Day 1 :
Keynote Forum
Hallgeir Rui
Medical College of Wisconsin, USA
Keynote: New approaches to quantitative immunohistochemistry in breast cancer
Time : 10:00-10:50
Biography:
Hallgeir Rui, MD, Ph.D. is internationally recognized for his research on breast cancer and has a strong track record of leadership, mentoring and collaboration. He is the WBCS Endowed Professor of Breast Cancer Research in the Department of Pathology at the Medical College of Wisconsin (MCW), Milwaukee, WI. He also serves as the Interim Co-Director of the MCW Cancer Center. He earned a medical degree and a doctorate in experimental pathology from the University of Oslo, Norway. His research on growth factor signaling in breast cancer is internationally recognized. He authored or coauthored more than 150 publications that have been cited nearly 8,000 times.
Abstract:
Breast cancer is a heterogeneous disease and there is a great need for individualized treatment. Immunohistochemistry provides valuable spatially resolved marker analysis at the tissue level, which is valuable due to extensive inter tumor and intratumor heterogeneity. Pathologists typically evaluate protein marker expression visually in formalin-fixed paraffin-embedded tumor sections by chromogenic immunohistochemistry. However, pathologist scoring of chromogen staining intensity is subjective, and provide only reduced data that is discrete, either ordinal or nominal (negative/positive). In contrast, digital pathology platforms allow quantification of chromogen or fluorescence signals by computer-assisted image analysis, providing continuous signal intensity values. Fluorescence-based immunohistochemistry (IF-IHC) provides greater dynamic signal range than chromogen-immunohistochemistry. Combined with image analysis software, fluorescence-based immunohistochemistry holds potential for enhanced sensitivity and greater analytic resolution, resulting in more robust quantification. We will show novel and unpublished progress with breast cancer markers related to immune checkpoints, proliferation, and metabolism, incorporating signal intensities at the cell-by-cell level and employing new spatial statistics to extract additional layers of therapy-relevant information. The path toward implementation of objective tumor marker quantification in pathology laboratories will be discussed.
Keynote Forum
Sveta Silverman
University of Alberta, Canada
Keynote: Electron microscopy of tumorous mitochondria in six cases of invasive ductal carcinoma of different biologic subtypes
Time : 11:05-12:00
Biography:
Sveta Silverman began her medical career as a Paediatric Surgeon in the former Soviet Union. After she made Canada as her home in 1991, she broadened her studies and work into the field of Pathology. As a Pathologist, she is really good at finding the root causes of medical problems and also good at finding ways to heal medical conditions.
Abstract:
Background: Breast cancer is the most common cancer among Canadian women (excluding non-melanoma skin cancers). It is the 2nd leading cause of death from cancer in Canadian women. The significance of mitochondria in breast carcinoma is widely recognized but insufficiently researched. This is the first study of electron microscopy of tumorous mitochondria, performed on six cases of human invasive ductal carcinoma of different biologic subtypes.
Methods: 6 cases of invasive ductal carcinoma of different biologic profile (two cases of triple negative, one case of luminal A, two cases of luminal B and one case of Her2-neu positive invasive ductal carcinomas) were reviewed and selected sections were subjected for digital electron microscopy.
Results: All 6 cases revealed abnormal mitochondria with a high degree of mitochondrial heterogeneity. All cases showed an increase in overall mitochondrial numbers and mitochondrial mass. We have shown extreme mitochondrial pleomorphism. Mitochondrial fusion and fission are observed.
Conclusions: This is the first study, performed on samples, obtained from human invasive ductal carcinoma of different biologic subtypes. We have shown that mitochondria in invasive ductal carcinomas not only dysfunctional but display conspicuous alterations in multiple ultrastructural aspects. We have captured the intracellular microenvironment in relations to tumorous mitochondria. All of these changes can be beneficial for future breast carcinoma treatments, whether it is the development of new anti-neoplastic therapeutic modalities or simple lifestyle alterations
Keynote Forum
Vinithasree Subbhuraam
Cyrcadia Health, USA
Keynote: Wearable sensor technology for breast health monitoring
Biography:
Vinithasree Subbhuraam has published 90 journal papers, conference articles, and book chapters, and her work is internationally recognized by her peers as evidenced by more than 3752 citations to her work. She is the Co-Editor of the book Diagnostic and Therapeutic Applications of Breast Imaging published by SPIE, USA, 2012. She is the Associate Editor of the Journal of Medical Imaging and Health Informatics (JMIHI), and an invited reviewer for several international journals such as International Journal Thermal Sciences, IEEE Transactions on Biomedical Engineering, Physical Review, IEEE Transactions on Information Technology in Biomedicine, Artificial Intelligence in Medicine, Computers in Biology and Medicine, Journal of Mechanics in Medicine and Biology, Neural Computing and Applications, and Neurocomputing. She holds M.S. and Ph.D. degrees in Biomedical Engineering from Nanyang Technological University, Singapore, and a bachelor’s degree in Electronics and Communication Engineering from PSG College of Technology, India.
Abstract:
The AprísÔ (iTBraÔ, CyrcadiaÔ) wearable sensor technology for breast health monitoring is a dynamic (time-based) thermal differential detection system, which detects abnormal circadian surface temperature changes such as those reported to be associated with breast cancer. Temperature measurements are sequentially taken over time to determine changes in circadian readings indicative of physiological changes in the breast tissue that may be associated with cancer. The AprísÔ consists of three major components: (1) Temperature Sensors (2) Recording device (3) Software for Analysis. The sensors are embedded in two fabric patches that are placed on the breasts. An associated data recorder gathers and transmits raw data to a mobile phone App which in turn transmits the raw data to a cloud-based proprietary analytic software. The user is expected to wear the patches continuously for 2-24hrs. The results of the analysis are transmitted back to the user or the user’s physician. Pilot clinical studies have indicated that the device is useful to detect abnormalities in all types of breast tissue, irrespective of breast density, with potential application for periodic breast health screening. The device was modified to address findings in the pilot study; clinical studies with the current version of AprísÔ are scheduled to begin in May 2019. AprísÔ is a tissue density independent, radiation-free, compression-free, non-invasive, low cost, early risk indication screening system for breast tissue. Early detection of breast cancer has been reported to include monitoring for dense tissue. The US FDA has announced its focus on dense breast tissue regarding breast cancer monitoring and diagnosis. Early dense breast tissue detection systems like AprísÔ have significant potential diagnostic and prognostic implications in conjunction with additional testing to confirm the presence or absence of breast cancer in consultation with the physician. Circadian changes in temperature could be a potentially excellent secondary diagnostic modality for breast cancer detection. We believe this could have a significant impact on the current practices for breast cancer monitoring and diagnosis.
- Cancer Diagnosis of Breast and monitoring | Breast Cancer Surgery |Breast Cancer and Breast Self Examination | Pervasiveness and Trends of Breast Cancer | Risk Awareness about Breast Cancer
Location: Montreal, Canada
Chair
Vinithasree Subbhuraam
Cyrcadia Health, USA
Session Introduction
Workinesh Daba
Addis Ababa University, Ethiopia
Title: Assessment of knowledge, attitude and practices on breast cancer and breast self examination among female students, school of medicine and health science, Ambo university, Oromiya region, Ethiopia
Biography:
Workinesh Daba Seboka has completed her B.Sc. at the age of 24 from Addis Ababa University, School of Nursing and Midwifery and Masters of Public Health in Reproductive and Family Health from Addis Ababa University School of Public Health. She is a Lecturer at Addis Ababa University College of Health Sciences, School of Nursing and Midwifery. She has six years of work experience and an expert midwife professional.
Abstract:
Background: In Ethiopia, breast cancer is the most common cause of cancer-related mortality and morbidity. Level of knowledge, attitude, and practices of female university students about breast cancer and breast self-examination are not thoroughly examined.
Objective: To assess the knowledge, attitude, and practices on breast cancer and breast self- examination of female students of the school of medicine and health science, Ambo University, 2017.
Methods: Institution based cross-sectional study design was conducted among 204 female students selected from the school of medicine and health science of Ambo University. Excel generated a simple random sampling technique was employed to select the study population using a list of identification card number obtained from university registrar. A self- administered questionnaire was used to collect data on socio-demographic characteristics, knowledge, attitude, and practices. SPSS version 23 was used for data entry and analysis. Descriptive statistics and chi-square tests computed. All p-values <0.05 are set to determine the statistical association.
Result: Majority of the respondents were aged between 20-24 years with mean(±SD) age 21.5(±2.82) years. The largest ethnic group was Oromo (57.2%) and Orthodox (44.8%) was the dominant religion. Though the majority of the respondents (95.3%) had information on breast cancer, nearly half of the respondents do not know its hereditary and curable disease if detected early. About 77% of the respondents cited breast self-examination as a method of early detection of breast cancer. Nearly half of the respondents (49%) had good knowledge score and44.8%oftherespondentshada positive attitude towards breast self-examination. However, only one-third of the respondents had practiced the self-examination. In this study, significant association were observed between knowledge and attitude (χ2 =10.832, df =1, P=0.001), knowledge and practice (χ2 =28.528, df =1, P=0.000), and attitude and practice (χ2 =7.184, df =1, P=0.007).
Layane Duarte e Souza
Université de Montréal, Canada
Title: Carbon nanotube-based ER and HER2 detection in breast cancer by Raman spectroscopy
Biography:
Layane Duarte e Souza is a biologist with a background in breast cancer molecular biology. She has developed her career in breast cancer development and mechanisms of treatment resistance. Currently a Ph.D. student, she uncovers the tumor microenvironment of breast cancer to determine the T lymphocytes landscape in each molecular subtype. This immune population as well the classic breast cancer markers ER, PR and HER2 will be targeted through Raman spectroscopy multiplex imaging (herein described). This way, understanding the immune profile of each subtype will support the safe implementation of immunotherapy for breast cancer patients.
Abstract:
Breast cancer is the most common cancer in Canadian women. Currently, diagnosis is based on immunohistochemistry to identify cells expressing estrogen and progesterone receptor (ER and PR) and human epidermal growth factor receptor 2 (HER2). This strategy targets cancer cells to determine the different molecular subtypes and requires one tissue section per marker. Until now, there is no option to detect all markers in the same section. Hence, determination of infiltrated lymphocytes in the tumor microenvironment is a crucial step to guide immunotherapy in combination with chemotherapy. The single detection would be costly and delay the diagnosis, which impairs the application of tumor landscapes in clinics. The development of simultaneous detection in one tissue section is fundamental to achieve the safe implementation of personalized treatment. Raman spectroscopy imaging emerges as a choice for simultaneous detection of these markers. Raman probes based on single-walled carbon nanotubes (SWCNT) have a unique spectrum, peaks widths of about 2 nm and non-bleaching signal. Each tube (~200nm length, 1.4nm diameter) contains internalized fluorescent dye (β-carotene, sexithiophene) emitting a specific Raman signature. The SWCNT were functionalized with an amine-polyethylene glycol-carboxylic acid (NH2-PEG-COOH) to allow the attachment of antibodies anti-ER and anti-HER2. Immunogold labeling confirmed the attachment of the antibody in the right orientation. Raman probes were used in formalin-fixed paraffin-embedded (FFPE) breast cancer tissues ER+ and HER2+; also in cell lines MCF-7 (ER+) and SKBR-3 (HER2+). IHC results using tissue and cell lines were compared to Raman imaging to evaluate probes sensitivity and specificity. Preliminary results show that anti-ER and anti-HER2 attach in both tissue and cells; however, the Raman signal is weak, compared to IHC. Currently, we are optimizing the Raman probe to obtain a better signal, as well as optimizing the Raman probe incubation with tissues.
Vitalis Ugochukwu Lumanze
Lumanze Clinic, Nigeria
Title: Pervasiveness and trends of breast cancer in Nigeria
Biography:
Vitalis Ugochukwu Lumanze completed his M.Sc. in Medical Microbiology at the age of 29 years from Imo State University, Imo state Nigeria and before that he obtained his MBBS from Nnamdi Azikiwe University (UNIZIK) Awka, Anambra state Nigeria. he practiced for three (3) years Nnamdi Azikiwe University after which he left to establish Lumanze Clinic Ltd. He is the Medical Director of Lumanze Clinic Ltd, a leading hospital based in Lagos state Nigeria. He is currently pursuing a Ph.D. in Pathology with University of Lagos, Lagos state Nigeria.
Abstract:
Background: Worldwide, breast cancer is the commonest cancer in women and characterized by regional variations and late clinical presentation in low and middle-income countries including Nigeria.
Objectives: The purpose of this communication is to highlight the trends of breast cancer in a Nigerian population in a way to assess the effectiveness of various control measures including mammography instituted to control the disease.
Materials and Methods: Data on new cases of breast cancer registered annually at the cancer registry of the hospital over a period of 5-years were obtained and analyzed. Cancer reporting was voluntary hence data were collected by the active search. Sources of information included pathology laboratories, clinics, and wards, etc. Information abstracted on both patients and cancer included age, sex, bases of diagnosis, incidence date, topography, (primary sites), and morphology among others. Breast cancer was coded as C50, using International Classification of Diseases 10th edition (ICD 10th) of the World Health Organization.
Results: There were 568 new cases of breast cancer registered at the cancer registry during the 10-year period, comprising of 7(12.23%) males and 561(98.77%) females. The youngest patient aged 18 years while the oldest was 87 years and the peak age of incidence was the 5th decade. Incidence of breast cancer in male was low and occurred at a relatively older age group. We observed a steady rise in cases of breast cancer at our center.
Conclusion: The steady rise in breast cancer cases in the study population is an indication of inadequate or ineffective control measures to curtail the disease or due to the diversion of global attention to HIV/AIDS and tuberculosis in the country. Therefore there is urgent need to step up activities through a non-governmental agency to promote advocacy, national policy on the training of personnel for clinical and self-breast examination, and nationwide screening program (mammography).
Elhadi Miskeen
University of Bisha College of Medicine, Saudi Arabia
Title: Knowledge, Perception, and Risk Awareness about Breast Cancer among medical students in university of Bisha, Southern Saudi Arabia, 2019
Biography:
Elhadi Miskeen, MD, Assistance Professor of Obstetrics and Gynaecology at University of Bisha College of Medicine, Saudi Arabia. Graduated from University of Gezira faculty of Medicine, Sudan in 2003. Awarded clinical MD in Obstetrics and Gynaecology from Sudan Medical Specialization Board. He has been actively involved in academic and clinical activities. His areas of interest include; safe motherhood and childhood, students support projects, medical education, social accountability, community empowerment, evidence-based medicine, medical education, and public health. He has carried out research and many publications in related fields with prizes and recognitions awarded. He has been involved in reviewing and editing of national and international medical journals with remarkable achievements.
Abstract:
Background: Breast cancer is the most common type of cancer and the primary cause of mortality in women worldwide as well as in Saudi Arabia. Education of women is recommended for early detection and treatment.
Objectives: This study aimed to evaluate the knowledge, perception, and risk awareness about breast cancer among medical students at the University of Bisha, Southern Saudi Arabia.
Methodology: In this institutional-based cross-sectional study 391 medical students from the college of medicine and college of applied sciences were enrolled. The knowledge status was as well as perception were assessed. Likert scale of 1–5 was also employed to rate the responses of participants regarding perception related questions. P<0.05 was considered statistically significant.
Results: The mean age of the respondents was 20.1±1.5 SD. Male was 128 (32.1%) and female were 263 (67.3%). The mean total knowledge score of the students regarding general knowledge, risk factor and symptoms was 70.3%. Majority of the participants 308 (78.8%) believed that woman can enjoy a good quality of life after receiving the treatment for breast cancer. However, only 117 (29.9%) believed that treatments for breast cancer are more helpful to young people. Very few participants 56 (14.3%) believed that breast cancer treatment is embarrassing. However, 124 (31.7%) agreed that the treatment of breast cancer results in the loss of physical beauty. A significant difference in breast cancer knowledge in gender, the male had significantly less knowledge as compared to female (p=0.05).
Conclusion: The curriculum should be updated to increase breast cancer awareness among medical students. Breast cancer awareness campaign with stress the importance of early detection as a part of the social accountability of the university was recommended.
- Coping Strategies of Breast Cancer | Breast Cancer Screening, Monitoring and Diagnosis | Neuropathic pain after surgery- prospective cohort study
Location: Montreal, Canada
Chair
Sveta Silverman
University of Alberta, Canada
Co-Chair
Vinithasree Subbhuraam
Cyrcadia Health, USA
Session Introduction
Ann E. Fonfa
The Annie Appleseed Project, USA
Title: On the path to better diagnosis of health called Prehabilitation- 3 Steps 4 Health
Biography:
Ann E. Fonfa was diagnosed with cancer in January 1993. Thus she is now a 26+ year survivor unable to take chemo, refused radiation, and hormonal therapy, lots of surgeries and many, many natural approaches. She began exploring Integrative Oncology before it was called that. She gathers the evidence around natural cancer strategies, lifestyle issues, and holistic therapies. Small and separate studies demonstrate that lifestyle makes a lot of difference for anyone with cancer at any stage including immediately after diagnosis. Her nonprofit Annie Appleseed Project has been online since June 1999 and has had millions of visits. Board members helped create the concept of 3 Steps 4 Health which is widely distributed as a postcard.
Abstract:
Annie Appleseed Project has been gathering evidence around simple natural steps that can make a big difference in the way people go through cancer treatment. We all agree that there are too much pain and suffering and it can start early on in treatment and sometimes last a very long time. Thus we suggest immediate acceptance and implementation of all 3 Steps. Many epidemiological studies suggest that the Mediterranean diet is an excellent one for health. It is has been shown to reduce cancer risks, heart disease, diabetes, etc. Step 1 of our plan is to eat ONE more fruit and ONE more vegetable each day. We start this so simply because asking people to make huge changes that may benefit their health in many ways, should begin with a step easily taken. Physical activity/movement/exercise has been well studied and shown to be helpful in any stage of cancer, i.e. in treatment and through survivorship, but also shown to improve overall health. Exercise professionals stressed the first 60 minutes a day, then 30 minutes of vigorous physical activity. Lately, studies are showing that just ten minutes daily can make a difference. Step 2 of our plan is to take a walk. Start at ‘your’ level. Stress has been shown to be a major factor in both mental and physical health. It is how stress is handled that seems to matter. Step 3 take 7 deep breaths before bedtime (sleep issues), before treatment or at any time needed.
Navpreet Arora
McGill University, Canada
Title: A contribution of type of surgery towards neuropathic pain after breast cancer surgery- 3-month prospective cohort study
Biography:
Navpreet Arora has passed her BDS (Bachelor of Dental Surgery) in 2008, from India. She has practiced dentistry for 5 years. Interest to explore new things has brought her to Canada. Cancer was always a fascinating field to her. Currently, she is pursuing her M.Sc. in Dental Sciences (Thesis) at McGill University, Montreal. Her study project is related to breast cancer and pain.
Abstract:
A 3-month prospective cohort study was designed to assess the relationship between the type of surgery and chronic neuropathic pain (CNP) after breast cancer surgery (BCS). 238 female breast cancer patients (18 years or older) were recruited from Segal Cancer Centre, Montreal. Information regarding acute post-operative pain, type of surgery, axillary status, anxiety, depression, CNP and DN-4 score was collected. CNP (outcome) was assessed by telephone using Douleur Neuropathique (DN-4) instrument at 3 months of BCS. Linear and logistic regression analyses were used to assess the association between type of surgery and CNP as well as DN-4 score. At three months following BCS, 44 patients (24%) reported CNP. The most frequent symptoms describing this NP were: burning (31%), itching (31%), numbness (24%), pin and needles (24%). The DN-4 score was positively associated with mastectomy (β=0.77, P=0.04). Participants who received mastectomy were almost 2.5 times as likely to present CNP at three months (OR=2.49, P=0.08) in comparison to those who received segmental mastectomy. This likelihood was specific to participants presenting painful cold (OR=21.6, P=0.01) or pins and needles (OR=4.15, P=0.006). This association was not modified by participants age or their emotional status. Results indicate that mastectomy increases the likelihood of DN-4 score, particularly with Pins and needles and painful cold. Knowing mastectomy may increase the CNP risk, we can seek improvements to the clinical protocol to prevent this risk among patients who need to receive this surgery.
Workinesh Daba
Addis Ababa University, Ethiopia
Title: Coping strategies of women with breast cancer seeking care at Black Lion Hospital, Department of Oncology, Addis Ababa, Ethiopia
Biography:
Workinesh Daba Seboka has completed her B.Sc. at the age of 24 from Addis Ababa University, School of Nursing and Midwifery and Masters of Public Health in Reproductive and Family Health from Addis Ababa University School of Public Health. She is a Lecturer at Addis Ababa University College of Health Sciences, School of Nursing and Midwifery. She has six years of work experience and an expert midwife professional.
Abstract:
Background: A diagnosis of breast cancer regardless of the stage can be stressful, impact multiple spheres of life, and disrupt physical status, emotional and spiritual well-being, and personal relationships for the patient and family. In order to adapt, the patient ought to employ certain coping mechanisms.
Objectives: The objective of the study is to assess the coping strategies of women with breast cancer in Black Lion Hospital, oncology department.
Methods: An institutional cross-sectional survey was employed to collect data on coping strategies of women with breast cancer seeking care at Black Lion Hospital, Oncology Department, Addis Ababa Ethiopia from March to April 2016. A structured interviewer-administered questionnaire was used to collect information from study participants. The data collection process was guided by an interviewer to gather information from the study participants. Data coding, entry, and cleaning were accomplished using Epi-Data3.1 after which it was exported to SPSS version 23 for analysis.
Results: The finding of this study showed the most commonly used coping strategies among women with breast cancer seeking care at Black Lion Hospital were self-distraction, planning, behavioral disengagement, and religion. It was found that coping with breast cancer was significantly associated with age less than 49 years which is 5 times more likely than with age greater than 50 years (AOR 4.582; CI95%: 1.532-13.699). Married women were 4 times more likely to cope with breast cancer compared to unmarried women (AOR 3.601; 95%: 1.434-9.044). Being educated secondary school and above is associated 4 times more likely to cope with breast cancer than illiterates.
Conclusion: A diagnosis of breast cancer causes stress to the patient. Predominant coping strategies used were: Self-distraction; planning; behavioural disengagement; and religion. The strategy employed influences adaptation to the diagnosis.