6^th World Congress and Expo on Breast Pathology and Cancer Diagnosis July 25-26, 2018 Vancouver, Canada

The involvement of pathologists in the management of breast disease divided into four main areas: Diagnosis, Assessment of adequacy of treatment and prognosis, effective communication and research. Biopsy is removal of breast tissue for examination by a pathologist. Mammography , is useful for finding early changes in the breast. Breast ultrasound scans Ultrasound scans use sound waves to make a picture of the inside of the body.

In Breast cancer Diagnosis, If tests show that you have breast cancer you will need to have further tests. The tests check the size of the cancer and whether there is any spread to nearby lymph nodes or to other parts of the body. This tells the doctor the stages of cancer. The stage is important because it helps your doctor to decide on the best treatment for you. Most women have blood tests, MRI scan, Lymph node Ultrasound scan and some have a chest X-ray. These may be done as part of standard preparation before surgery. 

In cancer care, doctors specializing in different areas of cancer treatment—such as surgery, radiation oncology, and medical oncology. Cancer care teams also include a variety of other healthcare professionals, including physician assistants, oncology nurses, social workers, pharmacists, counsellors, nutritionists, and others. The biology and behaviour of a breast cancer affects the treatment plan. Some tumours are small but grow fast, while others are large and grow slowly. Treatment options and recommendations are very personalized and depend on several factors, including: stage of tumour, tumour subtypes, genomic maker, patient age, and patient menopausal status, mutations in inherited breast cancer genes, such as BRCA1 or BRCA2. For both DCIS and early-stage invasive breast cancer, doctors generally perform surgery to remove the tumour. For larger cancers, or those that are growing more quickly, doctors may recommend systemic treatment with chemotherapy or hormonal therapy before surgery, called neoadjuvant therapy.

The cancer does return after treatment for early-stage disease, it is called recurrent cancer. When breast cancer recurs, it may come back in the following parts of the body, same place as the original cancer, chest wall, lymph node, bones, lungs, liver and brain. A local or regional recurrence is manageable and may be curable for women with a local recurrence in the breast after initial treatment with lumpectomy and adjuvant radiation therapy, the recommended treatment is mastectomy. Usually the cancer is completely removed with this treatment. For women with a local or regional recurrence in the chest wall after an initial mastectomy, surgical removal of the recurrence followed by radiation therapy to the chest wall and lymph nodes is the recommended treatment. However, if radiation therapy has already been given for the initial cancer, this may not be an option. Radiation therapy cannot usually be given at full dose to the same area more than once. For women with a local or regional recurrence in the chest wall after an initial mastectomy, surgical removal of the recurrence followed by radiation therapy to the chest wall and lymph nodes is the recommended treatment.

In medicine, a case report contains detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case report usually describes an unusual or novel occurrence. Case reports are an unexpected association between diseases or symptoms. It may results in finding the shed new light on the possible pathogenesis of a disease or an adverse effect.it may contour Unique or rare features of a disease, unique therapeutic approaches.

Mastectomy is the surgical removal of the entire breast. Some women have the option of mastectomy or lumpectomy (also called breast conserving surgery) plus radiation therapy. Other women can only have mastectomy. Some women have a very high risk of breast cancer due to an inherited gene mutation. These women may have one or both breasts removed to try to prevent breast cancer called ( prophylactic mastectomy).A woman at very high risk who has cancer in one breast may have her healthy breast removed to try to prevent breast cancer in the healthy breast (contralateral prophylactic mastectomy)A woman at increased risk who does not have breast cancer, may have both breasts removed to try to prevent breast cancer (bilateral prophylactic mastectomy).

Non-cancerous breast conditions are most common and most women have them. In fact, most breast changes that are tested turn out to be benign. Benign is another word for non-cancerous. Benign breast conditions are not life-threatening. Benign conditions and breast cancer has many of the same symptoms. So it can be hard to tell the difference from just symptoms alone. Some breast changes may not cause any symptoms and may be found during a mammogram. But sometimes they can cause symptoms that bother. Benign breast tumours may hurt, but they aren’t dangerous and don’t spread from the breast to other organs. Still, some benign breast conditions, such as papilloma’s and atypical hyperplasia, are important to know about because women with them have a higher risk of developing breast cancer. A biopsy is the only way to find out if a lump is benign or cancer. If a benign tumour is large, it may change the breast’s size and shape. If it’s growing into the tissue of the milk ducts, it may cause an abnormal discharge from the nipple. Depending on the type, size, and number of benign tumours, surgery to recommended.

The Separation of epithelial proliferative lesions and differentiation between usual epithelial hyperplasia. And atypical ductal hyperplasia (ADH) is the most common problems encountered. Intra duct benign epithelial proliferation, Epithelial and myoepithelial cells proliferate together. Therefore mixed pattern seen on CK 5/6 or P63 immunostaining. In this condition Streaming pattern usually seen and Peripheral slit-like spaces within ducts is present, Cells are smaller in size, more crowded and overlapping than in atypical proliferations or carcinoma in Situ. Atypical hyperplasia is of three types Atypical Ductal Hyperplasia (ADH): Columnar Cell Change with atypia, Atypical Lobular Hyperplasia (ALH). ADH is important because it carries a 4-5 times relative risk of breast cancer at 10-15 yrs. post biopsy.  It causes difficulty to diagnostic pathologists - inconsistency in diagnosis is common. It lies closest morphologically to low grade DCIS - it is not a high grade lesion.

"Cancer" is used as a generic term to cover the whole range of malignant disease of the breast. This area inevitably constitutes the main focus of study of breast disease as from a clinical point of view. Malignant tumours are cancerous and aggressive because they invade and damage surrounding tissue. When a tumour is suspected to be malignant, the doctor will perform a biopsy to determine the severity or aggressiveness of the tumour. CARCINOMA IN SITU is a type of malignant cancer and also known as pre-invasive carcinoma.it is confined with ducts or lobules this is Immunostains very helpful in diagnosis.

Research has developed ways of grouping breast cancers into different types. They sometimes call rarer breast cancers special type and the more common breast cancers no special type. More than 90% of breast cancers are invasive carcinoma and 10% are rare types of cancers. The rare types of breast cancers are, medullary breast cancer About 5 out of 100 breast cancers (5%) are medullary breast cancers. The cancer cells tend to be bigger than other breast cancer cells. Mucinous (mucoid or colloid) breast cancers about 2 in 100 breast cancers (2%) are mucinous breast cancers. This type of cancer tends to be slower growing than other types of breast cancers and is less likely to spread to the lymph nodes. Tubular breast cancer is called tubular because the cells look like tubes when seen under a microscope. Only about 1 in 100 breast cancers (1%) are tubular cancers.

Immunohistochemistry has an important role in the pathology of breast disease, as well as in other benign or malignant tumours. Overall, immunotherapy holds several key advantages over conventional chemotherapeutic and targeted treatments directed at the tumour itself. First, immunotherapy generally results in fewer side effects, enabling it to be administered for longer periods of time and/or in combination with other agents without added toxicity. The principal function of immunohistochemistry of breast pathology is: Solving common diagnostic dilemmas e.g., Benign/malignant, Epithelial proliferations, in situ v micro invasion. Tumour typing and confirming diagnoses, such as: Tumour typing, subtle foci of invasion, Status of margins, Lymph node metastases, demonstrating epithelial cells in necrotic material. For confirmation of this diagnosis most frequently used immunostains in breast pathology are: Myoepithelial markers - CK 5/6; P63, Lobular v Ductal - E Cadherin, Receptors - ER; PGR and Her2.

The two most common genetic risk factors for breast cancer are the BRCA1 & 2 genes.BRCA1 & BRCA2Approximately 5% of all breast cancers are caused by a recognised specific genetic predisposition due to germ line mutations of one of two different genes: BRCA1 located on Chromosome 17q, BRCA2 located on Chromosome 13q. BRCA1 mutations also predispose to carcinoma of the ovary and possibly carcinoma of the Fallopian tube. Mutationsof this gene are particularly common in Ashkenazy Jews (2%). The risk of developing breast cancer among carriers is around 55% by age 70. BRCA2: The product of BRCA2 is involved in controlling gene function and DNA repair. Gene function involves in transcriptional activation and completion of cell division by cytokinesis.  Majority of BRCA2-associated tumours are invasive ductal, no special-type tumours.

Malignant micro calcification involves, DCIS and LCIS. Calcification in DCIS may occur with any grade. Finer calcs associated with low grade DCIS, Coarse luminal calcs associated with comedo DCIS and Periductal stromal calcification may be seen alone or as well. LCIS: Florid LCIS & calcs, the uncommon variant of LCIS is commonly accompanied by comedo necrosis and coarse calcification. It may easily be mistaken for DCIS for this reason. The prognosis and management of this lesion if an isolated finding is unclear.

In Grading of Breast Cancer Histological grade provides important prognostic and management information.  The internationally accepted system is that defined by Elston and Ellis1. Grading is Assess by evaluating acinar formation, nuclear size/pleomorphism and mitotic activity. The Nuclear evaluation is the most subjective and can lead to inconsistency. Although originally designed for grading NST tumours it is recommended that it is applied to all cancers. An attempt should be made to grade the pre-operative core biopsy as there is acceptable concordance with excision grade. Staging: Stage is usually expressed as a number on a scale of 0 through IV — with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body.

20% of breast carcinomas are of special type and the majority of these are lobular carcinomas. Tubular and mucinous carcinomas occur next most frequently and thereafter the remaining special types are seen infrequently. In order to make a diagnosis of a special type of carcinoma >90% of the tumour is required to show the particular pattern in question. Special types of carcinoma should be distinguished from mixed carcinomas where the special type areas occupy between 50 and 90% of the tumour area with the remaining area being usually of no special type.

Breast cancer is found in about 1 in every 3,000 pregnant women. Breast cancer is the most common type of cancer found during http://www.omicsgroup.org/journals/pregnancy-and-child-health.phppregnancy, while breastfeeding, or within the first year of delivery. You may hear this called gestational breast cancer or pregnancy-associated breast cancer (PABC). When a pregnant woman develops breast cancer, it’s often diagnosed at a later stage than it would be if the woman were not pregnant. It’s also more likely to have spread to the lymph nodes. This is partly because hormone changes during pregnancy. Another reason it may be hard to find breast cancers early during pregnancy is that screening for breast cancer is often delayed until after the pregnancy is over. Pregnancy and breast feeding can also make breast tissue denser.

Women may prevent their risk of breast cancer by maintaining a healthy weight, drinking less alcohol, being physically active and breastfeeding their children. Avoiding risk factors and increasing protective factors may help prevent cancer. The following are risk factors for breast cancer: Older age, A personal history of breast cancer or benign (no cancer) breast disease, A family history of breast cancer, Inherited gene changes, Dense breasts, Exposure of breast tissue to oestrogen, made in the body, Taking hormone, therapy for symptoms of menopause, Radiation therapy to the breast or chest, Obesity, Drinking alcohol, Being white.