. The literature is rife with anecdotal reports of dramatic responses that were not able to be duplicated in broad phase II

or III trials and single-agent cisplatin remained the treatment of choice until the recent report demonstrating a modest survival advantage for the combination of Topotecan plus Cisplatin over Cisplatin alone. Further clinical trials need to be a reconciliation of this dilemma and the optimal treatment of disease need to be illuminated.

Jeethy Ram has completed his MPhil in Biotechnology from Madurai Kamaraj University, Tamil Nadu and Masters in Biotechnology from Mahatma Gandhi

University, Kottayam, Kerala. She has worked as a Junior Research Fellow in the Structural Biology Lab at Madurai Kamaraj University. She is currently pursuing

his Ph.D. in Regional Cancer Centre, Trivandrum.

Breast cancer is a heterogeneous disease with different subtypes. A higher incidence of a subtype defined by lack of expression of ER, PR as well as HER2, designated as Triple Negative Breast Cancers (TNBC), has been reported among Indian women (approximately 15-25%). This is the most aggressive form with poor prognosis and high recurrence rate. Expression of epithelial-mesenchymal transition-related is a major trait of cancer stem cells. The drug resistance, recurrence and disease progression is attributed to Cancer Stem Cells (CSCs). Galectin-3 (Gal-3) is involved in several pathological activities associated with tumor progression and chemoresistance. However, the role and molecular mechanism of Gal-3 activity in breast carcinoma epithelial-mesenchymal transition remain enigmatic. In the current study, we tried to examine the role of Gal-3 in EMT associated gene expression, tumor invasion, metastasis and apoptosis in hormone negative and hormone positive breast cancer cell lines. Knockdown of the galectin-3 gene increases the sensitivity of MDA-MB-231 cells to drug-induced apoptosis as well as Expression of epithelial-mesenchymal transition-related associated gene expression suggesting that Galectin-3 may have a functional role in stem cell regulation in TNBCs.

Yoshika Nagata has completed her Ph.D. from the University of Occupational and Environmental Health, Japan. She has worked as a Research Associate and Assistant Professor in the Department of Surgery. She is currently a Chief Physician in the Department of Breast Surgery at Shonan Kamakura General Hospital, Kanagawa, Japan. She has published papers on tumor immunology. She is a Board Certified Member and Senior Fellow of the Japanese Surgical Society, Board certified Member of the Japanese Breast Cancer Society, General Clinical Oncologist and Educational Physician of the Japanese Board of Cancer Therapy.

The incidence and mortality of lung cancer continue to increase worldwide and also that of breast cancer tends to increase in Japan. The prognosis for patients with Non-Small Cell Lung Cancer (NSCLC) remains extremely poor and therefore, additional predictive indicators are required to determine the high-risk groups and to improve the postoperative outcome. The Histocompatibility Leukocyte Antigen (HLA) in humans has some hereditary features with a high degree of genetic polymorphism. The present study was undertaken to investigate the correlation between HLA phenotype and the prognosis of patients with breast cancer and NSCLC. We reviewed the medical records of breast cancer and NSCLC patients who underwent surgical resection. Serological typing of HLA class I was performed and revealed that certain types of HLA themselves may be genetically involved in both the susceptibility and resistibility of breast cancer and NSCLC. Then, the correlation between HLA phenotypes and clinic-pathological features were analyzed. HLA-A2 and HLA-A24 were the prognostic factors in NSCLC patients. However, there was no significant difference in breast cancer patients. A large number of tumor-associated antigens have been used in vaccination trials for many melanomas. It is regarded as important to identify a novel antigen useful for immunotherapy. Analysis of an autologous tumor-specific CTL clone was established from RLNLs of a patient with lung cancer by a mixed lymphocyte-tumor cell culture. We identified an autologous tumor associated antigen recognized by a CTL clone from a patient with large cell carcinoma of the lung in the context of HLA-Cw*0702.

Mahir Jallo is a Clinical Professor of Medicine, HOD and Senior Consultant, Internal Medicine-Diabetes and Endocrinology in Gulf Medical University, UAE and Faculty in the Canadian Academy of Natural Health. He has completed his MBChB from Mosul Medical College in Iraq and Postgraduate studies from the Board Certification in Internal Medicine CABM and Ph.D. from the Arab Board. He has completed his Fellowship (FRCP Edin) from the Royal College of Physician in Edinburgh. He has completed his Fellowship from the American College of Endocrinology FACE in USA and Diploma in Dyslipidemia from Boston University School of Medicine in the USA. He joined Thumbay Hospital-The Academic Health Center of Gulf Medical University in UAE, establishing the Diabetes and Endocrinology care in the hospital, the Endocrinology Module Coordinator for MBBS Program. He is the Editorial Board Member and Reviewer for many international diabetes and endocrinology journals. He is also the Member of many national and international medical societies and associations AACE, EASD, ISPAD, ESE, and European Atherosclerosis Society.

Cancer is the second leading cause of death in the world, 1 in 4 women and 1 in 3 men, develop cancer during their lifetime. In 2015 there were 17.5 million incident cancer cases and 8.7 million cancer deaths globally. Diabetes prevalence has also grown rapidly. 415 million adults in 2015, with 5 million deaths attributed. Diabetes is a risk factor for all-site cancer for both men and women, but the increased risk is higher in women than in men. Diabetes, obesity, and breast cancer are distinct diseases, but they do not occur in isolation. Does diabetes elevate the risk of developing breast cancer? The answer isn't completely settled yet, but diabetes could increase the risk of developing post-menopausal breast cancer. A recent systematic search in PubMed MEDLINE to identify reports on the links between diabetes and cancer revealed that women with diabetes had a 27% higher risk of all-site cancer compared to women without diabetes for men with diabetes the risk was 19% higher than for men without. Calculation of the women-to-men ratio revealed that women with diabetes had a 6% greater excess risk of all-site cancer compared to men with diabetes. Possible explanations for the excess risk of all-site cancer conferred by diabetes in women, Hyperglycemia may have carcinogenic e ects by causing DNA damage-an effect that would be potentially more pronounced in women whom were likely to be undertreated, receive less intensive care, or show lower adherence to anti-diabetic medication compared to men. The average duration of impaired glucose tolerance or impaired fasting glucose has been found to be over 2 years longer in women, with more exposure to untreated hyperinsulinemia in the pre-diabetes state which has been found to promote cancer cell proliferation. Recent research provides evidence that insulin drives signaling pathways that define the aggressive biology of estrogen-receptor negative breast cancer such as Akt/mTOR and Wnt. For that notion, Metformin is known to reduce circulating insulin, was studied in numerous ongoing clinical trials to test its ability in to prevent breast cancers. Findings from a recent observational study show type 2 diabetes increased the risk for an aggressive ER-negative breast cancer in African-American women by more than 40 percent, primarily in the women who had diabetes for at least 5 years and was only observed in non-obese black women contrary to the wide acceptable concept that obesity has long been recognized as a cause of both diabetes and breast cancer. If these results are confirmed, type 2 diabetes would be a modifiable risk factor for ER-negative breast cancer. The study did not show diabetes increased incidence of Estrogen Receptor (ER)-positive breast cancer, which is the most common subtype (75%) and has a very high survival rate. Women with breast cancer and diabetes face worse outcomes than those with breast cancer without diabetes. In a recent Canadian database study, all-cause mortality was increased in women with diabetes a er adjusting for comorbidities, but breast cancer-specific mortality was not increased overall. Women with a longer duration of diabetes and those with the pre-existing cardiovascular disease had increased all-cause and cancer-specific mortality. This study uncovers new information about key risk factors for the poorer prognosis in women with diabetes and breast cancer. The connection between breast cancer and diabetes could also be

a two-way street. Breast cancer survivors may also be at an elevated risk of developing diabetes a er their treatment. Further long-term studies are needed to clarify the clear link between diabetes and breast cancer.

Roaa Abdullah Attieh has completed general surgery board at the age of 28 years from King Abdulaziz National Guard medical city and peurcod Specialized surgical oncology training at St.George Hospital affiliated to the New South Wales University of Sydney, Australia Followed by sub-specialized training in Breast oncoplastic and endocrine surgery in the Royal College of Surgeon, Ireland. Currently, She is a full-time Surgical oncology consultant in King Abdullah medical city, Makkah, Kingdom of Saudi Arabia.

Breast plasmacytomas are extremely rare entities that can be seen as primary malignant neoplasms in the absence of bone involvement or as secondary neoplasms from disseminated multiple myeloma. Clinicians should be aware of this entity, as it may mimic benign and malignant lesions in the breast. Microscopically, immature plasmacytomas may mimic other neoplasms, so caution should be made on histological examination to ensure the correct diagnosis and corresponding therapy. Here we present a case of a plasmablastic plasmacytoma of the breast in a 65-year-old woman that was originally thought to be a Breast adenocarcinoma. The mass was excised, and histological examination confirmed the diagnosis of plasmacytoma. Although plasmacytoma of the breast is rare, this tumor should be considered as a differential diagnosis of a breast mass, especially in patients with plasma cell dyscrasias.