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Addressing younger patient’s fertility concerns after a breast cancer diagnosis
ABSTRACTS variation within GCCSAs. Improved access to more comprehensive quantitative hospital-level data and stakeholder input is required to further explore the reasons behind such regional variation in BR services.
S51
Right
Left
IDC 31
IDC 28 ILC 11 Other 1 ILC 4 IDC 3 Other 2 Other 2 IDC 3 ILC 0
http://dx.doi.org/10.1016/j.ejso.2017.01.193 ILC 9 P141. To examine the clinico-pathological and oncological outcomes of patients who underwent mastectomy following ipsilateral therapeutic mammoplasty Natalie To, Dalia Elfadl, Jennifer Rusby, Peter Barry Royal Marsden Hospital, Sutton, UK Introduction: Patients with therapeutic mammoplasty (TM) may require further surgery for residual disease (involved margins) or recurrence. We aim to evaluate the pathological and technical, as well as oncological outcomes of patients who required a mastectomy having previously had ipsilateral TM. Methods: A retrospective record review identified patients who had mastectomy after ipsilateral TM between 2005 and 2016. We recorded information including age, reasons for mastectomy, tumour characteristics, margin involvement, re-excision and adjuvant treatment. Results: Of 1270 who had TM, 66 patients required post-TM mastectomy. They formed 3 groups: 43 (65%) patients with involved margins, 16 (24%) with disease recurrence and 7 for other reasons BRCA carrier. Ten (23%) patients with involved margins had re-excision prior to mastectomy. Reconstruction was carried out on 28 (65%) patients with involved margins of whom 21 (75%) were immediate, whereas all 12 (75%) patients had immediate reconstruction for recurrence. A minority (14%) underwent implant based reconstruction. Qualitative analysis suggests that mastectomy and reconstruction planning was influenced by previous TM incisions. 36 patients (83%) with involved margins were in remission from their disease, compared to only 10 patients (62.5%) in the recurrence group, the most common cause of death in both groups being metastatic breast cancer. Conclusion: We found that the majority of patients who had post-TM mastectomy for positive margins, did so without re-excision of margins. A large proportion of patients in both groups had immediate reconstruction, permitting non-standard mastectomy following TM.
Other 5
Right
Left
ER + 42
ER + 34 ER 2 ER 3 ER + 1 PR + 26 PR e 3 PR e 4 PR + 2 Her 2+ 1 Her e 3 Her 2e 35 Her 2+ 1
ER 4 PR+ 34 PR 7 Her 2+ 5 Her 2e 40
Conclusion: Bilateral mastectomy was confirmed to be the most common surgical treatment for SBCs. Half the tumours shared identical clinico-pathological features, suggesting either that SBC patients may have a propensity to develop tumours of a particular type, or that SBCs may be related. Genomic studies will be required to more clearly define these relationships. Comparison with matched controls will be necessary to determine whether SBCs have a worse prognosis than unilateral breast cancer, as suggested in the literature. http://dx.doi.org/10.1016/j.ejso.2017.01.195
http://dx.doi.org/10.1016/j.ejso.2017.01.194
P142. Bilateral synchronous breast cancer: Histological concordance and surgical management Gary Dobson1, Colin McIlmunn1, Kienan Savage1,2, Stuart McIntosh1 1 Belfast City Hospital, Belfast, UK 2 Centre for Cancer Research & Cell Biology, Belfast, UK Introduction: Synchronous breast cancers (SBC) account for up to 3% of breast cancer diagnoses, and are often managed with bilateral mastectomy, although the optimal treatment strategy is unclear. We present initial findings of tumour morphology and surgical management of a cohort of SBC patients in Northern Ireland (NI). Methods: Women with SBC diagnosed between 1992 and 2015 were identified from NI Cancer Registry data. Histopathology reports have been reviewed; pathological features of tumours and biomarker expression were collated. Data was collected on initial surgical treatment, and followup data was recorded where available. Results: Data was available on 60 SBC cases between 1992 & 2015. Mean age at diagnosis was 59 years (range 32e91) Fifty-two patients underwent surgical treatment: 35 patients had bilateral mastectomies, 12 underwent bilateral breast conserving surgery and the remainder a combination.
P143. Addressing younger patient’s fertility concerns after a breast cancer diagnosis Cathy McDaid Belfast Health and Social Care Trust, Belfast, UK Introduction: Every year in the UK, 5,000 women under 45 years are diagnosed with breast cancer. Some of the breast cancer treatments can affect fertility. I wished to assess if we are addressing these issues. Methods: A retrospective audit was conducted of women diagnosed under the age of 45, in Belfast Trust, between January and June 2015. Based on change in practice, a re-audit of women diagnosed between September and November 2016. Data was collected from the Breast Care Nursing notes. The standards used are the NICE guidelines for people with cancer who wish to preserve their fertility. Also those set out by BCC; patients under 45 years will be given a full explanation during initial treatment discussions about the possible impact of treatment on fertility. Results: In the initial audit 26 women were diagnosed. One was pregnant at the time of diagnosis (PBC) and one was metastatic. 3 women (14%) had a record of a fertility being discussed. The audit highlighted inaccurate recording of discussions about fertility therefore nursing paperwork was updated. In the re-audit period 17 women were diagnosed with breast cancer. 15 (88%) women had a
S52 record of a discussion about fertility. 2 (12%) did not (one PBC and one woman with learning difficulties). Conclusions: We are discussing fertility with most patients at an early stage unless there is a good reason not to. We are now accurately recording when these conversations happen. http://dx.doi.org/10.1016/j.ejso.2017.01.196
ABSTRACTS Results: Patients, carers and our support group have rated the information leaflet highly, and have found the clinic “easy” and “smooth” to attend. Conclusions: We commend this approach to other units, both to streamline other busy follow up clinics and for improved patient satisfaction so that all patients may receive the first-class treatment that they deserve. http://dx.doi.org/10.1016/j.ejso.2017.01.198
P144. An audit of staging investigations for breast cancer Duncan Simpson, Victoria Graham, Clare Shute Antrim Area Hospital, Northern Ireland, UK Introduction: Our protocol for staging in breast cancer is US abdomen and CXR in patients if clinically node negative, and CT and bone scan if clinically node positive. ABS guidelines suggest that US and bone scan are not useful unless symptomatic, part of a trial, or to undergo neoadjuvant treatment. We wanted to assess our protocol against this standard. Methods: All patients diagnosed with breast cancer in 2015 were identified. Demographics; decision to operate; pre-operative node status; staging investigations and subsequent changes to management were recorded. Results: 258 patients were diagnosed with breast cancer in 2015. 2 male, age range 30e86 (median 62). In 29 patients no surgery was planned. 33 patients had in-situ disease only and had no staging. The remaining 196 patients were planned for surgery. All had staging. 160 were clinically node negative: 149 had US, 150 had CXR, 21 had CT, 5 had bone scan No patient in this group had metastases detected. 36 were clinically node positive: 36 had CT, 35 had bone scan 5 of these patients had metastases on CT. 4 had metastases on bone scan (all also on CT). 2 of these 5 patients had their management changed from operative to non-operative. Conclusions: No clinically node negative patient had metastases diagnosed. No patient had metastases on US. No patient had metastases on bone scan that were not on CT. We recommend no staging if clinically node negative and no routine use of US, CXR or bone scan. We estimate savings around £60,000/year. http://dx.doi.org/10.1016/j.ejso.2017.01.197
P145. Monitoring response to primary hormonal treatment (PHM) in older women with oestrogen responsive (ER+ve) breast cancer. Are we giving the best to these patients? Rachel King, Rachel Bright-Thomas Worcestershire Royal Hospital, Worcester, UK Introduction: The proportion of the population over age 80 is increasing nationally. By 2050 it will be 1 in 10, 2/3 being women. Breast cancer is common in this group (1 in 14) and is predominantly ER +ve (90%). Many affected women have other co-morbidities and prefer to avoid surgical treatment if possible. One common treatment option is to commence primary hormonal manipulation (PHM) and to monitor response sequentially until this treatment fails. This has resource implications as the patients require frequent follow up and, with a good response, may need to return for focused USS assessment. Hearing and mobility issues can also prolong the appointment time required. Methods: Since 2014 we have collated a prospective record of >50 patients over age 80 treated with PHM. After receiving initial written information about treatment options, those choosing PMH are followed up in a dedicated nurse led clinic with, telephone reminders of clinic appointments, simultaneous USS available, more clinic time for assessment of cancer response and holistic assessment of needs, and open access back into the main clinic if the drug response is poor or if the patient wishes to try an alternative treatment path.
P146. Mammaglobin-A tissue expression, breast cancer pathology and survival Liz Baker, Louise Hall, Naomi Whiteoak, Lucy Hill, Deborah Wilson, Pud Bhaskar University Hospital of North Tees, Stockton on Tees, UK Introduction: Human mammaglobin-A is breast tissue specific, overexpressed in some breast cancers and associated with less aggressive phenotypes. Several previous studies have determined the association between mammaglobin-A protein expression with tumour pathology however it is not known whether expression correlates with survival. Methods: Paraffin sections from 327 consecutive patients who had undergone breast surgery (benign (n ¼ 28) or breast cancer (n ¼ 299)) between October 2007 and June 2010 were analysed for mammaglobin-A protein expression by immunohistochemistry. Tissue expression was compared with histological and clinical parameters; tumour grade, type, size and receptor status (where available; Chi-squared, p<0.05). Five year survival analysis was performed (Kaplan Meier, p<0.05). The study had ethics approval. Results: Positive mammaglobin expression was observed in 49% breast samples analysed and expression with tumour grade was in 54% benign tissue samples, 57% grade 1, 52% grade 2 and 38% grade 3 tumour samples. There was a significant correlation between mammaglobin-A expression with both oestrogen and progesterone receptor status (p ¼ 0.011 and p ¼ 0.013 respectively). At five year follow up, 296 patients were alive and well, 14 were alive with cancer, 14 had died and 3 were lost to follow up. There were no significant associations between mammaglobin expression and overall or disease-free five year survival. Conclusions: Mammaglobin-A expression in breast tissue was observed in a higher proportion of benign and low grade tumours, however this difference was not significant. Positive mammaglobin-A expression was associated with positive oestrogen and progesterone receptor status. There was no correlation between mammaglobin-A tissue expression and five year survival status. http://dx.doi.org/10.1016/j.ejso.2017.01.199
P147. A survey to determine statistics in Portsmouth for the relationship between breast surgery & post-operative upper limb functional problems Alexandra Stephenson, Joanne Burke Solent NHS Trust, Portsmouth, UK Introduction: Most women with breast cancer have surgery to the breast and axilla which can affect the muscles, nerves and lymphatic vessels in upper limb function. Guidelines advocate access to specialist physiotherapy services after treatment. There was no local data for women having breast cancer treatment with upper limb problems. This service evaluation aimed to investigate if there is an issue with women having these issues following treatment for breast cancer using the Quick DASH. Method: The data was collected for 3 months retrospectively (March, April and May 2015). The records of all patients aged >18yrs admitted with a diagnosis of histologically confirmed invasive or non-invasive primary breast cancer scheduled for surgical excision/ sentinel lymph node
S51
Right
Left
IDC 31
IDC 28 ILC 11 Other 1 ILC 4 IDC 3 Other 2 Other 2 IDC 3 ILC 0
http://dx.doi.org/10.1016/j.ejso.2017.01.193 ILC 9 P141. To examine the clinico-pathological and oncological outcomes of patients who underwent mastectomy following ipsilateral therapeutic mammoplasty Natalie To, Dalia Elfadl, Jennifer Rusby, Peter Barry Royal Marsden Hospital, Sutton, UK Introduction: Patients with therapeutic mammoplasty (TM) may require further surgery for residual disease (involved margins) or recurrence. We aim to evaluate the pathological and technical, as well as oncological outcomes of patients who required a mastectomy having previously had ipsilateral TM. Methods: A retrospective record review identified patients who had mastectomy after ipsilateral TM between 2005 and 2016. We recorded information including age, reasons for mastectomy, tumour characteristics, margin involvement, re-excision and adjuvant treatment. Results: Of 1270 who had TM, 66 patients required post-TM mastectomy. They formed 3 groups: 43 (65%) patients with involved margins, 16 (24%) with disease recurrence and 7 for other reasons BRCA carrier. Ten (23%) patients with involved margins had re-excision prior to mastectomy. Reconstruction was carried out on 28 (65%) patients with involved margins of whom 21 (75%) were immediate, whereas all 12 (75%) patients had immediate reconstruction for recurrence. A minority (14%) underwent implant based reconstruction. Qualitative analysis suggests that mastectomy and reconstruction planning was influenced by previous TM incisions. 36 patients (83%) with involved margins were in remission from their disease, compared to only 10 patients (62.5%) in the recurrence group, the most common cause of death in both groups being metastatic breast cancer. Conclusion: We found that the majority of patients who had post-TM mastectomy for positive margins, did so without re-excision of margins. A large proportion of patients in both groups had immediate reconstruction, permitting non-standard mastectomy following TM.
Other 5
Right
Left
ER + 42
ER + 34 ER 2 ER 3 ER + 1 PR + 26 PR e 3 PR e 4 PR + 2 Her 2+ 1 Her e 3 Her 2e 35 Her 2+ 1
ER 4 PR+ 34 PR 7 Her 2+ 5 Her 2e 40
Conclusion: Bilateral mastectomy was confirmed to be the most common surgical treatment for SBCs. Half the tumours shared identical clinico-pathological features, suggesting either that SBC patients may have a propensity to develop tumours of a particular type, or that SBCs may be related. Genomic studies will be required to more clearly define these relationships. Comparison with matched controls will be necessary to determine whether SBCs have a worse prognosis than unilateral breast cancer, as suggested in the literature. http://dx.doi.org/10.1016/j.ejso.2017.01.195
http://dx.doi.org/10.1016/j.ejso.2017.01.194
P142. Bilateral synchronous breast cancer: Histological concordance and surgical management Gary Dobson1, Colin McIlmunn1, Kienan Savage1,2, Stuart McIntosh1 1 Belfast City Hospital, Belfast, UK 2 Centre for Cancer Research & Cell Biology, Belfast, UK Introduction: Synchronous breast cancers (SBC) account for up to 3% of breast cancer diagnoses, and are often managed with bilateral mastectomy, although the optimal treatment strategy is unclear. We present initial findings of tumour morphology and surgical management of a cohort of SBC patients in Northern Ireland (NI). Methods: Women with SBC diagnosed between 1992 and 2015 were identified from NI Cancer Registry data. Histopathology reports have been reviewed; pathological features of tumours and biomarker expression were collated. Data was collected on initial surgical treatment, and followup data was recorded where available. Results: Data was available on 60 SBC cases between 1992 & 2015. Mean age at diagnosis was 59 years (range 32e91) Fifty-two patients underwent surgical treatment: 35 patients had bilateral mastectomies, 12 underwent bilateral breast conserving surgery and the remainder a combination.
P143. Addressing younger patient’s fertility concerns after a breast cancer diagnosis Cathy McDaid Belfast Health and Social Care Trust, Belfast, UK Introduction: Every year in the UK, 5,000 women under 45 years are diagnosed with breast cancer. Some of the breast cancer treatments can affect fertility. I wished to assess if we are addressing these issues. Methods: A retrospective audit was conducted of women diagnosed under the age of 45, in Belfast Trust, between January and June 2015. Based on change in practice, a re-audit of women diagnosed between September and November 2016. Data was collected from the Breast Care Nursing notes. The standards used are the NICE guidelines for people with cancer who wish to preserve their fertility. Also those set out by BCC; patients under 45 years will be given a full explanation during initial treatment discussions about the possible impact of treatment on fertility. Results: In the initial audit 26 women were diagnosed. One was pregnant at the time of diagnosis (PBC) and one was metastatic. 3 women (14%) had a record of a fertility being discussed. The audit highlighted inaccurate recording of discussions about fertility therefore nursing paperwork was updated. In the re-audit period 17 women were diagnosed with breast cancer. 15 (88%) women had a
S52 record of a discussion about fertility. 2 (12%) did not (one PBC and one woman with learning difficulties). Conclusions: We are discussing fertility with most patients at an early stage unless there is a good reason not to. We are now accurately recording when these conversations happen. http://dx.doi.org/10.1016/j.ejso.2017.01.196
ABSTRACTS Results: Patients, carers and our support group have rated the information leaflet highly, and have found the clinic “easy” and “smooth” to attend. Conclusions: We commend this approach to other units, both to streamline other busy follow up clinics and for improved patient satisfaction so that all patients may receive the first-class treatment that they deserve. http://dx.doi.org/10.1016/j.ejso.2017.01.198
P144. An audit of staging investigations for breast cancer Duncan Simpson, Victoria Graham, Clare Shute Antrim Area Hospital, Northern Ireland, UK Introduction: Our protocol for staging in breast cancer is US abdomen and CXR in patients if clinically node negative, and CT and bone scan if clinically node positive. ABS guidelines suggest that US and bone scan are not useful unless symptomatic, part of a trial, or to undergo neoadjuvant treatment. We wanted to assess our protocol against this standard. Methods: All patients diagnosed with breast cancer in 2015 were identified. Demographics; decision to operate; pre-operative node status; staging investigations and subsequent changes to management were recorded. Results: 258 patients were diagnosed with breast cancer in 2015. 2 male, age range 30e86 (median 62). In 29 patients no surgery was planned. 33 patients had in-situ disease only and had no staging. The remaining 196 patients were planned for surgery. All had staging. 160 were clinically node negative: 149 had US, 150 had CXR, 21 had CT, 5 had bone scan No patient in this group had metastases detected. 36 were clinically node positive: 36 had CT, 35 had bone scan 5 of these patients had metastases on CT. 4 had metastases on bone scan (all also on CT). 2 of these 5 patients had their management changed from operative to non-operative. Conclusions: No clinically node negative patient had metastases diagnosed. No patient had metastases on US. No patient had metastases on bone scan that were not on CT. We recommend no staging if clinically node negative and no routine use of US, CXR or bone scan. We estimate savings around £60,000/year. http://dx.doi.org/10.1016/j.ejso.2017.01.197
P145. Monitoring response to primary hormonal treatment (PHM) in older women with oestrogen responsive (ER+ve) breast cancer. Are we giving the best to these patients? Rachel King, Rachel Bright-Thomas Worcestershire Royal Hospital, Worcester, UK Introduction: The proportion of the population over age 80 is increasing nationally. By 2050 it will be 1 in 10, 2/3 being women. Breast cancer is common in this group (1 in 14) and is predominantly ER +ve (90%). Many affected women have other co-morbidities and prefer to avoid surgical treatment if possible. One common treatment option is to commence primary hormonal manipulation (PHM) and to monitor response sequentially until this treatment fails. This has resource implications as the patients require frequent follow up and, with a good response, may need to return for focused USS assessment. Hearing and mobility issues can also prolong the appointment time required. Methods: Since 2014 we have collated a prospective record of >50 patients over age 80 treated with PHM. After receiving initial written information about treatment options, those choosing PMH are followed up in a dedicated nurse led clinic with, telephone reminders of clinic appointments, simultaneous USS available, more clinic time for assessment of cancer response and holistic assessment of needs, and open access back into the main clinic if the drug response is poor or if the patient wishes to try an alternative treatment path.
P146. Mammaglobin-A tissue expression, breast cancer pathology and survival Liz Baker, Louise Hall, Naomi Whiteoak, Lucy Hill, Deborah Wilson, Pud Bhaskar University Hospital of North Tees, Stockton on Tees, UK Introduction: Human mammaglobin-A is breast tissue specific, overexpressed in some breast cancers and associated with less aggressive phenotypes. Several previous studies have determined the association between mammaglobin-A protein expression with tumour pathology however it is not known whether expression correlates with survival. Methods: Paraffin sections from 327 consecutive patients who had undergone breast surgery (benign (n ¼ 28) or breast cancer (n ¼ 299)) between October 2007 and June 2010 were analysed for mammaglobin-A protein expression by immunohistochemistry. Tissue expression was compared with histological and clinical parameters; tumour grade, type, size and receptor status (where available; Chi-squared, p<0.05). Five year survival analysis was performed (Kaplan Meier, p<0.05). The study had ethics approval. Results: Positive mammaglobin expression was observed in 49% breast samples analysed and expression with tumour grade was in 54% benign tissue samples, 57% grade 1, 52% grade 2 and 38% grade 3 tumour samples. There was a significant correlation between mammaglobin-A expression with both oestrogen and progesterone receptor status (p ¼ 0.011 and p ¼ 0.013 respectively). At five year follow up, 296 patients were alive and well, 14 were alive with cancer, 14 had died and 3 were lost to follow up. There were no significant associations between mammaglobin expression and overall or disease-free five year survival. Conclusions: Mammaglobin-A expression in breast tissue was observed in a higher proportion of benign and low grade tumours, however this difference was not significant. Positive mammaglobin-A expression was associated with positive oestrogen and progesterone receptor status. There was no correlation between mammaglobin-A tissue expression and five year survival status. http://dx.doi.org/10.1016/j.ejso.2017.01.199
P147. A survey to determine statistics in Portsmouth for the relationship between breast surgery & post-operative upper limb functional problems Alexandra Stephenson, Joanne Burke Solent NHS Trust, Portsmouth, UK Introduction: Most women with breast cancer have surgery to the breast and axilla which can affect the muscles, nerves and lymphatic vessels in upper limb function. Guidelines advocate access to specialist physiotherapy services after treatment. There was no local data for women having breast cancer treatment with upper limb problems. This service evaluation aimed to investigate if there is an issue with women having these issues following treatment for breast cancer using the Quick DASH. Method: The data was collected for 3 months retrospectively (March, April and May 2015). The records of all patients aged >18yrs admitted with a diagnosis of histologically confirmed invasive or non-invasive primary breast cancer scheduled for surgical excision/ sentinel lymph node