Management of Breast Cancer

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• Management of Breast Cancer
• By
• Hussein M. Khaled
• Prof. Medical Oncology
• Vice President
• Post graduate Studies and Research
• Cairo University

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BREAST CANCERWorldwide incidence in females
Western Europe
67.4 36.0 28.6 71.7 21.2 25.0 31.5 25.5 86.3
Eastern Europe
Japan
Australia/ New Zealand
South CentralAsia
Northern Africa
Southern Africa
Central America
North America
Incidence per 100,000 population.
Parkin DM, et al. CA Cancer J Clin. 19994933-64.
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CANCER CONTROL
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BREAST CANCERSigns and symptoms at presentation

• Mass or painin the axilla
• Palpable mass
• Thickening
• Pain
• Nipple discharge
• Nipple retraction
• Edema or erythemaof the skin

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BREAST CANCERDiagnosis path
Evaluation for biopsy
Normal
Cyst
Palpable mass
Nonpalpable mass
Cyst aspiration

• Biopsy
• Excisional biopsy
• Core-cutting needle biopsy
• Fine-needle aspiration

If persistent, short-term follow-up with surgeon
Needle localization
Continued appropriate screening
Ductal carcinoma in situ
Insufficient evaluation, rebiopsy
Invasive cancer
Lobular carcinoma in situ
Benign
Treatment Path
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Staging Classification of Breast Tumour
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Early Breast Cancer
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NSABP B-06Effect of Lumpectomy v. Mastectomy on
Survival
Cohort A
Cohort B
Cohort C
DISTANT DISEASE-FREE SURVIVAL ()
YEAR
No. of patients / No. of recurrences
Total Mastectomy
692/265
569/233
494/192
Lumpectomy
699/302
634/282
520/236
Lumpectomy XRT
714/278
628/253
515/204
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HT
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HER2 testing algorithm
Adapted from Bilous M, et al. Mod Pathol
20031617382Hanna W. Breast 200514(Suppl.1)S17
(Abstract 10)
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Locally Advanced Breast Cancer
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What elements drive therapy decision making ?
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GUIDELINE RECOMMENDATION FOR CHEMOTHERAPY FOR
STAGE I BREAST CANCER
T1a (0-5 mm)
T1b (6-10 mm)
T1c (11-20 mm)
NCI
ER
NCCN)
ER -
ER
St. Gallen
ER -
Optional
Recommended
Not Recommended
) NCCN National Comprehensive Cancer Network
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www/Adjuvant on line !
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The Breast Health Global Initiative
(BHGI)Guideline Publication 2003

• CONSENSUS STATEMENTS
• Early Detection Panel
• Diagnosis Panel
• Treatment Panel

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BHGI GLOBAL SUMMIT 2005Guideline Stratification

Breast J 200612 Suppl 1S117-120
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Diagnosis
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Controversial Issues

• FNAC or Frozen Sections
• 5 or 10 years of HT
• T and AI
• Type of CT
• Herceptin and others
• Pre or post op CT
• Ov ablation
• Cases who do not need systemic treatment

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Cancer Treatment
Application of cancer treatment
Cost of cancer treatment
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Situation Analysis Egypt
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EGYPT
Gharbia Populationbased registry
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Incidence Rates of Common Sites of
Cancer Population Data Females
Rate per 100 000 pop.
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GLOBAL STATISTICSAge-Specific Rates / 100,000
Females (all ages)
Globocan 2002 (IARC)
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The National Cancer Institute Cairo
Universitywww.nci.cu.edu.eg
Cairo University
National Cancer Institute
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NCI Most Common Sites in Males and females
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• 
  National Cancer Registry

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Age structure of Female breast cancer patients.
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Age-specific Incidence Rates of Breast cancerin
younger age groups Egypt and US SEER
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Magnitude of Breast Cancer in Egypt 2025
Projection of Magnitude of Breast Cancer
in Egypt 2025, 2050

• Population size 51 million females
• Crude incidence rate 55.1./100,000 females
• Incidence 14,000 ? 28,000 breast cancer cases
  
  
• Prevalence 42,000 ?84,000 breast cancer cases

Magnitude of Breast Cancer in Egypt 2050

• Population size 64 million females
• Crude incidence rate 68.8./100,000 females
• Incidence 14,000 ? 44,000 breast cancer cases
  
  
• Prevalence 42,000 ?132,000 breast cancer cases

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Breast cancer T stage 1984 - 2006, Port Said,
Egypt
SOURCE Prof. Dr. Ahmed Elzawawy
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Cancer Control in Egypt

• 
  
  

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Inflammatory Breast Cancer (IBC)

• Swollen
• Erythema
• Peau dOrange
• Frequently Mistaken for Mastitis

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ClinicoPathological Correlation in Breast
Cancer Cases (2002)

• Revision of the slides of 212 patients.
• Only 16 patients had both clinical and
  pathological features of IBC (8)
• Age distribution

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Biologic profile Immunphenotypic signature

• More than 90 of IBC showed positive axillary
  nodes.
• IBCs are characterized by
• High histologic grade tumors with high
  Nuclear grade, necrosis and high PCNA and
  MIB-1(Ki-67) labeling indices.
• ER PgR are frequently negative.
• p53 gt 70 positivity.
• HER-2/Neu gt 60.

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Tumor emboli and LYVE-1 and RhoC expression in
IBC tumors from Egypt and the United States
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RhoC Scoring and Tumor Emboli for Egyptian
patients with IBC and non-IBC
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Thank you
Cairo University
National Cancer Institute