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P003. Oncotype DX testing: Our experience at the Royal Bolton Hospital
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ABSTRACTS
Abstracts for poster presentation at the Association of Breast Surgery Conference & AGM, 15th & 16th June 2015, Bournemouth International Centre P001. Rural-urban differences in screening mammography uptake in Australia and Scotland Janni Leung1, Catriona Macleoad2, Deirdre McLaughlin1, Laura Woods3, Robert Henderson2, Angus Watson2, Richard Kyle4, Gill Hubbard4, Russell Mullen5, Iain Atherton4 1 School of Population Health, The University of Queensland, Brisbane, Australia 2 NHS Highland, Inverness, UK 3 London School of Hygiene & Tropical Medicine, London, UK 4 School of Health Sciences, The University of Stirling, Inverness, UK 5 The Highland Breast Centre, Raigmore Hospital, Inverness, UK Introduction: Previous research has shown that the uptake of health screening programs can be influenced by various demographics, such as deprivation, gender and, more recently, rural residence. This study tested the hypothesis that rural populations had lower uptake of screening mammography in the Scottish and Australian setting. Methods: Scottish data is based upon information from the Scottish Breast Screening Programme Information System describing uptake among women residing within the NHS Highland Health Board area who were invited to attend for screening during the 2008 to 2010 round (N ¼ 27,416). Australian data were drawn from the 2010 survey of the 1946e51 cohort of the Australian Longitudinal Study on Women’s Health (N ¼ 9,890 women). Results: Contrary to our hypothesis, results indicated that women living in rural areas were not less likely to attend for screening mammography compared to women living in urban areas in both Scotland (OR for rural ¼ 1.17, 95% CI ¼ 1.06e1.29) and Australia (OR for rural ¼ 1.15, 95%CI ¼ 1.01e1.31). Conclusion: The absence of a lower attendance of screening mammography among women living in rural areas suggests that mobile breast screening units serving rural areas of both Scotland and Australia can be effective in ensuring adequate service provision and may provide a model in other international contexts. In conclusion, mobile units are useful in reducing inequalities relating to healthcare service access for the rural population.
surgeon. Three core biopsies (4.6%) were repeated. Three out of 613 patients (0.4%) showed breast cancer, one with high grade DCIS, one with grade III invasive ductal carcinoma and one with grade III invasive ductal carcinoma with metastatic lymph node which has been detected clinically and radiologically. 44 patients with fibroadenomas, five with fibrocystic changes, three with hamartomas, the rest with lipomas, phylloides tumour, inflammation, papillary lesion, fat necrosis, tubular adenoma, infarcted lymph node. Conclusions: Under 40 breast clinic led by a surgeon and supported by sonographers is able to provide a comprehensive service with accurate diagnosis within all relevant guidelines. It is effective in ensuring cancers are being detected within the target population and in providing an excellent service. http://dx.doi.org/10.1016/j.ejso.2015.03.038
P003. Oncotype DX testing: Our experience at the Royal Bolton Hospital Sarah Hassan, Jane Ooi, R. Welsh, M. Pearson Royal Bolton Hospital, Bolton, UK Introduction: Oncotype DX is NICE approved as a diagnostic tool to assess risk recurrence in women with early breast cancer. It predicts potential benefits of adjuvant chemotherapy. We looked at correlation between multidisciplinary team (MDT) decision and Oncotype DX risk recurrence score (RRS) in all intermediate risk early breast cancers treated at Royal Bolton Hospital (RBH) between February and August 2014. Methods: We requested Oncotype DX tests as per NICE Guidance. MDT decision regarding adjuvant chemotherapy was recorded in advance of the Oncotype DX report. The subsequent test result was correlated with the clinical decision. Data was collected prospectively. 6 of 32 patients were excluded for inappropriate test request. Results:
http://dx.doi.org/10.1016/j.ejso.2015.03.037
P002. Single-institution experience with an under age 40 symptomatic breast clinic Alaa Abdel-Rahman, Ambika Anand, Elham Abdelaziz, Mandy Holland, Adel Rashed United Lincolnshire Hospitals Trust, Lincolnshire, UK Background: Experienced sonographers have extended their role within the symptomatic breast service. A study was undertaken to ascertain whether they could provide the radiology support to women under 40 years who do not require mammograms. The aim is to measure the effectiveness of this breast clinic to ensure that radiology is providing a good service and to ensure that cancers are being detected within the population. Methods: Under 40 years clinics started in August 2005. These included only female patients with symptoms referred by their GP. Sample size was 613 patients. Breast diaries were reviewed to ascertain core biopsies performed and reports of histological diagnosis. Results: 64 (10%) core biopsies were taken 38 (59%) ultrasound guided by the sonographer and 26 (41%) freehand by the consultant
High Risk (RRS) > 31 Intermediate or Low Risk (RRS) < 31
MDT recommended chemotherapy
MDT did not recommend chemotherapy
n ¼ 3 (11.5%) n ¼ 12 (46.2%)
n ¼ 2 (7.68%) n ¼ 9 (34.6%)
Patients with Intermediate RRS 18-31 are reputed to have little chemotherapy benefit however these remain the hardest group to advise. There were 4 cases in which Oncotype DX did not recommend chemotherapy but the clinical decision was to treat. In these cases, RRS was between 18e20 and the decision was made with the patient following an informed discussion. Conclusion: Our results show a reduction of adjuvant chemotherapy use in patients with intermediate risk breast cancer when utilising Oncotype DX. Over £20,000 was saved in this cohort. Further studies and long term follow up of patients is needed to convince specialists that chemotherapy can be omitted in patients with an intermediate RRS 18-31 http://dx.doi.org/10.1016/j.ejso.2015.03.039
ABSTRACTS
Abstracts for poster presentation at the Association of Breast Surgery Conference & AGM, 15th & 16th June 2015, Bournemouth International Centre P001. Rural-urban differences in screening mammography uptake in Australia and Scotland Janni Leung1, Catriona Macleoad2, Deirdre McLaughlin1, Laura Woods3, Robert Henderson2, Angus Watson2, Richard Kyle4, Gill Hubbard4, Russell Mullen5, Iain Atherton4 1 School of Population Health, The University of Queensland, Brisbane, Australia 2 NHS Highland, Inverness, UK 3 London School of Hygiene & Tropical Medicine, London, UK 4 School of Health Sciences, The University of Stirling, Inverness, UK 5 The Highland Breast Centre, Raigmore Hospital, Inverness, UK Introduction: Previous research has shown that the uptake of health screening programs can be influenced by various demographics, such as deprivation, gender and, more recently, rural residence. This study tested the hypothesis that rural populations had lower uptake of screening mammography in the Scottish and Australian setting. Methods: Scottish data is based upon information from the Scottish Breast Screening Programme Information System describing uptake among women residing within the NHS Highland Health Board area who were invited to attend for screening during the 2008 to 2010 round (N ¼ 27,416). Australian data were drawn from the 2010 survey of the 1946e51 cohort of the Australian Longitudinal Study on Women’s Health (N ¼ 9,890 women). Results: Contrary to our hypothesis, results indicated that women living in rural areas were not less likely to attend for screening mammography compared to women living in urban areas in both Scotland (OR for rural ¼ 1.17, 95% CI ¼ 1.06e1.29) and Australia (OR for rural ¼ 1.15, 95%CI ¼ 1.01e1.31). Conclusion: The absence of a lower attendance of screening mammography among women living in rural areas suggests that mobile breast screening units serving rural areas of both Scotland and Australia can be effective in ensuring adequate service provision and may provide a model in other international contexts. In conclusion, mobile units are useful in reducing inequalities relating to healthcare service access for the rural population.
surgeon. Three core biopsies (4.6%) were repeated. Three out of 613 patients (0.4%) showed breast cancer, one with high grade DCIS, one with grade III invasive ductal carcinoma and one with grade III invasive ductal carcinoma with metastatic lymph node which has been detected clinically and radiologically. 44 patients with fibroadenomas, five with fibrocystic changes, three with hamartomas, the rest with lipomas, phylloides tumour, inflammation, papillary lesion, fat necrosis, tubular adenoma, infarcted lymph node. Conclusions: Under 40 breast clinic led by a surgeon and supported by sonographers is able to provide a comprehensive service with accurate diagnosis within all relevant guidelines. It is effective in ensuring cancers are being detected within the target population and in providing an excellent service. http://dx.doi.org/10.1016/j.ejso.2015.03.038
P003. Oncotype DX testing: Our experience at the Royal Bolton Hospital Sarah Hassan, Jane Ooi, R. Welsh, M. Pearson Royal Bolton Hospital, Bolton, UK Introduction: Oncotype DX is NICE approved as a diagnostic tool to assess risk recurrence in women with early breast cancer. It predicts potential benefits of adjuvant chemotherapy. We looked at correlation between multidisciplinary team (MDT) decision and Oncotype DX risk recurrence score (RRS) in all intermediate risk early breast cancers treated at Royal Bolton Hospital (RBH) between February and August 2014. Methods: We requested Oncotype DX tests as per NICE Guidance. MDT decision regarding adjuvant chemotherapy was recorded in advance of the Oncotype DX report. The subsequent test result was correlated with the clinical decision. Data was collected prospectively. 6 of 32 patients were excluded for inappropriate test request. Results:
http://dx.doi.org/10.1016/j.ejso.2015.03.037
P002. Single-institution experience with an under age 40 symptomatic breast clinic Alaa Abdel-Rahman, Ambika Anand, Elham Abdelaziz, Mandy Holland, Adel Rashed United Lincolnshire Hospitals Trust, Lincolnshire, UK Background: Experienced sonographers have extended their role within the symptomatic breast service. A study was undertaken to ascertain whether they could provide the radiology support to women under 40 years who do not require mammograms. The aim is to measure the effectiveness of this breast clinic to ensure that radiology is providing a good service and to ensure that cancers are being detected within the population. Methods: Under 40 years clinics started in August 2005. These included only female patients with symptoms referred by their GP. Sample size was 613 patients. Breast diaries were reviewed to ascertain core biopsies performed and reports of histological diagnosis. Results: 64 (10%) core biopsies were taken 38 (59%) ultrasound guided by the sonographer and 26 (41%) freehand by the consultant
High Risk (RRS) > 31 Intermediate or Low Risk (RRS) < 31
MDT recommended chemotherapy
MDT did not recommend chemotherapy
n ¼ 3 (11.5%) n ¼ 12 (46.2%)
n ¼ 2 (7.68%) n ¼ 9 (34.6%)
Patients with Intermediate RRS 18-31 are reputed to have little chemotherapy benefit however these remain the hardest group to advise. There were 4 cases in which Oncotype DX did not recommend chemotherapy but the clinical decision was to treat. In these cases, RRS was between 18e20 and the decision was made with the patient following an informed discussion. Conclusion: Our results show a reduction of adjuvant chemotherapy use in patients with intermediate risk breast cancer when utilising Oncotype DX. Over £20,000 was saved in this cohort. Further studies and long term follow up of patients is needed to convince specialists that chemotherapy can be omitted in patients with an intermediate RRS 18-31 http://dx.doi.org/10.1016/j.ejso.2015.03.039