Day 1 :
University of Florida College of Medicine – Jacksonville, USA Shands Jacksonville Breast Health Center, USA
Keynote: Should we use the term “borderline breast disease” instead of low grade ductal carcinoma in-situ in breast core needle biopsy?
Time : 09:15-10:00
Shahla Masood is a Persian born Physician, who currently holds the positions of Professor and Chair of the Department of Pathology at University of Florida College of Medicine – Jacksonville and Chief of Pathology and Laboratory Medicine at UF Health Jacksonville. She is also the Director of the Cytopathology and Breast Pathology Fellowship Training Program and Medical Director of UF Health Breast Center. An internationally recognized expert in breast cancer diagnosis and prognosis, she has fostered the concept of an integrated multidisciplinary approach in breast cancer care, research, and education. She is the Founder and Editor-in-Chief of The Breast Journal, the Founder and past President of the “International Society of Breast Pathology,” the Director of the “Annual Multidisciplinary Symposium on Breast Disease”, and “The Breast Cancer Public Forum”. She is heavily involved in the study of minimally invasive procedures such as fine needle aspiration biopsy and ductal lavage in providing diagnostic and prognostic information in high risk and breast cancer patients.”
During the last several years, increased public awareness, advances in breast imaging and enhanced screening programs have led to early breast cancer detection and attention to cancer prevention. The numbers of image-detected biopsies have increased and pathologists are expected to provide more information with smaller tissue samples. These biopsies have resulted in detection of increasing numbers of high-risk proliferative breast disease and in-situ cancers. The general hypothesis is that some forms of breast cancers may arise from established forms of ductal carcinoma insitu (DCIS) and atypical ductal hyperplasia (ADH) and possibly from more common forms of ductal hyperplasia. However, this is an oversimplification of a very complex process, given the fact that the majority of breast cancers appears to arise de-novo or from a yet unknown precursor lesion. Currently, ADH and DCIS are considered as morphologic risk factors and precursor lesions for breast cancer. However, morphologic distinction between these two entities has remained a real issue that continues to lead to overdiagnoses and overtreatment. Aside from morphologic similarities between ADH and low grade DCIS, biomarker studies and molecular genetic testings have shown that morphologic overlaps are reflected at the molecular levels and raise questions about the validity of separating these two entities. It is hoped that as we better understand the genetic basis of these entities in relation to ultimate patient outcome, the suggested use of the term of “borderline breast disease” can minimize the number of patients who are subjected to overtreatment.
Institut du Sein-Nice Santa Maria, France
Keynote: Autologous fat grafting to the post mastectomy irradiated chest wall - A new way for minimal invasive breast reconstruction: A series of fifty four patients
Time : 10:00-10:45
Kais Razzouk is a Specialist in Women’s Oncology. He is concerned with breast disease, from surgery for benign or malignant diseases to breast reconstruction, is also a Specialist in gynecological cancers, having a global multidisciplinary approach using minimally invasive surgery. Since 2006, he has joined the Haute-Normandie Center for Cancer Research as a Cancer Surgeon. He has been Manager and Advisor in Onco-Gynecology focusing above all on women's cancer care and more particularly breast cancer. He has participated in the development of certain surgical techniques which he applies to breast cancer care. The aim is to minimize the patients’ physical and psychological pains, to preserve their self-image by paying particular attention not only to their cancer results but also the aesthetic side.
The optimization of skin trophicity by lipoﬁlling and its positive impact on the results of secondary prosthetic breast reconstruction led us to perform an autologous fat grafting prior to secondary implant breast reconstruction after mastectomy and radiotherapy. Patients & Methods: All patients were treated at the same center between 2012 and 2015. They all had a total mastectomy and irradiation. They all had one or more sessions of lipoﬁlling prior to breast implant reconstruction. Patients were followed to collect this data: postoperative complications, prosthesis removal, cosmetic result, and tumor recurrences. Fifty-four patients were included in the study. Results: The mean pre-pectoral lipoﬁlling session was 1.1 (1-2). The average volume of fat injected is 150 cc (80-250). The average time between the end of treatment and the ﬁrst session of lipoﬁlling is 20.4 months (3-60). The mean volume of the prosthesis is 400 cc (290-620). The mean followup time is 22 months. No local tumor recurrence was reported. One patient had a cutaneous necrosis after lipoﬁlling. Implant explanation was performed in three cases (5.5%). The mean cosmetic result is 4.7 (3.5-5). Conclusion: Pre-pectoral lipoﬁlling prior to implant breast reconstruction improves the chances of success by optimizing the trophicity of the skin. It signiﬁcantly reduces the risk of prosthesis explanation. Therefore, this protocol allows us to propose a minimal invasive breast reconstruction, with no additional scar and no additional pain
University of Athens, Greece
Keynote: Standards for quality of care in breast cancer treatment: European criteria for certification of breast units and breast surgeons
Time : 10:45-11:30
Ioannis G Papanikolaou has graduated with excellent votation. He was also selected to participate in the two years Post-graduate Programme in Robotic Surgery, Minimally Invasive Surgery and Telesurgery, in the University of Athens, Medical School in Greece. He passed with distinction and was awarded the title of Master of Science. He has completed his PhD on Stem Cells Transplantation in experimental models in the year 2018. He is the author of many publications in international and national journals and has been also selected as reviewer for many journals such as The British Medical Journal, Stem Cells International, Surgical Laparoscopy Endoscopy and Percutaneous Techniques, Journal of Medical Robotics & Computer Assisted Surgery, The European Journal of Obstetrics, Gynecology and Reproductive Biology. He works in the 1st Department of Obstetrics and Gynecology of the University of Athens, Medical School in Greece, in Alexandra Hospital
As the topic of my lecture suggests, I will focus on certif ication criteria of breast units and breast surgeons across Europe, which are crucial issues for the appropriate therapeutic management of breast cancer. The last GLOBOCAN estimates for breast cancer, classify this carcinoma as the most common in the female. Treatment options have changed and modern breast surgery tends to have a more conservative and cosmesis-preserving face. Breast cancer treatment involves many medical specialties and requires deep knowledge, training, expertise and dedication. The European Board for Surgical Qualification gives guidelines on eligibility criteria for involvement in breast surgery defining metrics for operations that a breast surgeon should have performed and defines with precise metrics the numbers of procedures in which a qualified breast surgeon should be involved. Different international societies are involved in education and certif ication of competency in breast surgery. Many authors highlight that treatment of breast cancer in high-volume centers is of crucial importance because it improves five-year survival up to 33%. Furthermore, the number of breast cancer surgeries that a breast surgeon performs per year seems to be an independent prognostic factor for patients’ survival, recurrence and general outcome. For all these reasons, treatment of breast cancer in certified breast units by specialized breast surgeons is mandatory. New techniques of oncoplastic breast-conserving surgery challenge the current armamentarium of therapeutic options, proving excellent cosmetic results with comparable oncological outcome to the standard breast-conserving surgery. Furthermore, oncoplastic techniques improve patients’ satisfaction and quality of life after breast cancer diagnosis. Genetic counselling, psychological support and multimodal treatment from a breast-dedicated team which involves many specialties are mandatory for qualitative standards of care.
There is an urgent need for certified education in breast surgery, not only for breast centers but also for breast surgeons. Dedication is a key principle in breast surgery, because it improves outcomes. Considering high incidence and mortality rates in the global population, current care for breast cancer needs to be based on quality. Breast surgery is a field with which, obstetricians and gynecologists should deal with and begin to be involved in Europe, after an accurate and strict training process which provided final certification
Ewha Womans Cancer Center Hospital for Women, South Korea
Time : 11:30-12:15
Nam-Sun Paik was graduated from School of Medicine, Seoul National University in 1973. Currently, he is the Director of Ewha Womens University Cancer Center for Women, Seoul, Korea. He was the President of Konkuk University Medical Center (2009-2011); Asian Breast Cancer Society (2006-2008); Korean Breast Cancer Society (2001-2003); and the 3rd Asian Breast Cancer Society Congress (2000-2001). He was selected as one of the top 100 Health Professional as of Breast and Stomach Surgical Oncologist, International Biographical center of Cambridge, England (2006). He was also selected as a Man of the Year, International Biographical center of Cambridge, England (2001). In 1986, he started BCS in Korea
Breast cancer is the most common cancer among Korean women, and still shows annual 6.1% increasing. Common causes of breast cancer includes first birth at late age, early menarche and late menopause, hormone replacement therapy, high fat and high calorie diet (BMI↑), alcohol abuse, low physical activity and genetic factors (24,000) in Korea, 2017. The survival rate of breast cancer patients in Korea was much improved with early detection with every two year national screening program and new treatment modalities which includes chemotherapy, radiotherapy, immunotherapy, hormonal therapy, target therapy and multimodality therapy including precision medicine. The five year and 10-year survival was 91.2% and 84.8% respectively. So breast cancer specialists started to consider about patients’ quality of life and developed new surgical technique (oncoplastic surgery) without change of recurrence and survival rates. Breast conserving surgery (BCS) has showed gradually increasing tendency in Korea, currently about 70%, which may be preferable to mastectomy in terms of psychologically and cosmetically. Recently in Korea, we have much considered for oncoplastic surgery. The principles of oncoplastic surgery of the breast are based on complete removal of breast cancer with minimal scarring and producing optimal breast shape and size. It includes careful preoperative planning as part of a multidisciplinary approach and a surgical plan that will result in optimal cancer management and the best possible aesthetic outcome. In some cases, patients were treated with neoadjuvant chemotherapy with or without target therapy for good results. Incidence of breast cancer increases according to improvement of economic status and women’s environmental factors in Korea. So breast cancer specialists should consider not only recurrence and survival rate but also QOL with BCS or oncoplastic surgery
Calvary Health Care, Australia
Keynote: Examining the role of specialist palliative care in geriatric-led care: A knowledge, practice and attitudes survey of geriatricians
Time : 12:45-13:15
Fiona I Runacres is a Palliative Care Specialist, working at Calvary Health Care Bethlehem and Monash Health in Melbourne. As a Clinician, she works in inpatient, consultation and community palliative care services, and within the state-wide progressive neurological disease service at Bethlehem focusing on neuro-palliative care. She enjoys clinical teaching, and holds Adjunct Lecturer appointments with Monash University and The University of Notre Dame. She is an early career Researcher with interests in palliative rehabilitation and models of integrating specialist palliative care.
Background: The global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care (SPC) has been shown to improve overall care and reduce health care costs, how best to provide SPC to older people is important.
Objectives: The aim of the study is to examine the knowledge, attitudes and practices of geriatricians in providing palliative care (PC), and working with SPC services. Specifically, to understand referral practices, experiences, barriers to SPC integration and models for integrated care. And also aim to capture self-reported knowledge, confidence and satisfaction providing PC.
Methods: A prospective cross-sectional study surveying Australasian geriatricians was conducted. This was a voluntary anonymous online survey, distributed to all full members of the Australian and New Zealand Society of Geriatric Medicine.
Results: One hundred and sixty eight (168) completed responses were received, 58.3% were female and 36.6% had over 20 year’s clinical experience. Most (85%) geriatricians reported caring for patients in their last 12-months of life represented a substantial or most of their practice. Geriatricians overwhelmingly believed they should coordinate care (84%), and derived satisfaction from providing PC (95%), and 69% believed all patients with advanced illness should receive concurrent SPC. Regarding PC knowledge, participants scored an average of 13.5 correct answers out of 18. The most poorly answered question related to the themes of psychiatric problems and pain management. Conclusions: Geriatricians enjoy providing generalist PC to their patients, however potential exists for improved collaborations with SPC services, which may aid knowledge and confidence gaps identified in this study and care delivery