Background High levels of stromal tumor-infiltrating lymphocytes (TILs) have been associated with... more Background High levels of stromal tumor-infiltrating lymphocytes (TILs) have been associated with better prognosis in early triple-negative breast cancer (TNBC). The Immunoscore® (IS) is a prognostic tool, which categorizes the densities of spatially positioned CD3 and CD8 cells in both invasive margins (IM) and the center of the tumor (CT), yielding a five-tiered classification (0-4). High IS values have been reported to predict improved outcomes in colorectal cancer. Methods The cohort consisted of 53 TNBC patients (pts) who previously received neoadjuvant anthracycline- and taxane-based chemotherapy. Quantitative analysis of the immune cells was carried out using computer-assisted image analysis in different tumor locations for CD3 and CD8 T-cell markers. Additionally, we measured stromal TILs according to the International TILs Working Group. Pre-treatment tumor samples were immune-stained for CD3 and CD8 T-cell markers and stromal TILs. The relationship between various clinical...
Table 1 Difference in median plasma concentrations of soluble systemic immune checkpoint molecule... more Table 1 Difference in median plasma concentrations of soluble systemic immune checkpoint molecules in newly diagnosed breast cancer patients and healthy controls.
: The increasing numbers of breast cancer survivors from newly diagnosed to metastatic requires m... more : The increasing numbers of breast cancer survivors from newly diagnosed to metastatic requires more personalised management by the medical breast cancer community. The increasing numbers of breast cancer survivors from newly diagnosed to metastatic requires more personalised management by the medical breast cancer community. Whereas oncology specialists provide useful information, patients may not hear it. An equal partnership between patients and their doctors is proposed. Patient involvement is more than patient surveys. Patients need appropriate information which they can understand and trust and is tailored to their specific needs at each step of the care pathway. Patients are facing difficulties navigating all the information and available options. Physicians need to understand that patients receive information from multiple sites. Many tools are available to help in shared decision-making.
3044 Background: Checkpoint proteins regulate the immune system. Breast cancer (BC) cells can up-... more 3044 Background: Checkpoint proteins regulate the immune system. Breast cancer (BC) cells can up-regulate or down-regulate these proteins to evade anti-tumor immune responses. Soluble forms of immune checkpoint molecules (ICMs) can be measured in human plasma. The study aimed to measure the systemic levels of a series of co-stimulatory and co-inhibitory ICMs at diagnosis, post-neo-adjuvant chemotherapy (NAC) and post-surgery in newly- diagnosed BC patients (pts) relative to those of a healthy control group. Methods: Soluble ICMs were measured using multiplex bead array technology in plasma from 72 BC pts and 45 healthy controls. Data was prospectively obtained and levels compared between pre-treatment, post-NAC, and post-surgery using non-parametric tests (Mann-Whitney & Kruskal-Wallis). Results: Pre-treatment levels of the soluble stimulatory molecules viz. GITR (p<0.0001), GITRL (p< 0.020), CD27 (p< 0.024), CD40 (p< 0.021), ICOS (p< 0.009), as well as the inhibitory...
Understanding the geography The Netcare Milpark Breast Care Centre is a multidisciplinary breast ... more Understanding the geography The Netcare Milpark Breast Care Centre is a multidisciplinary breast unit established in 2000 and sees patients that are 'private' or funded by medical aid. The unit is based in Johannesburg, South Africa. Since its formation, it has seen over 24 000 new patients
Background: In breast cancer with axillary involvement, lymphadenectomy has been the standard pro... more Background: In breast cancer with axillary involvement, lymphadenectomy has been the standard procedure until recently. Axillary involvement and the number of metastatic nodes was one of the main prognostic factors. There is an evidence that the administration of radiotherapy on ganglion areas in patients with positive axilla decreases the risk of recurrence. Nowadays a more conservative management is valued and this avoid comorbidities. The objective was to evaluate the axillary treatment, the evolution over time and to assess patients follow-up. Material and Methods: A retrospective observational study of patients diagnosed with breast cancer with positive axilla between 2010 and 2017 was done. The objective was to evaluate the axillary treatment, the evolution over time and to assess patients follow-up. Results: In a total of 1100 patients diagnosed of breast cancer, 168 of them were women with clinically and histologically positive axilla at diagnosis. 76% received primary chemotherapy (127/168) and they were subsequently treated with sentinel node biopsy, axillary lymphadenectomy or both tecniques. Those with positive sentinel node biopsy were studied differentiating the treatment on those who received radiotherapy or were into lymphadenectomy. 60 patients (46% of total) resulted in complete pathological axillary response after neoadjuvant chemotherapy. 5 axillary recurrences appeared (2.9%) of which none of them were registered in the sentinel node biopsy group associated with radiotherapy, avoiding axillary lymphadenectomy. These results compared to randomized studies as EBCTCG 2005 or AMAROS would support the benefit of lymph node radiotherapy treatment, bypassing the axillary lymphadenectomy, in situations with positive sentinel node biopsy in those patients who received primary chemotherapy. Likewise, according to the consensus of San Gallen 2015 sentinel node detection is considered appropriate after axillary negativization after chemotherapy. The asociation of Trastuzumab to chemotherapy has demonstrated a higher response rate in both axilla and breast as studies like Neosphere shows, wich significantly improves its results with the adition of Pertuzumab in neoadjuvant. Conclusions: With a 40% of complete axillary response rate to chemotherapy, sentinel node biopsy provides valid and reliable information about cancer stadification and could prevent lymphadenectomy, replacing it with radiotherapy and thus decreasing morbidity. The pathological response to systemic treatment has emerged as the most important predictive factor of disease-free survival on breast cancer. No conflict of interest.
e12610 Background: Multi-disciplinary meeting decisions may suggest chemotherapy prior to surgery... more e12610 Background: Multi-disciplinary meeting decisions may suggest chemotherapy prior to surgery. Prior to chemotherapy, localisation of the diseased tissue is important to ensure accurate retrieval. Magseed is induced to become a magnet when used in conjunction with a detector. The aim of this study was to assess the accuracy of placement, retrieval, and localisation of a Magseed into a radiologically suspicious loco-regional recurrence in patients requiring chemotherapy. Methods: Patients with loco-regional recurrence that had been assessed in the multidisciplinary meeting as requiring chemotherapy, as well as being potential candidates for surgery post-chemotherapy, were referred for placement of a Magseed prior to commencing chemotherapy or during treatment. The seed was placed by a senior radiologist in the unit. Ten patients have currently completed chemotherapy and surgery. Two patients had more than one Magseed placed. Giving a total seed placement number of 14 seeds. Resul...
Systemic neoadjuvant chemotherapy is utilized along with surgery and radiotherapy for the managem... more Systemic neoadjuvant chemotherapy is utilized along with surgery and radiotherapy for the management of patients with locally advanced breast cancer. The backbone of current chemotherapy regimens include anthracyclines and taxanes given either sequentially or concurrently for up to 8 cycles. Neoadjuvant treatment benefits include in vivo assessment of response to treatment with reduction in the extent of primary and regional metastases. Neoadjuvant chemotherapy for operable breast cancer is used in women who desire breast conservation surgery who are not candidates for such treatment at the time of the diagnosis. The use of neoadjuvant treatment in patients, who present with operable breast cancer, shows equivalent survival outcome compared with adjuvant breast cancer treatment. Several prospective studies have evaluated the role of trastuzumab in combination with neoadjuvant chemotherapy in patients with Her2-positive disease. The addition of trastuzumab to neoadjuvant chemotherapy...
: The three most important imaging methods for breast disease—mammography, ultrasound, and magnet... more : The three most important imaging methods for breast disease—mammography, ultrasound, and magnetic resonance imaging (MRI)—are discussed regarding their imaging principle, the advantages and disadvantages, and cost and cost-effectiveness in different contexts. The conditions to achieve a high-quality service with these methods are also mentioned. For imaging of symptomatic breast disease, the triple diagnostic approach is strongly advised: (a) clinical assessment, (b) imaging with ultrasound ± mammography, and (c) needle biopsy where appropriate. This approach prevents delay in the diagnosis in nearly all cases. The role of MRI in the primary investigation of symptomatic breast disease is strictly limited to special rare constellations. For screening of women of average risk, mammography is the preferred method in developed countries. Additional imaging for dense tissue is hampered by significant lowering of the specificity and is generally not recommended. In low- and middle-income countries, screening for breast cancer is not cost-effective. Only in high-risk women (genetic or otherwise) is screening with MRI plus mammography the method of choice. A short look into the future addresses upcoming and possible methodological developments in the imaging of breast disease with the prospect of further improving an already well-developed discipline.
: A continent-wide review of surgical management of breast care in Africa described a disproporti... more : A continent-wide review of surgical management of breast care in Africa described a disproportionate number of black African patients presenting with locally advanced and metastatic disease (stage 3 or 4). Only 25% presented with early-stage disease (stage 1 or 2). Investment in breast cancer research and treatment in low- and middle-income countries (LMICs) should be a global health priority. In South Africa and other LMICs the first screening goal is to reduce late presentation and late-stage disease through community-based population-level screening combined with open access to health care services for any women with breast symptoms. The aim is to decrease current provider-dependent delays. Increased availability of multidisciplinary teams functioning in specialist centres should improve access and thus decrease the numbers of locally advanced breast cancers presenting, with a knockdown effect on decreasing low survival rates.
Background High levels of stromal tumor-infiltrating lymphocytes (TILs) have been associated with... more Background High levels of stromal tumor-infiltrating lymphocytes (TILs) have been associated with better prognosis in early triple-negative breast cancer (TNBC). The Immunoscore® (IS) is a prognostic tool, which categorizes the densities of spatially positioned CD3 and CD8 cells in both invasive margins (IM) and the center of the tumor (CT), yielding a five-tiered classification (0-4). High IS values have been reported to predict improved outcomes in colorectal cancer. Methods The cohort consisted of 53 TNBC patients (pts) who previously received neoadjuvant anthracycline- and taxane-based chemotherapy. Quantitative analysis of the immune cells was carried out using computer-assisted image analysis in different tumor locations for CD3 and CD8 T-cell markers. Additionally, we measured stromal TILs according to the International TILs Working Group. Pre-treatment tumor samples were immune-stained for CD3 and CD8 T-cell markers and stromal TILs. The relationship between various clinical...
Table 1 Difference in median plasma concentrations of soluble systemic immune checkpoint molecule... more Table 1 Difference in median plasma concentrations of soluble systemic immune checkpoint molecules in newly diagnosed breast cancer patients and healthy controls.
: The increasing numbers of breast cancer survivors from newly diagnosed to metastatic requires m... more : The increasing numbers of breast cancer survivors from newly diagnosed to metastatic requires more personalised management by the medical breast cancer community. The increasing numbers of breast cancer survivors from newly diagnosed to metastatic requires more personalised management by the medical breast cancer community. Whereas oncology specialists provide useful information, patients may not hear it. An equal partnership between patients and their doctors is proposed. Patient involvement is more than patient surveys. Patients need appropriate information which they can understand and trust and is tailored to their specific needs at each step of the care pathway. Patients are facing difficulties navigating all the information and available options. Physicians need to understand that patients receive information from multiple sites. Many tools are available to help in shared decision-making.
3044 Background: Checkpoint proteins regulate the immune system. Breast cancer (BC) cells can up-... more 3044 Background: Checkpoint proteins regulate the immune system. Breast cancer (BC) cells can up-regulate or down-regulate these proteins to evade anti-tumor immune responses. Soluble forms of immune checkpoint molecules (ICMs) can be measured in human plasma. The study aimed to measure the systemic levels of a series of co-stimulatory and co-inhibitory ICMs at diagnosis, post-neo-adjuvant chemotherapy (NAC) and post-surgery in newly- diagnosed BC patients (pts) relative to those of a healthy control group. Methods: Soluble ICMs were measured using multiplex bead array technology in plasma from 72 BC pts and 45 healthy controls. Data was prospectively obtained and levels compared between pre-treatment, post-NAC, and post-surgery using non-parametric tests (Mann-Whitney & Kruskal-Wallis). Results: Pre-treatment levels of the soluble stimulatory molecules viz. GITR (p<0.0001), GITRL (p< 0.020), CD27 (p< 0.024), CD40 (p< 0.021), ICOS (p< 0.009), as well as the inhibitory...
Understanding the geography The Netcare Milpark Breast Care Centre is a multidisciplinary breast ... more Understanding the geography The Netcare Milpark Breast Care Centre is a multidisciplinary breast unit established in 2000 and sees patients that are 'private' or funded by medical aid. The unit is based in Johannesburg, South Africa. Since its formation, it has seen over 24 000 new patients
Background: In breast cancer with axillary involvement, lymphadenectomy has been the standard pro... more Background: In breast cancer with axillary involvement, lymphadenectomy has been the standard procedure until recently. Axillary involvement and the number of metastatic nodes was one of the main prognostic factors. There is an evidence that the administration of radiotherapy on ganglion areas in patients with positive axilla decreases the risk of recurrence. Nowadays a more conservative management is valued and this avoid comorbidities. The objective was to evaluate the axillary treatment, the evolution over time and to assess patients follow-up. Material and Methods: A retrospective observational study of patients diagnosed with breast cancer with positive axilla between 2010 and 2017 was done. The objective was to evaluate the axillary treatment, the evolution over time and to assess patients follow-up. Results: In a total of 1100 patients diagnosed of breast cancer, 168 of them were women with clinically and histologically positive axilla at diagnosis. 76% received primary chemotherapy (127/168) and they were subsequently treated with sentinel node biopsy, axillary lymphadenectomy or both tecniques. Those with positive sentinel node biopsy were studied differentiating the treatment on those who received radiotherapy or were into lymphadenectomy. 60 patients (46% of total) resulted in complete pathological axillary response after neoadjuvant chemotherapy. 5 axillary recurrences appeared (2.9%) of which none of them were registered in the sentinel node biopsy group associated with radiotherapy, avoiding axillary lymphadenectomy. These results compared to randomized studies as EBCTCG 2005 or AMAROS would support the benefit of lymph node radiotherapy treatment, bypassing the axillary lymphadenectomy, in situations with positive sentinel node biopsy in those patients who received primary chemotherapy. Likewise, according to the consensus of San Gallen 2015 sentinel node detection is considered appropriate after axillary negativization after chemotherapy. The asociation of Trastuzumab to chemotherapy has demonstrated a higher response rate in both axilla and breast as studies like Neosphere shows, wich significantly improves its results with the adition of Pertuzumab in neoadjuvant. Conclusions: With a 40% of complete axillary response rate to chemotherapy, sentinel node biopsy provides valid and reliable information about cancer stadification and could prevent lymphadenectomy, replacing it with radiotherapy and thus decreasing morbidity. The pathological response to systemic treatment has emerged as the most important predictive factor of disease-free survival on breast cancer. No conflict of interest.
e12610 Background: Multi-disciplinary meeting decisions may suggest chemotherapy prior to surgery... more e12610 Background: Multi-disciplinary meeting decisions may suggest chemotherapy prior to surgery. Prior to chemotherapy, localisation of the diseased tissue is important to ensure accurate retrieval. Magseed is induced to become a magnet when used in conjunction with a detector. The aim of this study was to assess the accuracy of placement, retrieval, and localisation of a Magseed into a radiologically suspicious loco-regional recurrence in patients requiring chemotherapy. Methods: Patients with loco-regional recurrence that had been assessed in the multidisciplinary meeting as requiring chemotherapy, as well as being potential candidates for surgery post-chemotherapy, were referred for placement of a Magseed prior to commencing chemotherapy or during treatment. The seed was placed by a senior radiologist in the unit. Ten patients have currently completed chemotherapy and surgery. Two patients had more than one Magseed placed. Giving a total seed placement number of 14 seeds. Resul...
Systemic neoadjuvant chemotherapy is utilized along with surgery and radiotherapy for the managem... more Systemic neoadjuvant chemotherapy is utilized along with surgery and radiotherapy for the management of patients with locally advanced breast cancer. The backbone of current chemotherapy regimens include anthracyclines and taxanes given either sequentially or concurrently for up to 8 cycles. Neoadjuvant treatment benefits include in vivo assessment of response to treatment with reduction in the extent of primary and regional metastases. Neoadjuvant chemotherapy for operable breast cancer is used in women who desire breast conservation surgery who are not candidates for such treatment at the time of the diagnosis. The use of neoadjuvant treatment in patients, who present with operable breast cancer, shows equivalent survival outcome compared with adjuvant breast cancer treatment. Several prospective studies have evaluated the role of trastuzumab in combination with neoadjuvant chemotherapy in patients with Her2-positive disease. The addition of trastuzumab to neoadjuvant chemotherapy...
: The three most important imaging methods for breast disease—mammography, ultrasound, and magnet... more : The three most important imaging methods for breast disease—mammography, ultrasound, and magnetic resonance imaging (MRI)—are discussed regarding their imaging principle, the advantages and disadvantages, and cost and cost-effectiveness in different contexts. The conditions to achieve a high-quality service with these methods are also mentioned. For imaging of symptomatic breast disease, the triple diagnostic approach is strongly advised: (a) clinical assessment, (b) imaging with ultrasound ± mammography, and (c) needle biopsy where appropriate. This approach prevents delay in the diagnosis in nearly all cases. The role of MRI in the primary investigation of symptomatic breast disease is strictly limited to special rare constellations. For screening of women of average risk, mammography is the preferred method in developed countries. Additional imaging for dense tissue is hampered by significant lowering of the specificity and is generally not recommended. In low- and middle-income countries, screening for breast cancer is not cost-effective. Only in high-risk women (genetic or otherwise) is screening with MRI plus mammography the method of choice. A short look into the future addresses upcoming and possible methodological developments in the imaging of breast disease with the prospect of further improving an already well-developed discipline.
: A continent-wide review of surgical management of breast care in Africa described a disproporti... more : A continent-wide review of surgical management of breast care in Africa described a disproportionate number of black African patients presenting with locally advanced and metastatic disease (stage 3 or 4). Only 25% presented with early-stage disease (stage 1 or 2). Investment in breast cancer research and treatment in low- and middle-income countries (LMICs) should be a global health priority. In South Africa and other LMICs the first screening goal is to reduce late presentation and late-stage disease through community-based population-level screening combined with open access to health care services for any women with breast symptoms. The aim is to decrease current provider-dependent delays. Increased availability of multidisciplinary teams functioning in specialist centres should improve access and thus decrease the numbers of locally advanced breast cancers presenting, with a knockdown effect on decreasing low survival rates.
Uploads
Papers by Carol Benn