Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 4th World Congress on Breast Pathology and Cancer Diagnosis Toronto, Canada [Holiday Inn Toronto International Airport].

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Day 1 :

  • Breast Cancer and Genetics

Session Introduction

Juliet Daniel

Professor and Cancer Biologist in McMaster University, Canada.

Title: Kaiso roles in racial disparity of TNBC prevalence and outcomes
Speaker
Biography:

Daniel obtained her Ph.D. in 1994 from the University of British Columbia, Vancouver, and
conducted her postdoctoral studies at St. Jude Children’s Research Hospital (Memphis) and
Vanderbilt University (Nashville) in Tennessee, USA. She is a Professor and Cancer Biologist in
the Dept. of Biology at McMaster University in Hamilton, Ontario, Canada. Dr. Daniel has
mentored over 20 graduate students and postdoctoral fellows, and published more than 30 articles in reputed journals such as PLoS ONE, Oncotarget and Oncogenesis.

Abstract:

Breast cancer (BC) is the most frequent female cancer and 2nd leading cause of female deaths
worldwide. However although BC death rates have significantly declined globally in the past 20
years, women of African ancestry (WAA) still have a disproportionately high BC mortality rate
despite a lower overall BC incidence rate than Caucasian women. Intriguingly, the aggressive and
often fatal BC subtype, triple negative breast cancer (TNBC), is most common in young WAA but
the reason for this racial disparity in TNBC prevalence and mortality is currently unknown.
Nonetheless, mounting evidence hints at genetic risk factors rather than socio-economic status as a
cause for this racial disparity. Recently, increased expression of the unique transcription factor
Kaiso was found to correlate with basal/TNBCs, suggesting that Kaiso may play a role in TNBC
aggressiveness and racial disparity in WAA. Using tissue microarray and immunohistochemistry,
we investigated Kaiso expression in a cohort of WAA TNBC patient tissues from Barbados and
Nigeria, and a multi-ethnic cohort from the USA. We found a significant correlation between high
Kaiso expression, the degree of African ancestry, and shorter metastasis-free survival in WAA.
Notably when Kaiso is depleted in BC cells, the cells exhibit decreased TGFβ signaling (a known
promoter of metastasis), and did not metastasize to lungs or liver in a mouse model of breast cancer.
Collectively these data implicate Kaiso in TNBC aggressiveness and racial disparity.

Nadeem Kizilbash

Faculty of Applied Medical Sciences, Northern Border University, Arar-91431, Saudi Arabia

Title: Promoter Region Polymorphisms in IL-6 and IL-10 Genes can lead to Pathogenesis of Breast Cancer
Speaker
Biography:

Updating Soon…

Abstract:

This study investigated polymorphisms in the promoter regions of IL-6 (-174 G>C) and IL-10 (-1082 G>A) genes through a case-control study. Features like the expression of estrogen and progesterone receptors, involvement of the lymph node, tumor morphology and tumor grades were observed, for the patient group. For the IL-6 -174G>C polymorphism, there was significantly higher frequency of C/C genotype in the patients. Further, the C/C genotype was significantly more prevalent among the patients who had lymph node involvement. For the IL-10 -1082G>A polymorphism, there was no difference in the distribution of genotypes among the patients and control subjects.

Biography:

Updating Soon…

Abstract:

MicroRNAs (miRNAs) are short, non-coding RNAs molecules of 19–25 nt,   involved in a wide array of physiological and pathological processes by modulating the expression of their cognate target genes through cleaving mRNA molecules or inhibiting their translation.  
In cancer, microRNAs  can act as oncogenes or tumor suppressor genes. Oncogenic miRNAs may be amplified, resulting in increased expression of the oncomir. Tumor-suppressive miRNAs could reside in chromosome fragile sites characterized by deletions or mutations, leading to reduced levels of these miRNAs.
Some miRNAs are emerging as a novel class of potential biomarkers  for early Breast Cancer (BC) diagnosis, prognosis, and prediction of therapeutic outcomes. miRNAs are of interest as easily accessible, affordable, non-invasive tools for the  management of patients with BC. MicroRNA expression signature appears to provide a better characterization of cancer subtypes than gene expression profiling  and may represent a new classification system for breast cancer. Abnormal microRNA expression patterns are closely related to specific tumor stages, lymph node, steps of the metastasis cascade, poor survival, disease outcomes and responses to specific therapies in many types of cancer. MicroRNA profiling has been assessed to  differentiate patients with BC as responding or not responding to therapies.
MicroRNA deregulation in the development of BC in several tissues and lineages,   have correlated miRNA profiles with mRNA subtypes.   
In this review, the potential value of these microRNAs as diagnostic and prognostic markers, and  the possible development of microRNA-based therapies will be assessed.

Speaker
Biography:

Lei Wei, a computational biologist, is currently an Assistant Professor at Roswell Park Cancer Institute. Specializing in genetic variation and somatic mutation detection through developing and unitizing sophisticated computational and statistical methods of Next Generation Sequencing (NGS), Wei has analyzed large numbers of NGS data sets, authored and co-authored many publications on high impact journals such as Nature, Nature Genetics, Cancer Cell, European Urology. His current researches focus on tumor heterogeneity, single cell sequencing and neoantigen in immunotherapy. Besides human tumors, he has extensive experience with analyzing patient-derived xenograft and genetically engineered mouse models.

Abstract:

Next-generation sequencing-based somatic mutations detection is becoming a standard analysis in neoplasms, which often requires a matched non-neoplastic sample for excluding germline events. One common tissue source for this purpose is non-neoplastic tissue adjacent to the excised neoplasm. However, these non-neoplastic tissues frequently contain low-level somatic mutations, which may impose additional challenges to somatic mutation detection as it complicates germline variant filtering. To test if this problem can be related to inadvertent contamination by neoplastic cells during the surgical pathology gross assessment or tissue procurement process, we applied a systematic protocol designed to collect multiple grossly non-neoplastic tissues using four different methods surrounding each single neoplasm. In each case, all samples were first sequenced by whole-exome sequencing, and then followed by ultra-deep sequencing targeting tumor-specific mutations to assess the exact contamination levels. Contamination was identified in at least half of the collected non-neoplastic tissues, at levels up to 20.9%. These contamination levels exhibited consistent pattern correlated with the manner of grossing and procurement. Our results suggest that the process of tissue procurement may contribute to contamination in non-neoplastic tissue, and the level of contamination can be minimized by using a carefully designed collection method. A standard protocol dedicated for acquiring adjacent non-neoplastic tissue that minimizes neoplasm contamination should be implemented for all future somatic mutation detection studies.

  • Breast Pathology and Treatment

Session Introduction

Anne Wilkinson

NKP Salve Institute of Medical Sciences and Research Centre, India.

Title: Endogenous sex steroid hormone levels in women with breast malignancy
Speaker
Biography:

Anne Wilkinson has completed her MD in Pathology from Christian Medical College and Hospital, Ludhiana, Punjab. She is currently working as Associate Professor in Pathology at NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, India. She has been teaching Pathology to undergraduate students and is also a guide for postgraduate students. She has more than 50 publications to her credit. She has been actively involved in organizing CME’s and Conferences and is the Past President of Vidarbha Association of Pathologists and Microbiologists in 2015-16

Abstract:

 Hormones play a critical role in breast carcinogenesis. In the recent past there has been extensive focus on the role of estrogen as a growth regulator of normal breast tissue and breast cancer. However, progesterone is also a potent breast mitogen. Testosterone or its metabolites might play a role in breast cancer etiology by altering the availability of estrogens or by acting as an estrogen precursor. 30 cases of newly diagnosed breast cancer cases were selected of which 12 were premenopausal and 18 were postmenopausal women. Most of the cases were in the age group of 41-50 years (47%), followed by 31-40 years. 79% of the patients presented with complaint of breast lump. Upper outer quadrant was most commonly involved followed by the upper inner quadrant. 73% of the cases were of infiltrating ductal carcinoma. Other cases included were of infiltrating lobular carcinoma, medullary carcinoma, mucinous carcinoma, apocrine carcinoma, metaplastic carcinoma, spindle cell sarcoma and malignant phyllodes.
Serum endogeneous sex steroid hormone levels (estradiol, progesterone and testosterone) of the 30 women with breast cancer and 40 healthy controls were analysed using the Enzyme Linked Immunofluoresence Assay (ELFA) method. Serum levels of estradiol were found to be raised in the premenopausal and postmenopausal phases with statistically significant association of p<0.05. Serum values of progesterone and testosterone were statistically insignificant with p>0.05. Although comparable data was found in other Western studies, we do not have many studies done on the endogenous sex hormone levels in breast cancer patients in our country and the surrounding areas.  Concentration of serum estradiol may predict the risk for breast malignancy and  hence may help the clinicians to decide further management to decrease breast cancer risk.

Bennani Amal

University hospital of oujda, Morocco.

Title: Primary angiosarcoma of the breast (about two cases)
Biography:

Amal bennani has completed his medical studies at the age of 25 years from mohamed ben abdellah FES School of Medicine. she is an assistant professor in university

Abstract:

Primary angiosarcoma (AS) of the breast is a rare neoplasia that is not related to radiation exposure. It represents less than 0.05% of all malignant breast tumors.
We report two cases of primary angiosarcoma of the breast. The first patient was a 33- year-old woman with a highly vascular mass in her right breast which is suggestive of malignancy at radiology. Initial core needle biopsy showed a benign hemangioma. The patient underwent a mastectomy. The tumor histology showed an angiosarcoma grade III. The patient is now receiving chemotherapy. She is still alive.The second patient was 19 year old women with a large and fast growing mass of her right breast which is no specific at radiology.Surgical biopsy showed a well differeciated angiosarcoma.she underwent  a mastectomy and after she recieved chemoterapy and died within 2 years.
This tumor is exceedingly rare, characterized by aggressive patterns and poor prognosis and by the absence of typical features at radiologic examination. His prognosis is usually poor because of the high rates of local recurrence and early development of metastasis. Surgical removal followed by adjuvant chemotherapy seems improve the prognosis.
We report this two cases in the aim of avoiding the common trap of a benign differential diagnosis, and achieving a better definition of the treatment of this cancer.

Eman El-Abd

Medical research institute (MRI), Alexandria University

Title: Reversal of TAM Resistance by Calcitriol and Tretinoin Combined
Speaker
Biography:

Eman El-Abd, Ass. Prof. in radiation sciences department, Medical research institute (MRI), Alexandria University.

Abstract:

Materials and methods: To investigate the role of single and combined therapeutic effect of tretinoin and calcitriol in reversal of tamoxifen resistance in LCC2, doses were determined by MTT assay.  The study included eight groups (triplicates); control group (1% v/v of DMSO), 100 nM 4-OH TAM, 250 nM calcitriol, 1mM tretinoin, tretinoin + calcitriol, TAM + calcitriol, TAM + tretinoin, TAM + calcitriol + tretinoin. After 72 hours, CCND1 was assayed by qRT-PCR while, ER, survivin, Her-2, and IGF-1R were detected by ELISA.
Results: TAMR was represented by a significant decrease in ER and significant increase of Her-2, survivin, and EGF-1R in TAM group. Tretinoin significantly increased Her-2, survivin, and IGF-1R while, calcitriol significantly increased ER. Combined calcitriol and tretinoin treatment significantly increased ER, Her-2, survivin, and IGF-1R than control. Addition of calcitriol to TAM significantly normalized Her-2, survivin, EGF-1R, and ER. However, addition of tretinoin significantly lowered Her-2, survivin, and EGF-1R and increased significantly ER to a normalized level. TAM plus both vitamins significantly increased ER than TAM alone and even more than the control level, normalized Her-2, and IGF-1R, and significantly lowered survivin than control.  Addition of tretinoin to TAM significantly increased CCND1 than TAM and control. A significant reversal correlations was detected between ER and survivin. A direct significant correlation was also detected between survivin and both IGF-1R and Her-2. Her-2 significantly correlated directly with IGF-1R.
Conclusion: Combined therapy alleviate TAMR via cross-talk of ER with Her-2, survivin, and IGF-1R with survivin being the most affected effector.

Shimae Nafarzadeh

Babol University of Medical Sciences, Dentistry school,Iran.

Title: Cancer stem cells as new targets for tumor treatment
Speaker
Biography:

Shimae have completed DDS in Dentistry in 2004 and herspecialty is in Oral and Maxillofacial Pathology in 2007  from Shahid Beheshti University of Medical Sciences, Tehran, Iran . she have been working as a university professor in the Oral and Maxillofacial pathology department of Babol Dentistry school since 2007, and as the dean of the department since two years ago.

Abstract:

Cancer stem cells (CSCs) are a small population of tumorigenic cancer cells which are considered as beginners for cancers. We conducted a systematic review article by surfing the PubMed and Scopus data bases, and  found 16 articles from 2000 to 2017. Few articles are published about CSCs in oral Squamous Cell Carcinoma, but similar to other tumors, these cells are able to self-renew and differentiate by cell devision . Studies showed that they play role in metastasis, therapies resistance and recurrencies through expression of different markers. Rapid tumor growth and weak prognosis have been related to the presence of CSCs. Helen H. Yu et al. noted three subpopulations in SCC. One CSC group exists in the tumor nests; the second group in the stroma between tumoral nests, and the third group in the endothelium of stromal vessels. Some studies focused on the mediators and cytokines produced by CSCs. Kelsey A. et al. showed that IL-6 is secreted by the third subpopulation named above, and induces the effect of Cisplatin, therefore increases the tumorigenic potential of Head and Neck CSCs. Moreover high serum levels of this cytokine has been correlated with patients poor survival. It is assumed that discovering the characteristics of CSCs in tumors would be a goal for better, more precise and targeted cancer treatments.

  • Special Types of Carcinoma

Session Introduction

Angela Flavia Logullo Waitzberg

Federal University of São Paulo, Brazil.

Title: Prognostic relevance of claudins 4 and 7 in invasive breast carcinoma subtypes
Biography:

Updating Soon…

Abstract:

Aims: Recently, a new molecular subtype denominated “claudin-low” (CL) was described in breast cancer and correlated to worse prognosis and to CD44+/CD24- stem cell profile. Among 19 known claudin proteins, isotypes 4 (CL4) and 7 (CL7) are the most common in the breast biology. Our aim was to verify differences in CL4 and CL7 immunoexpression between Luminal A, HER-2, and triple-negative breast cancer phenotypes; and their association to CD44/24 status and tumour prognosis. Methods: Estrogen and progesterone receptor status (ER/PR), HER-2, CL4 and CL7 expression and CD44/24 profiles were evaluated in 803 invasive ductal breast carcinomas arranged into four tissue microarrays (TMA) and results were correlated with prognosis and important clinical data. Results:  503 (62.6%) cases were positive for CL4 and 369 (46.0%) cases for CL7. The majority (199/283, 70.3%) of CL4 negative cases were clustered in the luminal A subtype whereas 63 (22.3%) showed triple-negative profile and the remaining 21 cases (7.4%) exhibited positive HER-2 expression (p<0.001). Claudin 7 negative samples (44.2%) tended to follow the same pattern. CL4 positive expression was significantly associated to HER-2 expression, presence of lymph nodes and increased tumour grades and inversely correlated to ER and PR expression. However, there was no association between CL7 expression and any of these features. Both CL4 and CL7 did not show correlation to the stem cell markers (CD44+/CD24-) or worse prognosis (survival and disease-free interval). Conclusions: Claudins 4 and 7 individual status did not provide additional prognostic information within breast cancer subtypes

Speaker
Biography:

She began her medical career as a paediatric surgeon in the former Soviet Union. After she made Canada my home in 1991, She broadened her studies and work into the field of pathology. As a pathologist, she is really good at finding the root causes of medical problems and also good at finding ways to heal medical conditions.

Abstract:

Background: for long time encapsulated and solid papillary carcinomas have been debated either an in-situ or an invasive entity. The goal of our study was to examine the presence or absence and the quality of myoepithelial cells, the presence or absence and thickness of basement membrane in all the selected cases.
Methods: 8 cases of encapsulated and solid papillary carcinomas, 3 cases of low to intermediate grade DCIS in association with low grade IDC NOS and 2 cases of combined IG DCIS and encapsulated papillary carcinomas as well as 2 cases of normal breast were selected from your database. The morphology was reviewed, immunohistochemical stains to highlight myoepithelial cells were performed and all cases were subjected for digital electron microscopy.
Results: All 5 cases of encapsulated papillary carcinoma show the presence of continuous or discontinuous attenuated basement membrane and absence of myoepithelial cells, 3 solid papillary carcinomas show possible small myoepithelial cells.
Conclusions:
We think that encapsulated papillary carcinomas represent a category of neoplasms in transition from an in-situ to invasive carcinomas, and at this stage should be interpreted as low grade invasive ductal carcinomas with favorable behavior. Solid papillary carcinomas should be divided into 2 categories: an invasive solid papillary carcinoma and an in-situ solid papillary carcinomas.

Speaker
Biography:

Updating Soon…

Abstract:

Occult breast cancer presenting as an axillary mass is a rare clinical finding. Less than 5% of breast carcinoma presents as an axillary mass without an obvious primary tumor. Axillary lymph node showing metastatic adenocarcinoma poses diagnostic and therapeutic problems, when it is the only clinical presentation. In a significant proportion of breast cancer cases, mammographic detection of micro-calcifications is indicative of the presence of a breast lesion. We present a rare case of a bilateral occult breast carcinoma in a 40 year female with bilateral axillary mass without any palpable breast mass.

  • Breast Pathology and Diagnosis
Speaker
Biography:

Angel Arnaout is a Breast Surgical Oncologist at the Ottawa Hospital, Associate Professor at the University of Ottawa, Associate Scientist at the Ottawa Hospital Research Institute, and Medical Director of the Breast Health Center in Ottawa, Ontario, Canada. She is the creator innovative programs for breast cancer patients including the Ottawa Hospital Rapid Diagnosis and Support (RADS) Program, The Advanced Multidisciplinary (TEAM) Program of Ottawa, and the “Window of Opportunity” Clinical Trials Platform in Canada. Dr. Arnaout has won numerous national awards for her work including the “Best Innovation in Cancer Care Delivery Award” at the Canadian Ontario Provincial Showcase, the Canadian Association of General Surgeon’s Award, the Canadian Cancer Society Research Award, and the Canadian Breast Cancer Foundation Research Award. Dr. Arnaout has published over 40 scientific papers in peer-reviewed journals.

Abstract:

Every year, countless women will be diagnosed and treated for breast cancer, most of whom will require surgery. A clean margin around the cancer site is the only prognostic factor that a surgeon can control in order to reduce local recurrence. Having an accurate method of assessing margin status is imperative not only for better oncologic outcomes for the patient, but also to prevent unnecessary additional surgeries for re-excision, additional emotional distress for patients, delays in subsequent adjuvant therapy for breast cancer, and associated additional health care costs. There are two commonly used techniques that surgeons use to orient breast specimens for the pathologists: intra-operative labeling of the margins with sutures and intra-operative inking of the margins. Using a creative, a novel 3D technique, we demonstrate the results of the world’s first prospective clinical trial that evaluates the accuracy of both techniques on the same lumpectomy specimen, in a blinded fashion, using with the aim of identifying the most accurate method of specimen orientation. The results of this trial are practice-changing with significant implications for patient safety and health care costs. This study will form the foundation for unifying breast cancer surgeons and pathologists on best practices for accurate specimen orientation and improved patient outcomes. Findings from the study can be extrapolated to the pathological assessment of other surgically resectable cancer types in which margin status is a quality indicator.

Biography:

Updating Soon…

Abstract:

Circulating tumor DNA (ctDNA) is gaining popularity in the evaluation of solid tumors through applications that complement direct tumor profiling. However, accurate detection of ctDNA in the background of thousands of normal DNA copies, is a challenge. A cell-free DNA based assay requires optimizing extraction and plasma handling for minimal loss of this component or its dilution by DNA from lysed cells. Further the technology platforms to detect ctDNA have to be order of magnitude more sensitive than qPCR or routine next-gen sequencing. We developed assays for directed mutation testing as well as broad profiling in the plasma, at high accuracy, using the ultra sensitive droplet-digital PCR, as well as our proprietary test and algorithm for NGS based detection. We present data from 120 matched tumor - plasma samples across 9 different cancer types. The tumor tissues were profiled for using NGS. Selected somatic mutations were tested for concordance in the plasma, collected at the same time as the tumor tissue. A stringent QC measure was adopted to rule out false negatives due to technical errors in the assay. The tumor-plasma concordance was the highest in the lung samples at >90% and relatively modest for breast cancer samples at around 30% for both early and advanced cases. The most frequently mutated gene in the breast was TP53 with each sample exhibiting a different mutations. The most common breast mutation was observed at the 1047 locus of PIK3CA gene where the His was mutated to either Arg (80%) or Leu. Overall, our data shows 65% detection of ctDNA across all advanced tumor samples and >35% for early stage tumors thereby showing that the approach can be deployed to profile and monitor a vast number of different cancers.

Speaker
Biography:

Dr. Majid Shokoufi is a postdoctoral fellow at Simon Fraser University (SFU) in November 2016.  He received his Masters and Bachelors degrees in electrical engineering (Electronic system design), and he received his Ph.D. in biomedical devices at the School of Mechatronic Systems Engineering at SFU. During his Ph.D. program, he was involved in several projects in the area of health care, wearable devices, internet of things and measurement instruments such as UV-VIS-NIR spectroscopy.

Abstract:

Diffuse optical spectroscopy (DOS) and diffuse optical Imaging (DOI) are relatively new methods for breast cancer diagnosis which are noninvasive and nonionizing techniques. In the present study, we have introduced a novel handheld diffuse optical breast scanning (DOB-Scan) probe to measure optical properties of breast tissue and create functional and compositional cross-sectional images of the breast. Four near-infrared wavelengths light emitting diodes (LED), encapsulated in a package (eLED), are used to illuminate the breast tissue. A linear charge coupled device (CCD) measures the intensity of the scattered photons at different radial destinations from the illumination source on the surface of the breast tissue. The proposed method replaces fiber optic based illumination techniques, which increases the complexity, size and cost of a potential probe, by multi-wavelengths eLED which acts as a pencil beam source in such a scattering media like the breast tissue. Although the introduced technique miniaturizes the probe, this study points to the reliability and accuracy of this technique in breast imaging. The average scattering coefficient of the medium and localized concentration variations in oxyhemoglobin and deoxyhemoglobin can be measured utilizing the probe. In order to evaluate the performance of DOB-Scan probe, a series of tissue-like materials, containing of Intralipid®, Black ink, Delrin®, and PierceTM have been used. We have received ethical approvals to test the DOB-Scan probe on patients who are known with breast cancer and we are currently testing the DOB-Scan probe on real subjects.

Maha Ali

Sudan University of Science and Technology, Sudan.

Title: Colored Computer Aided Diagnosis System for Breast Mammography
Speaker
Biography:

Updating Soon…

Abstract:

Breast Cancer is the most common and life threatening cancer among women. Mammography is a key screening tool for breast abnormalities detection. It is an effective way that has demonstrated the ability to detect breast cancer at early stages, because it allows identification of tumor before being palpable. Radiologists may miss the breast abnormality due to the textural variation of breast tissues intensity in mammogram. So, radiologists may result in False-positive or False-negative results. Efforts in developing the Computer Aided Detection/Diagnosis (CAD) systems for mammogram analysis improve the diagnostic accuracy by radiologists.
This study developed an algorithm to read mammograms automatically with colors. It proposed the use of discrete wavelet decomposition technique using Symlet wavelet as a feature extraction, and the linear discriminant analysis (LDA) as a classifier in order to discriminate the extracted features to find out this detection.
The algorithm achieved 98.8% accuracy, 95.0% sensitivity in breast tissue classification. This accuracy has been verified with the ground truth given in the mini-MIAS database. So, this algorithm will help radiologists for a true diagnosis and decrease the number of the missing cancerous regions or unnecessary biopsies which are very stressful for women, it can help in early detection of breast cancer, and following treatment can significantly improve the chance of survival for patients with breast cancer. So, it will save women lives.

  • Breast Cancer and Surgery
Speaker
Biography:

Updating Soon…

Abstract:

We studied a patient (NS), who passed away († 2008) at the age of 56. She had been exposed to gel bleed from her silicone breast implants for 17 years. She was one of the women who developed health complaints while she had these implants. She donated her body, so that her organs and nervous tissue could be obtained for analysis.
Methods: During autopsy, many tissue samples were harvested, frozen and  embedded in paraffin and EPON. The paraffin samples were stained with Hematoxylin and Eosin (HE) as well as with Modified Oil O Red (MORO). Tissues embedded in EPON were sectioned and prepared for light microscopy using toluïdin blue staining for electron microscopy and EDX measurement of elemental Si.
Results: We found 2 types of silicone material in multiple body and brain samples of this patient. The first is a droplet-like form. EDX measurements demonstrated that the droplets are composed of elemental Si. The second is a plaque-like form. EDX measurement of the EPON embedded samples revealed that these structures are comprised of elemental Si and Ti (Titanium). All the plaque-like structures are morphologically the same and contain small dens particles. Occasionally we found that these plaques are located inside the tissue without a  lining and sometimes they were located inside the lumen of blood vessels.
Conclusion: This novel approach, presents a contributing factor for the establishment of silicone bleeding and migration throughout the whole body, which therefore also highlights the phenomenon of epigenetic aging as the likely explanation of the health related concerns of silicone breast implants, rather than autoimmunity.

  • Breast Cancer Pathology

Session Introduction

Nam-Sun Paik

Director of Ewha Womens University Cancer Center for Women, Korea

Title: Current Status of Korean Breast Cancer and Oncoplastic Surgery
Speaker
Biography:

Graduated from School of Medicine,Seoul National University in 1973
2011.5: Currently Director of Ewha Womens University Cancer Center for Women, Seoul, Korea.
2009.7-2011.4; President of Konkuk University Medical Center
2006-2008; President of Asian Breast Cancer Society
2006.7 ; Selected as one of the top 100 Health Professional as of Breast and Stomach Surgical Oncologist. International Biographical center of Cambridge, England
2001.6-2003.6;.President of Korean Breast Cancer Society

Abstract:

Breast cancer is one of most common cancer among Korean women, and still shows annual 6.1% increasing, the 2nd most common female cancer since 2006. Common causes of breast cancer includes first birth at late age, early menarche and late menopause, hormone replacement therapy, high fat and high calorie diet (BMI↑), alcohol abuse, low physical activity and genetic factors 21,484 in Korea, 2014.
The survival rate of breast cancer patient in Korea was much improved with early detection and new treatment modalities which includes chemotherapy, radiotherapy, immunotherapy, hormonal therapy, target therapy and multimodality therapy including precision medicine. The 5-year and 10-year survival was 91.2% and 84.8% respectively. So breast specialists started to consider about patients’ quality of life and developed new surgical technic (oncoplastic surgery) without change of recurrence and survival.
Breast conserving surgery (BCS) has showed gradually increasing tendency in Korea, currently about 70%, which may be preferable to mastectomy in terms of psychologically and cosmetically, Recently in Korea we have much considered for Oncoplastic surgery.
The principles of oncoplastic surgery of the breast are based on complete removal of breast cancer with minimal scarring and producing optimal breast shape and size. It includes careful preoperative planning as part of a multidisciplinary approach and a surgical plan that will result in optimal cancer management and the best possible aesthetic outcome. Conclusion: Incidence of breast cancer increases according to improvement of economic status and women’s environmental factors in Korea. So breast specialists should consider not only recurrence and survival rate but also QOL with BCS or oncoplastic surgery.

Speaker
Biography:

Dr. Areej Al Nemer is an Anatomic Pathology Booard certified Pathologist since 2010. She then completed her Breast Pathology Fellowship program from University of Toronto in 2013. Currently, Dr. Al Nemer works in the University of Dammam and King Fahd Hospital of the University, SA  as an associate professor and consultant. She is the presentor of Pathology Department in KFHU breast unit. She has published more than 25 papers in reputed journals and has been serving as peer reviewer for different scientific journals.

Abstract:

While the incidence of breast cancer (BCa) shows less geographic variability than many other malignancies such as prostate cancer, the biologic behavior is, however, different. Many local studies have documented the earlier age of onset in Arab females and a more advanced stage at the time of diagnosis. Therefore, we planned to determine the spectrum of pathologies of palpable breast lumps in Saudi females and their significance in different age groups. This knowledge is crucial for modifications in the current screening programs, which is adopted from the international guidelines. All needle biopsies for the complaint of breast mass felt by the female patients were retrospectively included over 4 years. Fisher Exact test was used to determine the age of significant cancer risk. Out of 140 cases met the inclusion criteria, 110 were BCa. The median age of BCa was 46 y. There was 68% positivity for BCa in cases belong to females below 40 years, and 75% in patients aged younger than 50 years. The age of 40 year-old show significant cancer risk. The results showed that almost 4 out of 5 females with palpable breast lumps subjected to needle biopsy had BCa. Although this risk is higher with increased age, BCa is a disease of young in the population under study. Review of the current preventive and management measures is critically needed in our nation. Besides, it is advisable to customize the screening age for each country.

Speaker
Biography:

Dr. Feng Yan is the vice  director of Department of Clinical Laboratory in Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital. The research works focus on the bioanalytical chemistry in laboratory medical diagnostics, particularly in detection of tumor markers and tumor cells. She has published 42 papers in SCI journals.She was the Outstanding Medical Talents, Excellent Medical Talent and Leading Medical Talent of Jiangsu Province.

Abstract:

Through increasing evidences have documented that microRNA-145 (miR-145) acts as a tumor suppressor in breast cancer, its exact role in triple negative breast cancer (TNBC) remains poorly defined. In this study, the expression of miR-145 in human TNBC cells and samples from 30 patients was analyzed by stem-loop real-time PCR. We found that miR-145 was significantly downregulated in TNBC tissues and cells. Upregulating miR-145 in HCC1937 cells dramatically suppressed cell proliferation and induced G1 phase arrest, whereas MDA-MB-231 cells did not show growth inhibition. MiR-145 exhibited inhibitory role in cell invasion through the post-transcriptional regulation of the novel targets MMP11 and Rab27a in TNBC cells. Additionally, miR-145 silencing could be reversed by DAC. These results demonstrated that miR-145 plays inhibitory role in TNBC malignancy by targeting MMP11 and Rab27a, which might be potential therapeutic and diagnostic targets for TNBC.

  • Breast Cancer and Psychology
Speaker
Biography:

Michael Grube is 59 years old, married and father of two daughters. He received the license as a physician 1983 after finishing school and medical studies at the University of Aachen (RWTH). In 1986,He moved to the municipal clinic Frankfurt Höchst, a teaching hospital of the Johann Wolfgang Goethe University Frankfurt.1988 I became specialist for psychiatry, 1998 specialist for psychiatry and psychotherapy. In 1999, Gurbe has completed his psychoanalytic training. In 2007, He was appointed assistant professor of the Johann Wolfgang Goethe University and in 2008. He was appointed head physician of the clinic for Psychiatry and Psychotherapy - Psychosomatics at the municipal clinic Frankfurt Höchst. In 2011 he passed the exam for forensic psychiatry. His main scientific topics are: psychooncology, perinatal psychiatry, aggression in psychiatric patients, and psychotherapy in patients suffering from psychosis.

Abstract:

Background: Psychosocial stress and psychopathological abnormalities are expected in cancer patients at a frequency of 30 to 60 percent. Apart from decreased quality of life psychological factors may cause a negative impact on treatment-compliance and on the biological course of the tumour development subsequently.
Materials and methods: We examined the association of different psychiatric and psychotherapeutic interventions in liaison-consultation psychiatry with the four psychopathological dimensions derived by factor analysis based on the items of Psycho Oncological Basic Documentation in a group of 141 breast cancer patients without pre-existing mental disorders who were inpatients of a gynaecologic cancer centre. In addition information concerning subjective stress experience was gathered with the Distress-thermometer.
Results: The plausible “fit” of the various psychiatric and psychotherapeutic interventions due to the psychopathological dimensions and due to the subjective experience of stress could be demonstrated. Those intervention variables that were associated with an improvement of the psychological state could be described as well. The findings showed that improvement or at least permanence of the psychological state was associated with completing of oncological treatment regularly in the relevant index inpatient stay. In addition, it was found that the interventions offered could contribute to improved psychological well-being in the subgroup of patients without mental disorders particularly in normal grief reactions.
Conclusions: Despite methodological limitations our investigation contributes to describe relevant psychopathological syndromes in a group of breast cancer patients without pre-existing mental disorders and the “goodness of fit” of the different psychiatric and psychotherapeutic interventions. Finally the study confirms the assumption that the stabilization of the mental state may help to avoid treatment interruptions in an oncological inpatient setting and therefore decreases the likelihood that reduced psychological well-being may impact the biological course of the tumour development negatively.

  • Rare type of Breast Cancer
Speaker
Biography:

Roberto N. Miranda, MD, completed his MD at the Universidad Peruana Cayetano Heredia, in Lima, Peru and after emigrating to United States, completed an AP CP Residency at Brown University, fellowship in Hematopathology at Vanderbilt University, and has been Faculty at MD Anderson Cancer Center since 2007, where he is currently Professor in the Department of Hematopathology. Dr. Miranda has an interest in T-cell lymphomas and has developed an expertise in breast implant-associated anaplastic large cell lymphoma, a topic on which he has several landmark publications and book chapters, and on which he has lectured nationally and internationally. (Up to 100 words)

Abstract:

Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a newly recognized clinicopathologic entity that affects patients who received breast implants for cosmetic or reconstructive reasons. The lymphoma arises in the capsule around the breast implant and usually presents with effusion, less frequently with a mass, and more rarely with lymphadenopathy. Based on our experience with more than 100 cases, we have developed a pathologic staging that correlates with the risk of lymphadenopathy and clinical outcomes. We have determined that complete surgical resection is the cornerstone of therapy, and in many cases makes the use of chemotherapy unnecessary. We have also evaluated pathogenic mechanisms and assessed epidemiologic evidence that may result in the develpment and progression of this lymphoma.
Therefore, I would like to present my experience with this lymphoma with a focus in the diagnosis, provide a historical perspective and summarize the features that determined the World Health Organization to recognize that this is a distinct clinicopathologic entity. Lastly, I would like to propose a strategy for screening of patients with suspicion of having this lymphoma, a diagnostic algorithm, the pathological handling, sampling, and reporting for this lymphoma

Speaker
Biography:

Rani Kanthan is a consultant Anatomical pathologist in the Dept. of Pathology & Laboratory Medicine at the University of Saskatchewan with a focused interest in surgical oncology including breast and gastrointestinal tract. She has published more than 100 peer reviewed manuscripts that are indexed in PubMed /Google scholar and serves as an editorial board member in various journals. She is an active educator and continues to participate and present at various national and international meeting.

Abstract:

Adenoid cystic carcinoma [ACC] is the most common malignant epithelial tumor of the minor salivary glands and is characterized by the presence of a dual population of both epithelial/luminal and myoepithelial/basaloid (abluminal) cell proliferation.  Rarely, ACC is detected outside of the salivary glands in locations including the uterine cervix, Bartholin’s glands, lacrimal glands, auditory canal, skin, upper respiratory tract and lung, kidney, esophagus, prostate, and breast. Adenoid cystic carcinoma of the breast is rare, with an incidence of ~1/1 million female-years, a rate that has remained stable since the 1980s despite increases in mammogram screening. These tumors usually occur in Caucasian women, though rarely this tumor has also been reported in the male breast.  
  This talk will provide a focused review on the clinical features, radiological findings, key pathological features including the unique immunohistochemical staining properties with a brief purview on the differential diagnosis. The controversial views on its histopathogenesis will be explored including the underlying molecular mechanisms. Similarities and differences to salivary gland tumors will be highlighted. Best practice management and the role for surgery, radiotherapy, chemotherapy and hormonal therapy will be discussed. This talk will conclude with an update on the prognostic and predictive factors of this unique breast tumor.

Manal elhabbash

Tripoli Medical university, Libya.

Title: Bilateral Breast cancer BBC
Speaker
Biography:

Manal elhabbash graduated from tripoli university in Libya on 1992 then I finished my internship for one year. She started working in general medicine. She gets her general medicine doctorate In 1998. She started on oncology & Hematology Department on Jan 1999 till date in tripoli medical center tripoli /Libya She got diploma in clinical oncology &radiotherapy on Dec 2000.She started as lecture on medical department in tripoli university then assistance professor and now she’s associate professor. She’s full medical consultant and head of one unit in hematology & and oncology department.She has research paper about 22 published in local & Arabic journal about mainly Breast cancer

Abstract:

Breast cancer BC is the most common malignancy among female and is a major cause of cancer related death among women in the world. However the epidemiology of bilateral Breast cancer BBC is reported to range from 1.4%_11.8%.
On average, the annual risk of contra lateral Breast cancer is approximately 0.5%but increase to 3%in carrier of BRCA 1or BRCA 2 mutations.
It remains controversial weather BBC represent increase susceptibility to BC or is simply a second occurrence of BC.To investigate BBC characteristics and its outcome in comparison to unilateral BC a retrospective study of BCC patients who were registered in Tripoli Medical Center /Libya in the period between Jan 2005 and Dec 2012.
They were 437 patients with BC , 25 (5.7%) of them developed BCC.
They were younger age and presented with more likely advanced tumor size and more likely to have estrogen & progesterone receptors negative status. The have a shorter survival than unilateral BC.

  • Further Tests for Breast Cancer
Speaker
Biography:

Dr. Sirin Adham has obtained the PhD. degree in 2002 from University of Leon, Spain she worked as postdoctoral fellow at University of Waterloo and University of Guelph, Canada from 2003 to 2009, from 2009 until present she is working as an Assistant Professor at Sultan Qaboos University, Oman.

Abstract:

Circulating plasma and peripheral blood mononuclear (PBMCs) cells provide an informative snapshot of systemic physiology state. The role of Neuropilin-1 (NRP-1) and its interacting molecules was investigated in breast tumor tissue; however, the clinical impact of their systemic levels was not fully evaluated. In this cross-sectional study, we found that plasma NRP-1 and placental growth factor (PlGF) were increased in advanced nodal and metastatic breast cancer compared with locally advanced disease. Triple negative breast tissues expressed higher levels of both NRP-1 and PLGF compared with other subtypes. Furthermore, in PBMCs, NRP-1 and its interacting molecules SEMA4A and SNAI1 were significantly downregulated in breast cancer patients compared with healthy controls. SEMA4A, SNAI1, PLXNA1 and VEGFR3 were inversely expressed with disease stage, indicating protective role. Moreover, two signature molecules; VEGFR3 and PLXNA1 were exclusively upregulated in PBMCs of Triple Negative Breast cancer (TNBC) cases, which underlines the ability of PBMC expression profiles to differentiate among tumor molecular subtypes. These molecules showed differential levels according to patient’s age a notion which might impact therapeutic plan. Finally, this work supports the importance of NRP-1-associated molecules present in the circulation to characterize poor prognosis breast cancer and emphasizes on their role as favorable drug targets.

  • Patient Quality of Life During and After Treatment
Biography:

Dr. Poupak Rahimzadeh MD, FIPP  is an associate Professor with six years' experience in academic teaching in anesthesiology and pain medicine. She is currently employed with department of anesthesiology and pain medicine in Iran University of Medical Sciences (IUMS).

Abstract:

The incidence of menopausal symptoms caused by drug therapy, such as hot flashes and sleep disturbances are common problems in breast cancer patients improved. Due to limitations in the use of hormone therapy in these patients, several studies have been conducted to find alternatives. This study compared the effectiveness of stellate ganglion block with paroxetine drug approved by the Food and Drug Administration as a medical treatment for the treatment of hot flashes and sleep disturbances caused by it is evaluated.
    Methods: 40 patients who improved breast cancer and complained of mentioned symptoms, 20 were in each group. In the study group stellate ganglion block (SG) injection of 10 mL bupivacaine 0.5% under ultrasound-guided, and in the control group (paroxetine) daily administration of 7.5 mg of paroxetine (P) for 6 weeks were performed. Estimate the frequency and severity of hot flushes and sleep quality of patients before the intervention and then at 2, 4 and 6 weeks after it was done. The incidence of adverse events during treatment or during follow-up were recorded.
    Results: In both groups a significant decrease in hot flash score and sleep disturbance index were observed. Comparison of the results showed no significant difference between the two groups. Among the groups (p) 2 subjects discontinued due to gastrointestinal symptoms related to drug. In Group (SG) only a mild headache was reported.
    Conclusion: stellate ganglion block as paroxetine in controlling hot flashes and sleep disturbances in patients recovered from breast cancer and is associated with few complications.

Biography:

Dr. Seyed Hamid Reza Faiz MD, is an Anesthesiologist in Iran University of Medical Sciences. He is working as an Associate Professor in Anesthesiology departement. He is interested in postoperative pain field especially regional anesthesia techniques.

Abstract:

Mastectomy can lead to acute pain are significant. Various methods such as the use of systemic analgesics, methods of neuraxial (epidural thoracic block), regional methods (as measured block) is used to control pain after these surgeries each of them has side effects. In this study, we evaluated the impact of the serratus anterior blocks on acute pain after mastectomy..
Methods: In this double-blind study, sixty patients undergoing breast cancer surgery were selected and divided into two groups. They were undergoing general anesthesia similarly. After recovery, a group of patients undergoing serratus anterior block under ultrasound guidance (Group SAB) but for the other group no block performed (Group C). Also after recovery for both groups patient controlled analgesia (PCIA) using fentanyl content started. Visual analogue Scale(VAS)  at intervals of one, six, twelve, twenty-four hours after recovery was evaluated, and if VAS> 5 acetaminophen 1 g was injected. The first request time for fentanyl and total opioid consumption were recorded.The incidence of adverse events during treatment or during follow-up were recorded.
Results: The pain score was not significantly different between the two groups before the block but there were less VAS score in the selected interval times in SAB group.
The first time use of PCIA pump in the Group C was significantly longer.Acetaminophen consumption in SAB group was significantly less than group C.
None of the patients experienced side effects during follow-up.
Conclusion: The serratus anterior blocks in acute pain control after mastectomy is efficient

  • Breast Cancer Prevention

Session Introduction

Maurizio Montella

Unit of Epidemiology, Istituto Tumori Fondazione Pascale IRCCS.

Title: Obesity, Diabetes and Breast Cancer Prognosis in Mediterranean Women
Speaker
Biography:

Updating soon..

Abstract:

Obesity and diabetes reached epidemic proportion and may be associated with breast cancer (BC) survival outcomes. We therefore studied the association of obesity, diabetes and their combination (DM&Ob) with disease-free survival and overall survival.  Our study included 991 pre- and post-women with non-metastatic BC treated with mastectomy or breast-conserving surgery in two oncologic hospitals  in Naples (Italy). Obesity was assessed as body mass index >30kg/m2, while diabetes was categorized according to the American Diabetes Association guidelines. Patients and tumor characteristics including staging and molecular subtyping were evaluated using the Kruskal-Wallis H test for age, the Mantel-Haenszel linear-by-linear association chi-square test for trends for the ordered categorical variables and chi-square test for other categorical variables. Patient outcomes were analyzed in terms of both disease-free survival (DFS; with local, contralateral and distant disease recurrence and secondary primary tumors and death from any cause defined as “event”) and overall survival (OS; with death from any cause defined as “event”).
There was a total of 137 recurrences after five years, mostly in the DM&Ob group (28%).  There were no significant differences in DFS or OS between obese only (p=0.4 and 0.7, respectively) or diabetes only (p=0.8 and 0.5, respectively) compared to those without obesity or without diabetes. The fully adjusted multivariate Cox regression analyses showed a direct association of DM&Ob with DFS (HR=2.54, 95% CI 1.30-4.98) and with OS (HR=2.30; 95% CI 1.02-5.17), suggesting that the co-presence of diabetes and obesity had an independent and strong prognostic value.

  • Breast Pathology and Immunohistochemistry
Speaker
Biography:

Usha Rani Singh has Completed MBBS & MD Pathology from LLRM Medical College,
Meerut,India. She Worked at AIIMS Delhi as Assistant Research Office rand Joined
University College Of Medical Sciences, Delhi in 1985. Presently she is Director Professor
in the Department of Pathology at University College of Medical Sciences. Chief of
Histopathology & Autopsy. Reporting histopathology and cytology. She Have more than
50 publications and Won best international poster award at ASCP Conference held at
Chicago in 2013. Was Visiting Professor at B.P.Koirala Institue of Health Sciences,
Dharan, Nepal for 3 years. Been Supervisor & Co Supervisor for numerous MD and
PhD thesis.

Abstract:

Patients attending government hospitals cannot afford immunohistochemistry for prognosis and therapeutic decisions. Tissue microarray (TMA) brings down the cost of immunohistochemistry. Automated tissue array being expensive the aim of this study was to validate if manual TMA could be used in molecular classification of breast carcinoma. The study included 65 cases of histologically confirmed carcinoma breast. Manual TMA was constructed using two techniques (Kononen et al and Chen et al) and were assessed in terms of ease of preparation, microtomy, quality of sections and molecular classification of breast carcinoma. Immunohistochemistry for ER, PR, Her-2 and CK 5/6 were performed on manual TMA sections. Whole section immunohistochemistry was used as control. Both the methods were found to be easy and economical. No significant difference in the average time for TMA construction was seen between the two techniques . Sections from both methods were of optimum quality. The Chen-technique had an easier learning curve and the number of sections with all cores was higher. Mal-alignment of cores was frequently associated with
Kononen-technique. The molecular distribution of carcinoma breast was: Luminal A- 40 %, Luminal B-27%, Normal breast like-5%, Basal type-17% and Her-2 positive- 11% by both the techniques. A good agreement was found between the immunohistochemistry results on routine and tissue microarray sections. It was concluded that manually created tissue microarrays could be used instead of routine whole sections for molecular classification. The decreased reagents used would have a tremendous implication in the Indian context by reducing the overall cost of immunohistochemistry.

  • Preclinical and Clinical Studies of Novel Breast Pathology

Session Introduction

Humera Mahmood

Head Oncology Department Atomic Energy Cancer Hospital (AECH) NORI , Pakistan .

Title: Effect of Different Clinicopathological Features on Overall Survival of Breast Cancer Patients-A Cohort Study From Northern Pakistan
Speaker
Biography:

Humera Mahmood Joined Atomic Energy cancer Hospital NORI in 1994. She was First female FCPS in Oncology in Pakistan in 1998. She was Faculty Member, Supervisor and Examiner of College of Physicians and Surgeons Pakistan for FCPS in Clinical Oncology since 2000. She wasMember Board of Studies of PIEAS for MSc in Radiation and Medical Oncology, Trained a number of doctors who are serving not only in Pakistan but abroad as well. She is the Incharge Research Training and Monitoring Cell  And cancer Awareness Program at NORI:regularly organizing a number of Cancer Awareness Programs for General Public as well as Doctors. A number of International publications in her name in well reputed journals with an Impact Factor of more than 70, Member  Editorial Review Boards of number of journals. She is the Vice President Pakistan Society of Clinical Oncology.

Abstract:

Background: A number of studies have been carried out worldwide to find out prognostic and predictive significance of different clinicopathological and molecular variables interms of overall survival in breast cancer. No such study has been carried out initially in Pakistan. This study was carried out at Atomic Energy Cancer Hospital NORI Islamabad to find out the impact of age, menopausal status, recepto status, tumor size and lymph node involvement on overall survival of breast cancer patients coming from Northern Pakistan.
 Material and Methods: This observational retrospective study was carried out in the Oncology Department of NORI Hospital. A total of 2,666 patients were included. Data were entered into SPSS 20. Multinomial logistic regression analysis was performed to determine associations of different variables with overall survival. P values  <0.05 were considered significant.
Results: The mean age of the patients studied was 47.6 years, 49.5% being postmenopausal. One thousand seven hundred and eight ( 1,708) were ER positive and 1,615 were PR positive, while Her 2 neu oncogene positivity was found in 683. A total of 1,237 presented with skin involvement and 426 had chest wall involvement. One thousand six hundred and sixty three ( 1,663)  had more than 5cm tumors. Lymph node involvement was detected in 2,131. Overall survival was less than 5 years in 669 patients, only 324 surviving for more than 10 years, and in the remainder overall survival was in the range of 5-10 years.
Conclusions: Tumor size, lymph node metastases, receptor status, her 2 neu positivity, skin involvement, and chest wall involvement have significant effects whereas age and menopausal status have no significant effect on overall survival of breast cancer patients in Pakistan.