Presentation on theme: "Management of Breast Cancer Post graduate Studies and Research"— Presentation transcript:
1Management of Breast Cancer Post graduate Studies and Research ByHussein M. KhaledProf. Medical OncologyVice PresidentPost graduate Studies and ResearchCairo University
2BREAST CANCER Worldwide incidence in females* WesternEurope67.436.028.671.721.225.031.525.586.3EasternEuropeJapanAustralia/New ZealandSouth Central AsiaNorthernAfrica1. Breast Cancer: Worldwide Incidence in FemalesBreast cancer is the third most frequent cancer worldwide and the most common malignancy among women (21% of all new cancer cases). Incidence rates are high in all developed countries, except Japan, and highest in North America with 86.3 cases per 100,000. Incidence rates for selected countries are shown on the map.SouthernAfricaCentralAmericaNorthAmerica*Incidence per 100,000 population.Parkin DM, et al. CA Cancer J Clin. 1999;49:33-64.
4BREAST CANCER Signs and symptoms at presentation Mass or pain in the axillaPalpable massThickeningPainNipple dischargeNipple retractionEdema or erythema of the skin16. Breast Cancer: Signs and Symptoms at PresentationAlthough the use of mammography is increasing, more than 80% of all breast cancers are still diagnosed as a result of symptoms, most often a painless mass. However, as many as 10% of patients present with breast pain and no mass. Less common symptoms include nipple discharge, nipple erosion or ulceration, diffuse erythema of the breast, axillary adenopathy, and symptoms associated with distant metastases.
6BREAST CANCER Diagnosis path EvaluationforbiopsyCystNormalPalpable massNonpalpablemassCystaspiration22. Breast Cancer: Diagnosis PathAny dominant breast mass lesion should be biopsied.BiopsyExcisional biopsyCore-cutting needle biopsyFine-needle aspirationNeedlelocalizationIf persistent, short-termfollow-upwith surgeonContinuedappropriatescreeningInsufficientevaluation,rebiopsyDuctalcarcinomain situInvasivecancerLobularcarcinomain situBenignTreatment Path
12NSABP B-06: Effect of Lumpectomy v. Mastectomy on Survival Cohort ACohort BCohort CDISTANT DISEASE-FREE SURVIVAL (%)YEARNo. of patients / No. of recurrencesTotal Mastectomy:692/265569/233494/192Lumpectomy:699/302634/282520/236Lumpectomy + XRT:714/278628/253515/204
26What elements drive therapy decision making ? PrognosisTreatmenttoxicityCo morbidityTreatmentefficacy
27GUIDELINE RECOMMENDATION FOR CHEMOTHERAPY FORSTAGE I BREAST CANCERT1a (0-5 mm)T1b (6-10 mm)T1c (11-20 mm)NCIER +NCCN*)ER -This slides summarize the real problem, 3 standards all pretending the classification low-high riskThree gold standards makes it a little bit busy and to be spoilt for choice highlights the real issue that the gold standard is not that shiny at all, not to mention all local adapted variants on these standardsAlso if ones wander away from the standard one enters non validated territoryMaybe it is time for one new gold standard?MammaPrint?ER +St. GallenER -OptionalRecommendedNot Recommended*) NCCN = National Comprehensive Cancer Network27
41Age structure of Female breast cancer patients. Cumm. %Proportion7.720.335.152.768.979.390.595.5100.012.614.817.616.210.411.25.04.5<3535-40-45-50-55-60-65-70+
42Age-specific Incidence Rates of Breast cancer in younger age groups: Egypt and US SEER 188.8.131.521.7117.5192.1253.11.49.828.963.696.7171.5181.220-2425-2930-3435-3940-4445-4950-54……
43Magnitude of Breast Cancer in Egypt: 2025 Projection of Magnitude of Breast Cancer in Egypt: 2025, 2050Magnitude of Breast Cancer in Egypt: 2025Population size: million femalesCrude incidence rate: 55.1./100,000 femalesIncidence: 14,000 28,000 breast cancer casesPrevalence: 42,000 84,000 breast cancer casesMagnitude of Breast Cancer in Egypt: 2050Population size: million femalesCrude incidence rate: 68.8./100,000 femalesIncidence: 14,000 44,000 breast cancer casesPrevalence: 42,000 132,000 breast cancer cases
44Breast cancer T stage 1984 - 2006, Port Said, Egypt SOURCE: Prof. Dr. Ahmed Elzawawy
46Inflammatory Breast Cancer (IBC) SwollenErythemaPeau d’OrangeFrequently Mistaken for Mastitis
47Clinico–Pathological Correlation in Breast Cancer Cases (2002) Revision of the slides of 212 patients.Only 16 patients had both clinical and pathological features of IBC (8%)Age distribution4 patients35 yrs or less8 patients45 yrs or lessMore than 45 yrsThe youngest25 yrsThe oldest76 yrs
48“ Immunphenotypic signature” Biologic profile“ Immunphenotypic signature”More than 90% of IBC showed positive axillary nodes.IBC’s 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%.
49Tumor emboli and LYVE-1 and RhoC expression in IBC tumors from Egypt and the United States
50RhoC Scoring and Tumor Emboli for Egyptian patients with IBC and non-IBC IBC (N=46)No. (%)Non-IBC (N=64)P-valueRhoC Score12341 (2)5 (10)(44)20 (44)24 (38)29 (45)7 (10)4 (6)<0.0001RhoC Categories1-23-46 (13)40 (87)53 (83)11 (17)Tumor EmboliMean ± SD0-12-89+14.1 ± 14.0(41)26 (57)7.0 ± 12.932 (50)18 (28)14 (22