Day 1 :
Keynote Forum
Omar Tillo
Bedford Hospital NHS Trust, United Kingdom
Keynote: Overview of breast reconstruction options and latest advances and controversies
Time : 08:30-09:10
Biography:
Omar Tillo is a Plastic and Reconstructive Surgeon who’s special interest is breast and body reconstructive and aesthetic surgery. After graduating in 1997 he completed specialty training in general surgery. He later completed a second specialty training in plastic and reconstructive surgery in some of the leading United Kingdom NHS Hospitals. He developed an early special interest in breast and body surgery and build a successful NHS and private practice. During his employment in Bedford Hospital NHS Trust, he succeeded in establishing a comprehensive breast reconstruction service providing all range of procedures to the local residents from implant based to autologous free flaps. His team was recently nominated for the ‘Team of the Year’ award.
Abstract:
Breast cancer is the most commonly diagnosed cancer in females affecting 1 in every 8 women in their lifetime. In the majority of cases, surgical excision continues to be the first line of treatment by means of mastectomy or wide local excision. These surgical modalities very often result in breast or chest deformities that can have the devastating psychosocial impact on patients, such as low self-esteem and feel incomplete, with adverse impact on their quality of life in terms of sexual activity, relationships, clothing, sport, swimming, and other daily activities. Unfortunately, the large majority of women having breast surgery worldwide are not offered even the simplest types of reconstruction due to lack of awareness, training or resources. Even in the developed countries, it is estimated that 25-50% of women are still not offered the full range of reconstruction options. This paper provides a step-by-step guide in establishing a new breast reconstruction service starting with setting up a dedicated local staff teaching program, arranging specific logistics and equipment, fulfilling administrative and legislative processes, implementing quality assurance measures, audits and patient-reported outcome measures. This is derived from the author’s experience in establishing a breast reconstruction service in an NHS General Hospital in the United Kingdom. A view the current and National Guidelines for best practice is also reviewed along with sources of patient’s education material. In conclusion, no woman should be denied the right of having breast restoration surgery following the treatment of cancer. This service should be made available universally across the globe. Internet and social media platforms are powerful and cost effective educational tools for patients.
- Breast Cancer|Women’s Health and Fitness
Location: Abu Dhabi
Co-Chair
Najwa Alfarra
King Faisal specialist hospital, Saudi Arabia
Session Introduction
Kathleen Meehan
Khawarizmi International College, United Arab Emirates
Title: Radiation-induced lymphocyte apoptosis as a predictor of radiosensitivity in breast cancer patients
Biography:
Abstract:
Despite awareness campaigns, breast cancer remains the most common cancer in women and it is estimated that 1.6 million new breast cancer cases are diagnosed each year and around 500,000 deaths are reported annually. Breast cancer is also the most prevalent malignancy found in Arab populations. The average age at presentation of breast cancer in Arab women is a decade earlier than in European and US individuals and the most prevalent presentation is invasive ductal carcinoma with lymph node involvement reported in more than 70% of cases. Due to the larger tumor, aggressive surgical and radiotherapy is often required. Although radiation is widely used as a curative agent, it also poses the risk of serious damage to normal healthy tissue. Radiotherapy should maintain a relationship where cancer cell death exceeds cancer cell proliferation, which would successfully eliminate the cancer. Although radiation toxicity risks for populations of patients are generally known, the determination of an individual’s normal tissue radiosensitivity is rarely possible before treatment. Therefore, oncologists currently stratify the radiation therapy dose according to clinical predictors. The Leukocyte Apoptosis Assay (LAA) has been developed to predict a patient’s radiosensitivity, A recent multicenter trial of over 500 breast cancer patients has confirmed that the LAA assay significantly predicts the risk of late effects of radiation and has validated the assay as a rapid screening test prior to radiotherapy. To include this assay in routine clinical radiation oncology practice in the UAE, radiosensitivity data in the Emirati population will need to be determined. This study will focus on gamma (low-LET) radiation as this is the modality used for treatment of breast cancer. Radiosensitivity will be measured using flow cytometry after in vitro exposure of patient blood samples to 0 Gy (control), 2Gy and 8Gy of gamma radiation. An assay that determines individual radiosensitivity will have numerous applications in the clinic and would ensure a significant reduction of acute responses and prediction of normal tissue toxicity, thereby increasing the efficacy of radiotherapy.
Najwa Alfarra
King Faisal Specialist Hospital and Research Centre, Saudi Arabia
Title: Impact of action II Petite Lady Laser Machine in the treatment of urinary incontinence and sexual dysfunction female
Time : 11:25-11:50
Biography:
Abstract:
Gul Cankaya
NHS Marmara University Pendik Training Hospital, Surgical Nursing, Turkey
Title: The role of navigating nurse for women with breast cancer
Biography:
Gul Cankaya is currently working as a Surgical Nurse at NHS Marmara University Pendik Training Hospital, Surgical Nursing, Turkey. She has worked mostly in a pediatric critical care unit, cardiovascular surgery operating room and general surgery operating room. She has attended international certification for Breast Cancer Nursing program (MEHEM).
Abstract:
Humariya Heena
King Fahad Medical City, Saudi Arabia
Title: Knowledge, attitudes and practices of cervical cancer screening among female health care professionals in Saudi Arabia: A cross-sectional survey
Biography:
Abstract:
Introduction & Aim: Among women in developing countries, cervical cancer is the most common type of cancers and a leading cause of mortality. Our review revealed a lack of available literature on the knowledge and awareness of screening for this cancer in the Middle East. Therefore, we aimed to assess the knowledge, attitudes and practices of breast and cervical cancer screening among female healthcare professionals at King Fahad Medical City (KFMC), Saudi Arabia. Methods: A cross-sectional study was conducted at KFMC. A pre-designed and tested, self-administered, questionnaire was distributed to 420 female health care professionals. Data collection was anonymously completed from December 2017 to April 2018. Descriptive statistics were used to summarize responses of the knowledge, attitude and practice questions. Results: Three-hundred and ninety-five participants were included in the final analysis. The mean age of the participants was 34.7 years, majority were married 239 (60.5%) and 201 (51%) had one or more children. The respondents were mainly nurses, 261 (66.1%) or physicians 63 (16.0%). Only 16 (4.2%) participants appeared to have good level of knowledge of cervical cancer. Majority of the participants disagreed with the statements for assessing attitude towards cervical cancer (proportion disagreed ranged from 53-86%). Majority 343 (88%) responded that Pap smear is a useful tool for early detection of cervical cancer but only 103 (26%) had undergone through the screening. Conclusion: Participants showed low level of knowledge and negative attitudes towards screening for cervical cancer. Health care organizations need to encourage women of older age group particularly above 40 years of age for screening and educate them about the significance of screening in the absence of symptoms.
Alicia Y Lefas
Chelsea and Westminster Hospital, United Kingdom
Title: Obesity & Breast Cancer: Investigating the impact of adipose tissue macrophage phenotype on HER2+ breast cancer patient outcomes
Biography:
Abstract:
Background & Aim: In their lifetime, 1:8 women will be diagnosed with breast cancer. However, 27% of breast cancers in the UK population are preventable, with 9% linked to obesity. Macrophages can be polarized towards the anti- (M2), leading to the production of immunosuppressive factors IL-10 and ARG1 or via iNOS stimulation, pro-(M1) inflammatory subtype. Moreover, inflammatory foci termed Crown-Like Structures (CLS) i.e. dead adipocytes circumscribed by macrophages have recently been identified in breast tissue histology. It has been proposed that obesity induces breast Adipose Tissue Macrophages (ATMs) to form CLS. The study aims to investigate the phenotype of ATMs forming CLS using immunohistochemistry techniques. Method: Formalin-fixed paraffin-embedded breast tissue samples were collected correlating to a database of 235 HER2+ breast cancer patients treated in Southampton. Immunohistochemistry was conducted on the Leica BondMax Autostainer using antibodies against: CD68, CD163, iNOS and ARG1. Immunoreactivity was assessed using light-microscopy. Monocytederived macrophages skewed in the laboratory towards the M1 or M2 phenotype served as controls. Result: 37% of cases were positive for CLS, which were primarily (83.8%) observed in clusters at the tumor-adipocyte interface. The majority of ATMs associated with CLS expressed the pro-inflammatory M1 phenotype (iNOS+/CD68+ and ARG1-/ CD163+ or CD68+). No statistically significant association was observed between obesity (BMI≥30) and the formation of CLS. Instead CLS were positively associated with other (↑CD16/↓CD32B) intra-tumoral markers (pro inflammatory) suggesting that their formation likely resulted from the inflammatory influences of the tumor microenvironment. Moreover, CD163 proved a macrophage-specific but not M2-specific marker; as both cohort ATMs and controls displayed CD163+/CD68+ dualpositivity irrespective of macrophage phenotype. Conclusion: In this HER2+ breast cancer cohort, ATMs comprising CLS express the pro-inflammatory M1 phenotype. However, CL occurrence was not statistically associated with obesity (BMI≥30). Understanding the mechanism of CLS formation may offer targets for interventions to reduce risk or improve prognosis of breast cancer.
Biography:
Abstract:
Kathleen Meehan
Khawarizmi International College, United Arab Emirates
Title: Radiation-induced lymphocyte apoptosis as a predictor of radiosensitivity in breast cancer patients
Time : 10:35-11:00
Biography:
Abstract:
Despite awareness campaigns, breast cancer remains the most common cancer in women and it is estimated that 1.6 million new breast cancer cases are diagnosed each year and around 500,000 deaths are reported annually. Breast cancer is also the most prevalent malignancy found in Arab populations. The average age at presentation of breast cancer in Arab women is a decade earlier than in European and US individuals and the most prevalent presentation is invasive ductal carcinoma with lymph node involvement reported in more than 70% of cases. Due to the larger tumor, aggressive surgical and radiotherapy is often required. Although radiation is widely used as a curative agent, it also poses the risk of serious damage to normal healthy tissue. Radiotherapy should maintain a relationship where cancer cell death exceeds cancer cell proliferation, which would successfully eliminate the cancer. Although radiation toxicity risks for populations of patients are generally known, the determination of an individual’s normal tissue radiosensitivity is rarely possible before treatment. Therefore, oncologists currently stratify the radiation therapy dose according to clinical predictors. The Leukocyte Apoptosis Assay (LAA) has been developed to predict a patient’s radiosensitivity, A recent multicenter trial of over 500 breast cancer patients has confirmed that the LAA assay significantly predicts the risk of late effects of radiation and has validated the assay as a rapid screening test prior to radiotherapy. To include this assay in routine clinical radiation oncology practice in the UAE, radiosensitivity data in the Emirati population will need to be determined. This study will focus on gamma (low-LET) radiation as this is the modality used for treatment of breast cancer. Radiosensitivity will be measured using flow cytometry after in vitro exposure of patient blood samples to 0 Gy (control), 2Gy and 8Gy of gamma radiation. An assay that determines individual radiosensitivity will have numerous applications in the clinic and would ensure a significant reduction of acute responses and prediction of normal tissue toxicity, thereby increasing the efficacy of radiotherapy.