Christine Obondo

Optimisation of breast MRI compatibility after sentinel node biopsy with paramagnetic tracers

Optimisation of breast MRI compatibility after sentinel node biopsy with paramagnetic tracers

P2-16-11: Role of Proper Patient Counselling in Combination with Effect of Socioeconomic Deprivation on the Rate of Immediate Breast Reconstruction after Mastectomy.

Introduction: current guidelines in the United Kingdom suggest that the possibility of breast reconstruction should be discussed with all patients prior to mastectomy. However, the majority of patients are still treated with mastectomy alone and no reconstruction is carried out. It has also been suggested that women from more deprived areas are less likely to undergo immediate breast reconstruction (IBR). We investigated potential pitfalls in patient counselling and consequent decision making contributing to present IBR rate in combination with the effect of socioeconomic deprivation. Methods: data from 89 consecutive mastectomy patients was prospectively collected in a single centre in Glasgow between August 2010 and March 2011. Each patient was scored for deprivation based on The Scottish Index of Multiple Deprivation. The patients were then divided into two groups: high and low deprivation levels. Consultations about IR and patients’ acceptance of counselling were analysed. For statistical calculations Fischer9s exact test was applied. Results: IBR was offered to 41 (46%) patients, but it was not to 42 (47%) (6 were excluded due to incomplete data). 25 patients accepted IBR, and of those 24 (27%) underwent IBR. 16 of 41 patients refused to undergo IBR due to lack of interest (10), not feeling ready for it (2), preference of delayed procedure (2) and fear of delaying adjuvant therapy (2). Of 42 patients whom IBR was not offered, only 10 were documented in the notes, while there was no reference for discussing reconstruction in 32 (36%) cases. Reasons for not even discussing reconstruction were the following: age (15), co-morbidities (18), locally advanced cancer (2), co-morbidities with age (5), and locally advanced cancer with age (2). As regards to socioeconomic deprivation; 44 (49%) patients were from deprived areas and 39 (44%) from affluent areas. 41 patients were offered IBR and of these 23 (26%) were from affluent areas compared to 18 (20%). Of the 42 patients who were not offered IR, 26 (29%) were from deprived while 16 (18%) from affluent areas (p Conclusions: while none of the reasons for not offering IBR represent absolute contraindication to IBR, decisions about refusal are based mostly on patients’ subjective intuitions. Further, a greater proportion of the patients who were not offered IBR were from more deprived areas, and it seems that patients from affluent areas are more likely to be offered IBR compared to ones from deprived areas. However, confounding factors such as co-morbidities may contribute to the above. We believe, therefore, that detailed counselling about reconstruction of each patient requiring mastectomy is necessary, which is likely to further increase IBR rate. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-11.

The relationship between tumour NF-kB expression, hormone status and survival in primary invasive breast cancer.

CTRC-AACR San Antonio Breast Cancer Symposium: 2008 Abstracts Abstract #4041 Breast cancer is one of the most common and lethal malignancies in the UK. Conventionally, prognosis is based on hormone status, tumours size, grade and lymph node involvement. We have recently observed that NF-kB expression and activation was associated with progesterone receptor (PR) expression irrespective of oestrogen receptor (ER) status in primary invasive breast cancer (Tannahill et al., unpublished observations). The aim of the present study was to examine the relationship between NF-kB, PR and survival in a selected cohort of ER positive tamoxifen treated primary invasive breast cancer. Immunohistochemistry was performed on 372 breast tumours, with full clinicopathological characteristics. Antibodies were directed total NF-kB and NF-kB phosphorylated at serine 536 (phospho NF-kB). Two observers independently scored expression using the weighted histoscore technique, and grouped expression as tertiles. There was a minimum follow-up period of 4.9 years and a median follow-up of 6.8 years. During follow-up 104 patients died, 65 of which died of their disease, 96 patients recurred, 70 of which was while on tamoxifen. Nuclear NF-kB, either total or phosphorylated, expression was not associated with recurrence or survival. However, when the cohort was subdivided into PR positive (n=220) and PR negative tumours (n=140), increased nuclear phospho NF-kB expression was associated with increased recurrence (p<0.05) and increased recurrence on tamoxifen therapy (p<0.05) in PR positive tumours. In contrast, increased nuclear phospho NF-kB expression was associated with decreased recurrence (p<0.05) and decreased recurrence on tamoxifen therapy (p<0.05) in PR negative tumours. The results of the present study suggest that the effect of nuclear expression of phospho NF-kb on outcome in ER positive primary invasive breast cancer is dependent on PR status. The study highlights the importance of patient selection for the evaluation of the use of NF-kb inhibitors in patients with breast cancer. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4041.

The Relationship between Pre-Operative Biomarkers of Inflammation, Clinicopathological Characteristics and Cancer Specific Survival in Early Breast Cancer.

Breast cancer is the second most common malignancy in women. Established prognostic factors include tumour size, grade, nodal involvement, and hormonal receptor status. Recently, the systemic inflammatory response (as evidenced by elevated C-reactive protein and low serum albumin) has been established as an independent predictor of survival in patients with metastatic breast cancer (1). However, the relationship between these systemic inflammatory markers, clinicopathological characteristics and cancer specific survival has not been established in early breast cancer.During the period June 2001 to May 2008, patients with early breast cancer presenting to two hospitals in the West of Scotland were prospectively included into this study (n=959). Preoperative C-reactive protein, albumin and clinico-pathological data were recorded for each patient. The thresholds for normal C-reactive protein and albumin were taken as 43g/l respectively.The median follow-up of the survivors was 4.1yrs. During this period, 93 patients died of their cancer. On multivariate analysis, tumour size (HR 2.03; 95%CI 1.41-2.91, P Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6033.

The relationship between tumour NF-kB expression, hormone status, and clinicopathological factors in primary invasive breast cancer.

Abstract #4038 Breast cancer is one of the most common and lethal malignancies in the UK. Conventionally, prognosis is based on hormone status, tumour size, grade and lymph node involvement. Recently it has been proposed that Nuclear Factor Kappa B (NF-kB) is associated with breast cancer development and progression (1). The aim of the present study was to examine the relationship between NF-kB, hormone status and clinicopathological factors in primary invasive breast cancer.
 Immunohistochemistry was performed on 168 breast tumour sections, with full clinicopathological characteristics. Antibodies were directed against total NF-kB and NF-kB phosphorylated at serine 536 (phospho NF-kB). Two observers independently scored expression using the weighted histoscore technique and grouped tumours as having high or low expression according to the median value.
 Cytoplasmic and nuclear NF-kB expression, either total or phosphorylated did not correlate with grade, size or lymph node involvement. However, nuclear phospho NF-kB expression was inversely associated with Ki67 proliferation index (p Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4038.