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1 Management of Breast Cancer By Hussein M. Khaled Prof. Medical Oncology Vice President Post graduate Studies and Research Cairo University.

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Presentation on theme: "1 Management of Breast Cancer By Hussein M. Khaled Prof. Medical Oncology Vice President Post graduate Studies and Research Cairo University."— Presentation transcript:

1 1 Management of Breast Cancer By Hussein M. Khaled Prof. Medical Oncology Vice President Post graduate Studies and Research Cairo University

2 2 BREAST CANCER Worldwide incidence in females* *Incidence per 100,000 population. Parkin DM, et al. CA Cancer J Clin. 1999;49: EasternEurope Japan Australia/ New Zealand South Central Asia NorthernAfrica SouthernAfrica CentralAmerica Western Europe Europe NorthAmerica

3 3 CANCER CONTROL EARLYDETECTION DIAGNOSIS PRIMARYPREVENTION TREATMENT

4 4 BREAST CANCER Signs and symptoms at presentation Mass or pain in the axilla Mass or pain in the axilla Palpable mass Palpable mass Thickening Thickening Pain Pain Nipple discharge Nipple discharge Nipple retraction Nipple retraction Edema or erythema of the skin Edema or erythema of the skin

5 5

6 6 BREAST CANCER Diagnosis path Evaluation for biopsy Cyst aspiration Biopsy Excisional biopsy Core-cutting needle biopsy Fine-needle aspiration Palpable mass Ductal carcinoma in situ Invasive cancer Lobular carcinoma in situ Benign Insufficient evaluation, rebiopsy If persistent, short-term follow-up with surgeon Continued appropriate screening Cyst Normal Nonpalpable mass Treatment Path Needle localization

7 7 Staging Classification of Breast Tumour

8 8

9 9 Early Breast Cancer

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11 11

12 12 NSABP B-06: Effect of Lumpectomy v. Mastectomy on Survival DISTANT DISEASE-FREE SURVIVAL (%) Cohort A Cohort BCohort C Total Mastectomy: 692/265569/233494/192 Lumpectomy:699/302634/282520/236 No. of patients / No. of recurrences YEAR Lumpectomy + XRT:714/278628/253515/204

13 13

14 14 HT

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17 17 HER2 testing algorithm Adapted from Bilous M, et al. Mod Pathol 2003;16:173–82 Hanna W. Breast 2005;14(Suppl.1)S17 (Abstract 10) + – FISH/CISH Patient tumour sample IHC FISH/CISH +– Herceptin ® therapy

18 18 Locally Advanced Breast Cancer

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25 25

26 26 What elements drive therapy decision making ? Prognosis Treatment efficacy Treatment toxicity Co morbidity

27 27 ER + ER - ER + ER - T1a (0-5 mm) T1b (6-10 mm) T1c (11-20 mm) NCI NCCN *) St. Gallen GUIDELINE RECOMMENDATION FOR CHEMOTHERAPY FOR STAGE I BREAST CANCER Not Recommended OptionalRecommended *) NCCN = National Comprehensive Cancer Network

28 28 www/Adjuvant on line !

29 29 The Breast Health Global Initiative (BHGI) Guideline Publication 2003 CONSENSUS STATEMENTS Early Detection Panel Diagnosis Panel Treatment Panel

30 30 BHGI GLOBAL SUMMIT 2005: Guideline Stratification Breast J 2006;12 Suppl 1:S

31 31 Diagnosis

32 32 Controversial Issues : FNAC or Frozen Sections FNAC or Frozen Sections 5 or 10 years of HT 5 or 10 years of HT T and AI T and AI Type of CT Type of CT Herceptin and others Herceptin and others Pre or post op CT Pre or post op CT Ov ablation Ov ablation Cases who do not need systemic treatment Cases who do not need systemic treatment

33 33 Cancer Treatment S Chemo. Radio. Types of cancer treatment Application of cancer treatment Cost of cancer treatment

34 34 Situation Analysis Egypt

35 35 EGYPT Gharbia Population–based registry

36 36 Rate per pop. Incidence Rates of Common Sites of Cancer Population Data: Females

37 37 GLOBAL STATISTICS: Age-Specific Rates / 100,000 Females (all ages) Globocan 2002 (IARC)

38 38 The National Cancer Institute Cairo University Cairo UniversityNational Cancer Institute

39 39 NCI Most Common Sites in Males and females

40 40 National Cancer Registry National Cancer Registry

41 41 Cumm. % Proportion < Age structure of Female breast cancer patients.

42 42 US SEER Egypt …… Age-specific Incidence Rates of Breast cancer in younger age groups: Egypt and US SEER

43 43 Magnitude of Breast Cancer in Egypt: 2025 Population size: 51 million females Population size: 51 million females Crude incidence rate: 55.1./100,000 females Crude incidence rate: 55.1./100,000 females Incidence: 14,000 28,000 breast cancer cases Incidence: 14,000 28,000 breast cancer cases Prevalence: 42,000 84,000 breast cancer cases Prevalence: 42,000 84,000 breast cancer cases Magnitude of Breast Cancer in Egypt: 2050 Population size: 64 million females Population size: 64 million females Crude incidence rate: 68.8./100,000 females Crude incidence rate: 68.8./100,000 females Incidence: 14,000 44,000 breast cancer cases Incidence: 14,000 44,000 breast cancer cases Prevalence: 42, ,000 breast cancer cases Prevalence: 42, ,000 breast cancer cases Projection of Magnitude of Breast Cancer in Egypt: 2025, 2050 Projection of Magnitude of Breast Cancer in Egypt: 2025, 2050

44 44 Breast cancer T stage , Port Said, Egypt SOURCE: Prof. Dr. Ahmed Elzawawy

45 45 Cancer Control in Egypt

46 46 Inflammatory Breast Cancer (IBC) Swollen Erythema Peau dOrange Frequently Mistaken for Mastitis Swollen Erythema Peau dOrange Frequently Mistaken for Mastitis

47 47 Clinico–Pathological Correlation in Breast Cancer Cases (2002) Clinico–Pathological Correlation in Breast Cancer Cases (2002) Revision of the slides of 212 patients. Revision of the slides of 212 patients. Only 16 patients had both clinical and pathological features of IBC (8%) Only 16 patients had both clinical and pathological features of IBC (8%) Age distribution Age distribution 4 patients 35 yrs or less 8 patients 45 yrs or less 8 patients More than 45 yrs The youngest 25 yrs The oldest 76 yrs

48 48 More than 90% of IBC showed positive axillary nodes. IBCs are characterized by: High histologic grade tumors with high Nuclear grade, necrosis and high PCNA and MIB- 1(Ki-67) labeling indices. ER & PgR are frequently negative. p53 > 70% positivity. HER-2/Neu > 60%. Biologic profile Immunphenotypic signature

49 49 Tumor emboli and LYVE-1 and RhoC expression in IBC tumors from Egypt and the United States

50 50 RhoC Scoring and Tumor Emboli for Egyptian patients with IBC and non-IBC IBC (N=46) No. (%) Non-IBC (N=64) No. (%) P-value RhoC Score (2) 5 (10) 5 (10) 20 (44) 24 (38) 29 (45) 7 (10) 7 (10) 4 (6) < RhoC Categories (13) 6 (13) 40 (87) 53 (83) 11 (17) < Tumor Emboli Mean ± SD ± (2) 19 (41) 26 (57) 7.0 ± (50) 18 (28) 14 (22 <0.0001<0.0001

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53 53 Cairo University National Cancer Institute Thank you


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