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PO68 Breast cancer in young patients in the Galilee
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Clinical Research / The Breast 21S1 (2012) S13–S24
group, though statistically not significant. The incidence of lymph nodal positivity, perinodal extension and lymphovascular invasion was comparable in both the groups. Conclusion: Triple negativity is higher in younger breast cancer patients and has worse prognosis. Triple negative patients tend to undergo mastectomy more often than breast conservation surgery. PO67 The outcome of patients with pregnancy associated breast cancer: retrospective review L. Vohra, S. Khan *, O. Saleem, N. Khan, N. Riaz. Aga Khan University, Breast Section, Department of Surgery, Karachi, Pakistan Pregnancy associated breast cancer (PABC) has been defined as breast cancer diagnosed during pregnancy or within one year of delivery. It is believed that pregnancy itself is a poor prognostic factor that affects survival as compared to non pregnant women. A retrospective case-control study was conducted among patients treated at Aga Khan University Hospital from 1988–2011 to compare the 5-year survival outcome for PABC with women treated for breast cancer who were not pregnant. Total 156 patients were selected. 52 were pregnant and 104 were non pregnant (control). Overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method, and log rank tests were used to assess the associations between OS, DFS, pregnancy status, HER-2 status, ER/PR status, nodal status & LVI. After adjusting for age and stage, there are more Stage III patients in the pregnant group than non pregnant group (40% vs. 15%). PABC patients had higher risk of both death (p = 0.01) and distant recurrence compared with non pregnant controls. Women with PABC had significantly shorter OS (82.7% vs. 91.3%) and DFS compared with non pregnant age and stage-matched controls. PO68 Breast cancer in young patients in the Galilee A. Hadary *. Ziv Medical Center, Department of General Surgery, Safed, Israel Purpose: To retrospectively review data of women <40 years with primary breast cancer (BC) treated in the Oncology institute at Ziv throughout 5 years. Background: BC arising in younger than 45 years women comprises 15% of total BC cases in Jews and 30% in Arabs in Israel. Arabs are 23% of the population in Upper Galilee region. BC in young is considered to be biologically more aggressive and to have worse prognosis than in older patients. Methods: Information was gathered from Oncology files of the patients using a structured questionnaire according to common international standards. Patients age at diagnosis were divided into 2 groups; <35 years (very young) and 35–40 years (young). Results: 87 women with breast cancer aged <40 years were treated between 2002 and 2007. Of them 24 were <35 years of age at diagnosis. 58% were Jews and 42% were Arabs. 33% of them had 1ST or 2nd degree family relative with BC. 33% used oral contraceptives in the past. 75% had Invasive duct cancer, 12% Invasive lobular cancer and only 4% DCIS. Tumour detection was by the patient in 88%. Stage was 1 in 45%, 2 in 6%, 3 in 41% and 4 in 8%. Tumour stage was 1 in 60% of Jews compared to only 21% in Arabs. (P = 0.002). Estrogen receptors were (+) in 47%. Her-2 was overexpressed in 38%. 54% had breast conserving surgery. 92% had chemotherapy. No significant difference was found in stage of tumour, ER, PR, HER2 status and type of primary surgery (lumpectomy and mastectomy) between very young and young patients. Both groups had similar incidence of tumour pathologic subtypes and similar incidence of familial breast cancer. Five year disease free survival (DFS) was 57% in the very young group compared to 66% in the young group (P = not significant).
PO69 The rate of mastectomies and breast conservative surgery in young women with breast cancer in Albania E. Kozma *, A. Sallaku. University Hospital Mother Theresa, Department of Oncology, Tirana, Albania Purpose: To determine the rate of mastectomies and breast conservative surgery (BCS) in young women with breast cancer in Albania. Method and Materials: Between 2008 and 2011, 205 young women under 50 years are diagnosed and treated with limited stage breast cancer in the Service of Oncology of the University Hospital Mother Theresa in Albania (Stage I 15%; stage II 49%; stage III 36%). All these patients underwent surgery (mastectomies or BCS and radiotherapy). Results: From all the patients that underwent surgery, in stage I (15%), 83% underwent mastectomies and 17% BCS; in stage II (49%) 65% underwent mastectomies and 35% BCS and from young women with stage III breast cancer (36%) 100% underwent mastectomies. As we can see from the results a high rate of mastectomies is still in use in our country. The BCS is still a taboo for surgeon and also for patients and their relatives. Conclusion: The high rate of mastectomies in these young women treated with breast cancer is probably because the majority of them are diagnosed in stage II and III of disease, neoadjuvant therapy is still under use, and population have a low level of medical education. The lack of awareness campaign and screening are also main issues to be resolve, but sometimes is also the choice of the surgeon! PO70 Breast cancer in young women – scenario of sub optimal surgery from a developing world A.A. Agarwal1 *, J.K. Kushwaha1 , A. Kumar1 , N. Hussain2 , A.A. Sonkar1 . 1 CSM Medical University, Department of Surgery, Lucknow, India, 2 RML Institute of Medical Sciences, Department of Pathology, Lucknow, India Background: A significant portion of breast cancer in India occurs at very young age (<40 years) sometimes leading to diagnostic dilemma. Intervention by an uninitiated surgeon ranging from transtumour biopsies, lumpectomies or simple incision and drainage thinking it to be an abscess, upstages the disease. Methods: 208 patients were enrolled between May 2010 and May 2012 at Department of Surgery, CSMMU Lucknow. Clinico-histopathological data of breast cancer occurring at younger age group n = 96 was studied, median age 35.8 years. Sub optimal surgery in young breast cancer group (SOSY) patients were n = 36. In this group n = 24 patients revision surgery was done per primum. n = 12 were operated after adjuvant chemotherapy. MRM was offered if patients had clinically evident residual disease or palpable axillary lymph nodes or when HPE status was unknown. Results: In SOSY group n = 14 were ER/PR positive, n = 22 were ER/PR negative and TNBC n = 16. 26 patients had clinically palpable axillary lymphadenopathy. Mean numbers of lymph nodes dissected were11.2 and the mean positive lymph nodes being 6.4. Histopathology was infiltrating ductal carcinoma-NOS (100%). Discussion: In India the health care system has a wide spectrum of facilities ranging from poor to ultramodern. Poor combined with illiteracy in SOSY group often do not have access to a centre with adequate facilities. In this group magnitude of subsequent therapy increases, putting burden on health system and patient alike. Treating physician needs to have a very high suspicion index in young patients. The training programme should be robust where either the surgeon is able to perform cancer directed surgery in a setup with adequate facilities or refer if required.
Clinical Research / The Breast 21S1 (2012) S13–S24
group, though statistically not significant. The incidence of lymph nodal positivity, perinodal extension and lymphovascular invasion was comparable in both the groups. Conclusion: Triple negativity is higher in younger breast cancer patients and has worse prognosis. Triple negative patients tend to undergo mastectomy more often than breast conservation surgery. PO67 The outcome of patients with pregnancy associated breast cancer: retrospective review L. Vohra, S. Khan *, O. Saleem, N. Khan, N. Riaz. Aga Khan University, Breast Section, Department of Surgery, Karachi, Pakistan Pregnancy associated breast cancer (PABC) has been defined as breast cancer diagnosed during pregnancy or within one year of delivery. It is believed that pregnancy itself is a poor prognostic factor that affects survival as compared to non pregnant women. A retrospective case-control study was conducted among patients treated at Aga Khan University Hospital from 1988–2011 to compare the 5-year survival outcome for PABC with women treated for breast cancer who were not pregnant. Total 156 patients were selected. 52 were pregnant and 104 were non pregnant (control). Overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method, and log rank tests were used to assess the associations between OS, DFS, pregnancy status, HER-2 status, ER/PR status, nodal status & LVI. After adjusting for age and stage, there are more Stage III patients in the pregnant group than non pregnant group (40% vs. 15%). PABC patients had higher risk of both death (p = 0.01) and distant recurrence compared with non pregnant controls. Women with PABC had significantly shorter OS (82.7% vs. 91.3%) and DFS compared with non pregnant age and stage-matched controls. PO68 Breast cancer in young patients in the Galilee A. Hadary *. Ziv Medical Center, Department of General Surgery, Safed, Israel Purpose: To retrospectively review data of women <40 years with primary breast cancer (BC) treated in the Oncology institute at Ziv throughout 5 years. Background: BC arising in younger than 45 years women comprises 15% of total BC cases in Jews and 30% in Arabs in Israel. Arabs are 23% of the population in Upper Galilee region. BC in young is considered to be biologically more aggressive and to have worse prognosis than in older patients. Methods: Information was gathered from Oncology files of the patients using a structured questionnaire according to common international standards. Patients age at diagnosis were divided into 2 groups; <35 years (very young) and 35–40 years (young). Results: 87 women with breast cancer aged <40 years were treated between 2002 and 2007. Of them 24 were <35 years of age at diagnosis. 58% were Jews and 42% were Arabs. 33% of them had 1ST or 2nd degree family relative with BC. 33% used oral contraceptives in the past. 75% had Invasive duct cancer, 12% Invasive lobular cancer and only 4% DCIS. Tumour detection was by the patient in 88%. Stage was 1 in 45%, 2 in 6%, 3 in 41% and 4 in 8%. Tumour stage was 1 in 60% of Jews compared to only 21% in Arabs. (P = 0.002). Estrogen receptors were (+) in 47%. Her-2 was overexpressed in 38%. 54% had breast conserving surgery. 92% had chemotherapy. No significant difference was found in stage of tumour, ER, PR, HER2 status and type of primary surgery (lumpectomy and mastectomy) between very young and young patients. Both groups had similar incidence of tumour pathologic subtypes and similar incidence of familial breast cancer. Five year disease free survival (DFS) was 57% in the very young group compared to 66% in the young group (P = not significant).
PO69 The rate of mastectomies and breast conservative surgery in young women with breast cancer in Albania E. Kozma *, A. Sallaku. University Hospital Mother Theresa, Department of Oncology, Tirana, Albania Purpose: To determine the rate of mastectomies and breast conservative surgery (BCS) in young women with breast cancer in Albania. Method and Materials: Between 2008 and 2011, 205 young women under 50 years are diagnosed and treated with limited stage breast cancer in the Service of Oncology of the University Hospital Mother Theresa in Albania (Stage I 15%; stage II 49%; stage III 36%). All these patients underwent surgery (mastectomies or BCS and radiotherapy). Results: From all the patients that underwent surgery, in stage I (15%), 83% underwent mastectomies and 17% BCS; in stage II (49%) 65% underwent mastectomies and 35% BCS and from young women with stage III breast cancer (36%) 100% underwent mastectomies. As we can see from the results a high rate of mastectomies is still in use in our country. The BCS is still a taboo for surgeon and also for patients and their relatives. Conclusion: The high rate of mastectomies in these young women treated with breast cancer is probably because the majority of them are diagnosed in stage II and III of disease, neoadjuvant therapy is still under use, and population have a low level of medical education. The lack of awareness campaign and screening are also main issues to be resolve, but sometimes is also the choice of the surgeon! PO70 Breast cancer in young women – scenario of sub optimal surgery from a developing world A.A. Agarwal1 *, J.K. Kushwaha1 , A. Kumar1 , N. Hussain2 , A.A. Sonkar1 . 1 CSM Medical University, Department of Surgery, Lucknow, India, 2 RML Institute of Medical Sciences, Department of Pathology, Lucknow, India Background: A significant portion of breast cancer in India occurs at very young age (<40 years) sometimes leading to diagnostic dilemma. Intervention by an uninitiated surgeon ranging from transtumour biopsies, lumpectomies or simple incision and drainage thinking it to be an abscess, upstages the disease. Methods: 208 patients were enrolled between May 2010 and May 2012 at Department of Surgery, CSMMU Lucknow. Clinico-histopathological data of breast cancer occurring at younger age group n = 96 was studied, median age 35.8 years. Sub optimal surgery in young breast cancer group (SOSY) patients were n = 36. In this group n = 24 patients revision surgery was done per primum. n = 12 were operated after adjuvant chemotherapy. MRM was offered if patients had clinically evident residual disease or palpable axillary lymph nodes or when HPE status was unknown. Results: In SOSY group n = 14 were ER/PR positive, n = 22 were ER/PR negative and TNBC n = 16. 26 patients had clinically palpable axillary lymphadenopathy. Mean numbers of lymph nodes dissected were11.2 and the mean positive lymph nodes being 6.4. Histopathology was infiltrating ductal carcinoma-NOS (100%). Discussion: In India the health care system has a wide spectrum of facilities ranging from poor to ultramodern. Poor combined with illiteracy in SOSY group often do not have access to a centre with adequate facilities. In this group magnitude of subsequent therapy increases, putting burden on health system and patient alike. Treating physician needs to have a very high suspicion index in young patients. The training programme should be robust where either the surgeon is able to perform cancer directed surgery in a setup with adequate facilities or refer if required.