Breast Cancer In Egypt Research Articles

Association between estrogen receptor alpha and aryl hydrocarbon receptor gene polymorphisms in the prognosis of breast cancer in Egypt

Breast cancer is the most malignant tumor among women in the world. Single nucleotide polymorphisms (SNPs) might better predict breast cancer prognosis. PvuII (T/C substitution), XbaI (A/G substitution), and aryl hydrocarbon (AhR) (G/A substitution) were evaluated as possible genetic prognostic factors for breast cancer. The aim of the current study was to assess the relation between PvuII (rs2234693), XbaI (rs9340799), and aryl hydrocarbon receptor gene polymorphisms AhR (rs2066853) in breast cancer prognosis. This was a case-control study that included 120 breast cancer patients classified into two groups. The first group included 60 patients with good prognostic factors, and the second group included 60 patients with poor prognostic factors. Blood samples were taken from all study participants to perform the genotyping assay. We found that positive genotypes of PvuII, XbaI, and AhR polymorphisms were strongly associated with better prognostic factors for breast cancer patients, while negative genotypes of PvuII and XbaI were more and significantly prevalent in poor prognostic breast cancer patients. We conclude that PvuII T/C, XbaI G/A, and AhR G/A alleles may be prognostic for breast cancer progression. ‎

The Landscape of BRCA Mutations among Egyptian Women with Breast Cancer.

Deleterious germline mutations in BRCA1 and BRCA2 genes are associated with a high risk of breast and ovarian cancer. In many developing countries, including Egypt, the prevalence of BRCA1/2 mutations amongwomen with breast cancer (BC) is unknown. We aimed to determine the prevalence of deleterious germline BRCA mutations in Egyptian patients with breast cancer. We report the results of a cohort study of 81 Egyptian patients with breast cancer who were tested for germline BRCA1/2 mutations during routine clinical practice, mostly for their young age of presentation, BC subtype, or presence of family history. In addition, we searched five databases to retrieve studies that reported the prevalence of BRCA1/2 mutation status in Egyptian women with BC. A systematic review of the literature was performed, including prospective and retrospective studies. In our patient cohort study, 12 patients (14.8%) were positive for either BRCA1/2 deleterious mutations. Moreover, 13 (16.1%) patients had a variant of unknown significance (VUS) of BRCA1/2 genes. Twelve studies were eligible for the systematic review, including 610 patients. A total of 19 deleterious germline mutations in BRCA1/2 were identified. The pooled prevalence of BRCA1/2 mutations was 40% (95% confidence interval 1-80%). The reported prevalence was highly variable among the small-sized published studies that adopted adequate techniques. In our patient cohort, there was a high incidence of VUS in BRCA1/2 genes. Accordingly, there is an actual demand to conduct a prospective well-designed national study to accurately estimate the prevalence of BRCA1/2 mutations among patients with BC in Egypt.

The social determinants associated with the advanced stage diagnosis of breast cancer in Egypt in the previous ten years: a single-center quantitative retrospective cohort study

The social determinants associated with the advanced stage diagnosis of breast cancer in Egypt in the previous ten years: a single-center quantitative retrospective cohort study

Presentation and management of female breast cancer in Egypt.

There have been system inefficiencies in the profiling and management of female breast cancer in Alexandria, Egypt. To identify barriers to full implementation of international guidelines for the management of female breast cancer patients. Female breast cancer data were extracted from records of 3 public oncology services in Alexandria, Egypt, from 2007 to 2016 and analysed. A total of 5236 of the available 7125 records were usable. Median age of the patients was 54 years, and the median duration of pre-diagnosis complaint was 3.1 months. Some 522 (31.5%) of the patients had a family history of cancer. For tumour stage, 2527 (55.2%) were early, 1717 (37.6%) were locally advanced, and 331 (7.2%) were at stage IV. Estrogen receptor, progesterone receptor, and HER2 were positive in 3869 (85%), 3545 (78%), and 461 (15.3%) patients, respectively. Chemotherapy started after a median 1.03 months. Adjuvant chemotherapy was given to 3667 (91.7 %) patients and neoadjuvant chemotherapy to 333 (8.3%); 3686 (92.1%) received anthracycline-based combination chemotherapy, and 3613 (86%) received hormonal treatment. One hundred and eighty of 317 eligible patients received Trastuzumab. Local and/or distant recurrence was seen in 1109 (21.2%) patients. In nonmetastatic cases, median overall and disease-free survival were 149.1 and 77.1 months, respectively. In metastatic cases, median progression-free survival was 19.6 months. We observed defects in the record system, there was delay in diagnosis and treatment, and nonadherence to targeted therapy in many patients. Strengthening of national and hospital-based registries is needed in Alexandria, Egypt, with a robust patient navigation system and targeted information, education and communication strategies. Continuous outcomes monitoring and adaptation to implementation needs should be sustained.

Characterisation of Inflammatory Breast Cancer in Egypt

Abstract Background Inflammatory breast cancer is a rare type of breast cancer, with a lower median age at diagnosis than other types of breast cancer. It is known that; the four molecular subtypes are shown in inflammatory breast cancer and they reveal the prognosis. However, no populationbased studies investigated these factors on Egyptian patients. Methods We searched the medical records at Breast Surgery Unit at Ain Shams University Hospitals to identify female patients diagnosed with IBC from July 2007 through June 2017. Data were scored, tabulated and statistically analyzed. Results The median age was 47 years. LNs were affected in all patients. Grade III tumors were higher at younger age. Higher incidence of hormonal negative and HER2 positive tumors with prevalence at younger age group. Conclusions IBC is an aggressive disease affecting Egyptians at younger age with prevalence of hormonal negative, HER2 positive and triple negative subtypes.

Multi Institutional Retrospective Study about Median Survival Outcome for Women with Metastatic Triple Negative and HER2 Positive Breast Cancer in Egypt

Abstract Background Breast cancer is the most common malignant tumor among females around the world. It represents 1.7 million new cases per year and 25% of all types of cancers. Objectives Assessment of median overall survival in most aggressive subtypes of metastatic breast cancer (Triple –Ve and HER2+Ve) & to compare survival of metastatic HER2+Ve breast cancer in group received targeted versus that did not receive. Patient and Methods Multi institutional retrospective study for assessment of median OS in metastatic breast cancer for themost aggressive subtypes (HER2+Ve &Triple-Ve) at Ain Shams University Hospitals and El-Matarya teaching Hospital. Results Seventy-three metastatic breast cancer patients were included (31 Triple-Ve & 42 HER2+Ve) in the period between January 2014 and December 2016 At Ain Shams University Hospitals and El-Matarya teaching Hospital, we found that median OS for Triple negative group is 16 months with (95% CI 8.8- 23.6) , that for HER2+Ve group is 17 months with (95% CI 13.9 – 20.6) & for patients did not receive targeted therapy, median OS is 10 months (95% CI. 4-19.4,P.000). Conclusion From our study,we highlight that metastatic breast cancer patients (HER2+Ve subtype) &received targeted therapy, had the most superior survival outcome. so,targeted therapy must be included in first line treatment.

Breast cancer in Egypt:a review of disease presentation and detection strategies

Carcinoma of the breast is the most prevalent cancer among Egyptian women and constitutes 29% of National Cancer Institute cases. Median age at diagnosis is one decade younger than in countries of Europe and North America and most patients are premenopausal. Tumours are relatively advanced at presentation. The majority of tumours are invasive duct subtype and the profile of hormone receptors is positive for estrogen receptors and/or progesterone receptors in less than half of cases. This overview examines genetic changes, potential and established predictive and prognostic markers and end results of surgery, radiotherapy and systemic therapy for early, locally advanced and metastatic disease stages. Disease presentations common to the region and early detection strategies are presented.

180P Factors associated with late-stage diagnosis of breast cancer among Egyptian women

Tumor stage of breast cancer (BC) crucially determines its prognosis. Detecting BC at earlier stages comes with better prognosis, better response to treatment, and thereby higher survival rates, while diagnosis at late-stages (stage III & IV) has poor outcomes and responsible for the escalating mortality rates from the disease. Late-stage diagnosis of BC is a common problem in limited resources setting. The aim of the study was to understand the underlying factors associated with the late-stage diagnosis of BC in Egypt.

P031 - Physician survey in the treatment of HR+/HER2 − metastatic breast cancer in Egypt

P031 - Physician survey in the treatment of HR+/HER2 − metastatic breast cancer in Egypt

Assessment of Human Papillomavirus Infection and Risk Factors in Egyptian Women With Breast Cancer.

Numerous risk factors for breast cancer (BC) have been identified. High-risk human papilloma virus (HR-HPV) is the etiological agent of cervical cancer and in some cases of head and neck cancer, specifically oropharyngeal cancer, but the role of HR-HPV in evoking neoplasia in BC is still unclear. In this study, all women above the age of 18 visiting the oncology clinic at Al-Azhar university hospital and Ain Shams specialized hospital between the period of February 2017 and March 2018 were invited to participate. We determined the prevalence of HR-HPV genotypes 16, 18, and 31 in breast tissue samples from 72 women with treatment-naïve BC and 15 women with benign breast lesions (BBL) by quantitative real-time PCR (qRT-PCR) and primer sets targeting the E6 and E7 regions. High-risk human papilloma virus DNA was detected in 16 of 72 (22.2%) BC cases (viral load range = 0.3-237.8 copies/uL) and 0 of 15 women with BBL. High-risk human papilloma virus was detected in 14 of 16 (87.5%), 2 of 16 (12.5%), and 0 of 16 (0%) for genotypes 16, 18, and 31, respectively. Forty-three age-matched healthy Egyptian women were enrolled as controls for assessment of local risk factors that can be used to initiate a strategy of BC prevention in Egypt. Assessment of the risk factors demonstrated that low education level, passive smoking, lack of physical activity, family history of cancer, and use of oral contraception were significant risk factors for BC. In conclusion, our results lead us to postulate that HR-HPV infection may be implicated in the development of some types of BC in Egyptian women. In addition, identification of local risk factors can support practical prevention strategies for BC in Egypt.

Validation of Online Prognostication Model that Predicts Survival for Women with Early Breast Cancer in Egypt


 Introduction: Breast Cancer is estimated to be the most common female cancer in Egypt. The decision on adjuvant therapy in early breast cancer is complex and requires many considerations. PREDICT is an online prognostication tool for early breast cancer. It was first revealed in 2011 and it has been widely used. This study aimed to illustrate the applicability of this model on Egyptian patients. Methods: This study included 128 female patients treated for early breast cancer with surgery and adjuvant therapy in Alexandria, Egypt in 2005 to validate the efficacy of PREDICT as an online prognostication model to estimate survival in those patients. Patients’ data were obtained from the archives of the Department of Clinical Oncology, Faculty of Medicine, and the Department of Cancer Management and Research, Medical Research Institute, University of Alexandria, Egypt. Patients’ data were manually entered into the prognostication model and the predicted survival results obtained were compared to the actual survival of study patients. Results: The predicted number of survivors after 5 years in the entire cohort was 125 (97.7%) compared to 123 (96.1%) actual survivors. The difference was 1.6% which was not significant (p= 0.625). The predicted number of survivors after 10 years in the entire cohort was 77 (60.2%) compared to 81 (63.3%) actual survivors. The difference was -3.1% which was not significant (p= 0.671). Conclusion: PREDICT accurately predicts 5-year and 10-year OS in the entire study population. This validates the use of this online model to aid in the decision as regard systemic therapy.

BRCA1 and BRCA2 truncating mutations and variants of unknown significance in Egyptian female breast cancer patients

BackgroundBreast cancer is the most common malignancy among women worldwide and the leading cause of cancer death in economically developing countries. We sought to study the contribution of BRCA1/2 mutations to the burden of breast cancer in Egypt. Patients and methods103 Egyptian female breast cancer patients, unselected for age of onset or family history, were included in the study. Mutational screening of some exons of BRCA1/2 genes was performed using High Resolution Melting analysis followed by direct sequencing of detected variants. ResultsTwenty sequence variants were identified. According to the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) guidelines, 8 variants were classified as pathogenic (Class 5), 1 as likely pathogenic and 11 as variants of unknown significance (Class 3). The pathogenic variants comprised 5 novel frameshift mutations; BRCA1 c.5205delA and BRCA2 (c.3641delT, c.3291dupT, c.3292delA, and c.787dupA) mutations; 1 novel nonsense mutation (BRCA2 c.3280A>T) and 2 previously described missense mutations (BRCA1 c.117T>G, c.110C>A). ConclusionThis study provides the results of our attempt to delineate the genetic aspect of breast cancer among the Egyptian population and emphasizes the necessity of implementing screening strategies for early diagnosis and counseling for breast cancer in Egypt.

Clinical Significance of Immunohistochemical Expression of Neuropeptide Y1 Receptor in Patients With Breast Cancer in Egypt.

Breast cancer (BC) is the most common malignancy in female individuals worldwide. It constitutes about 38.8% of all malignant tumors among Egyptian female individuals. Neuropeptide Y1 receptor (NPY1R) is one of the most abundant peptides in the central and peripheral nervous systems of mammals. It has been found to promote proliferation, vascularization, and stimulate migration in several cell types and tissues and some types of tumor. This the first immunohistochemical study to evaluate the expression of NPY1R in BC and its correlation with clinicopathologic parameters and patient survival. This study included 92 patients with BC. Immunohistochemical staining for NPY1R was done on paraffin-embedded formalin-fixed tissue sections. Statistically significant increases in NPY1R expression was seen in malignant (46/92; 50%) versus non-neoplastic tissue (12/29; 20.7%) (P<0.001). The receiver operating characteristic curve showed that NPY1R is a poor diagnostic test for BC (P<0.001, area under the curve=0.686) in breast tissue. Membranous was the most common pattern of positivity in carcinoma cases (24/46; 52.2%). Statistically significant associations were found between positive NPY1R expression and the presence of metastatic disease (P<0.001), clinical stage (P=0.0003), perineurial invasion (P=0.003), estrogen receptor expression (P=0.004), molecular subtype (P=0.015), Nottingham Prognostic Index risk group (P=0.04), radiotherapy treatment (P=0.01), hormonal treatment (P=0.015), and type of endocrine therapy (P=0.011). Although no significant association was detected between NPY1R-positive and NPY1R-negative cases regarding overall survival and progression-free survival, cases with non-nuclear (membranous+cytoplasmic) expression showed near significantly shorter survival (P=0.063). This study shows that NPY1R was identified in about 50% of malignant BC cases. Its expression correlates with some features of the aggressive disease being associated with metastasis, perineurial invasion, advanced stages, and poor Nottingham Prognostic Index. This suggests a potential prognostic role of NPY1R in BC. Non-nuclear expression of NPY1R seems to be more important in terms of prognosis of BC.

Cost-effectiveness of six months versus 1-year adjuvant trastuzumab in HER2 positive early breast cancer in Egypt

Introduction: Breast cancer is the most prevalent cancer among women in Egypt. Trastuzumab is administered with chemotherapy for patients with HER2-positive advanced breast cancer (HER2 + ve ABC) in the metastatic and adjuvant settings resulting in improved treatment outcomes, and long-term follow-up. Some studies have evaluated whether equivalent outcomes can be achieved with reduced treatment duration. This study evaluates the cost-effectiveness of 6-month versus 1-year trastuzumab treatments from payer perspective over a 10 year time horizon.Methods: A half-cycle corrected Markov model was developed with five mutually exclusive health states; patient with HER2 +ve ABC, disease-free survival (DFS), local or regional relapse, metastatic relapse, and death. A cycle length of 6 months was applied, direct medical costs including cost of treatments, day-care, surgery, health states and follow-up visits were collected, and indirect costs such as lost productivity were not estimated. The transition probabilities and utilities were extracted from published literature, and deterministic sensitivity analyses were conducted.Results: Among the HER2 +ve ABC patient population in Egypt, the total QALYs of the 6-month trastuzumab were estimated to be 2.99 compared with 2.93 for the 1-year trastuzumab which resulted in a difference of 0.06 QALYs. The total costs were EGP 271,647 ($106,947) and EGP 381,248 ($150,097), respectively. These costs yielded an ICER of –109,600 EGP/QALY (–43,149 $/QALY) for the 6-month trastuzumab. The 6-month trastuzumab is a dominant strategy when compared to 1-year trastuzumab, resulting in improved effectiveness at a reduced cost. All analyses results confirmed the dominance of 6-month trastuzumab and our model robustness.Conclusions: This study concluded that 6-month trastuzumab is a cost-effective option when compared to 1-year trastuzumab in patients with HER2 +ve ABC in Egypt. Our findings provide health care decision makers with additional insights to best allocate available resources concurrently with the improvement of the Egyptian patient’s outcomes.

Clinicopathological Study of Breast Cancer in Young Females (Under 40‐Year‐Old)

BackgroundThe average age at presentation of breast cancer in Egypt appears to be a decade earlier than in western countries. Breast cancer is the leading cause of cancer‐related deaths in women under 40 years and survival rates for young women with breast cancer are lower than their older counterparts.Aimwas to assess the clinicopathological characteristics of breast cancer female patients less than 40 years and to compare them with their counterpart above the age of 40 years. In addition, the impact of age as an independent factor on survival was studied.Materials and methodsThis was a retrospective cohort study of an institutional database of all cases of breast carcinoma patients, whom prospectively were followed up during the period from January 2000 to December 2009, performed at Alexandria Main University Hospital, Egypt. After collecting data of breast carcinoma patients; clinicopathological characteristics, chosen management option and disease‐free survival (DFS), as well as overall survival (OS), were compared among the two age groups. Prognostic factors were evaluated for association with DFS and OS.ResultsIt has been found that the number of young patients (≤ 40 years) was 180 (25.4%) while the number of older patients was 529 (74.6%). The age of the patients varied between 21 years and 90 years (mean 47.8). The histopathological assessment showed that the incidence of infiltrated ductal carcinoma (IDC) was higher than the other types in both groups; 641 tumors (91.7 % from the total sample) were IDC; 165 (92.7 %) were in young age group and 476 (91.4 %) in old age group. There was no significant association between the two studied groups in relation to the histopathological types of breast carcinoma. Recurrence rates were significantly higher among young women (49.2%) when compared to older women (30.6%) (p=0.000). Five‐year DFS duration in young women was shorter, the mean follow‐up time of young patients was 44.4 months while in old age group, it was 51.6 months with a hazard ratio of 1.67 (95% CI: 1.117–2.499) greater than old patients, although there was no significant difference between the two groups as regard OS. Multivariate analyses identified larger tumor size, the presence of lymphovascular invasion and young age being ≤ 40 as independent factors associated with poor DFS.ConclusionYounger age (≤ 40 years) at the diagnosis of breast cancer can be considered an adverse prognostic factor for the development of locoregional recurrence or distant metastases.Support or Funding InformationThe study was not fundedThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Immunohistochemical Expression of Cyclooxygenase-2 (COX-2) in Breast Cancer

Background: breast cancer (BC) is the most common type of diagnosed cancers in women. It is still the second leading cause of cancer-related death among women after lung cancer all over the world. Breast cancer is the first of top ten cancers in Egypt. It ranks as the first malignancy affecting females, contributing 30% of all female cancers. It affects 1 in 14 women during their life time. Aim: This study investigated the association between cyclooxygenase-2 (COX-2) expression in female breast cancer versus the expression of ER, PR, as well as its association with other established prognostic indicators like age, tumor size, lymph nodal status, stage, grade, lymphovascular invasion, insitu component and histological subtype, and aims to validate the role of overexpression of COX-2 as a prognostic marker in female patients with breast cancer in Egypt. Results: High significant correlation was found between lymph node metastasis, negative ER and PR cases and COX-2 expression. No significant correlation could be detected between age, tumor size, site, histologic type, grade, insitu component, LVI and COX-2 expression. Conclusion: Cyclooxygenase-2 has poor prognostic parameter in breast cancer, as it is over expressed in majority of breast carcinoma, especially with lymph node metastasis, ER and PR negative hormone receptor.

Significance of Serum Survivin and -31G/C Gene Polymorphism in the Early Diagnosis of Breast Cancer in Egypt

BackgroundBreast cancer is one of the most relevant malignancies among women. Molecular abnormalities in promotor region of survivin gene may account for overexpression of survivin and increased breast cancer risk. This study aimed to explore the potential association between survivin promotor gene -31G/C single nucleotide polymorphism (rs9904341) and its serum level alteration on one hand, and the risk of breast cancer in Egyptian patients on the other hand. It also aimed to assess the usefulness of survivin as an early noninvasive diagnostic biomarker and in breast cancer staging. Patients and MethodsA total of 135 patients with physically and pathologically confirmed breast cancer and 40 unrelated control subjects as well as 40 patients with benign breast mass were recruited from the early detection unit at National Cancer Institute, Cairo University. Genotyping was performed using allelic discrimination probes by real-time quantitative PCR and serum survivin by enzyme-linked immunosorbent assay. ResultsThe minor allele C of -31G/C survivin single nucleotide polymorphism was more frequent in breast cancer patients (19.3%) compared to the control group (7.5%). Furthermore, subjects with the GC + CC genotype were at increased risk of breast cancer compared to the GG genotype of the control group and also the benign group. Moreover, those patients exhibited higher serum levels of survivin compared to GG genotype. There was also significant elevation of serum survivin in different breast cancer stages. ConclusionGenetic variation in -31G/C of the survivin gene may contribute to the disposition of breast cancer in the Egyptian population. Serum survivin alteration played a pivotal role in the pathogenesis of breast cancer.

National Egyptian Model of Breast Cancer Care Project As a Model for Low Resource–Setting Countries to Improve Outcomes From Early Screening Early Treatment

Background: 40% of Egyptians has access to public health system, 60% served by NGOs and private centers. The problem is the late presentation and inadequate access to services due to lack of a structured screening program and awareness. Aim: To present a model of breast cancer (BC) care in low resource setting (LRS) and to assess risk factors for BC in Egypt the high BC incidence country based on registry estimates stating that about 22000 new BC cases will be diagnosed by 2020. Strategy: In Giza region there used to be no mammographic (MMG) reference service. Women with breast symptoms were referred to the NCI, where they were offered the services (diagnosis, treatment). With very long waiting times. Women aged 20 years or older visiting one of the 5 participating centers were evaluated in a cross-sectional study, which included: (1) Data entry form questionnaire of risk factors for breast cancer - including family history of cancer - and presence of breast symptoms, and (2) Breast examination by a trained professional (nurse or medical doctor). All patients with breast complaints or an abnormal physical exam were referred to NCI, MISR Cancer Center, Kasr El Aini, Agouza and Bahia Hospital for further evaluation. Women 40-69 years of age were invited to participate in the screening both actively (digital invitations, Facebook groups, brochures distributed in governmental buildings and WhatsApp groups) and passively (women that attended for any reason to other hospitals in the region are called and delivered brochures and vouchers to join the project). The screening program is based on annual MMG in women between the ages of 40 and 69 years, which are always preceded by physical examination performed by a breast surgeon or a trained nurse. Program: Close control of the frequency of visits using a simple computer program with patient listing and reminder. The close contact and continuous feedback that helped adherence to the screening program. The proposal of the project includes the performance of all clinical, imaging and pathology exams, as well as clinical visits and surgical treatment, in the same center in the shortest time and the highest standards of care. The health care approach is multidisciplinary, including nurses, breast surgeons and a nutritionist. Outcomes: High rate of compliance is the main strength of project, achieved by patient education about the importance of the screening, intense contact with the primary trained staff, with provision of lists of patients who should come next visits. Free transportation for women with very low income is arranged. Every 3-4 months, we established jointly a charity workshops and projects of handmade cloths and bags for BCPs and encouraged social clubs and societies to adopt parties and to host educational BC advocacy campaigns. What was learned: A simple project is successful and its cost-effectiveness is balanced in Egypt as a developing country where the mortality associated with this disease is very high.

National Egyptian Model of Breast Cancer Care

Purpose Forty percent of Egyptians have access to the public health system, and 60% are served by nongovernmental organizations and private centers. A problem exists, however, with the late presentation and inadequate access to services because of a lack of a structured screening program and awareness. The aim of this work was to present a model of breast cancer (BC) care in a low-resource setting and to assess risk factors for BC in Egypt, which has a high incidence of BC on the basis of registry estimates that indicate that approximately 22,000 new BC cases will be diagnosed by 2020. Methods In the Giza region, there was no mammographic reference service. Women with breast symptoms were referred to the National Cancer Institute, where they were offered services—diagnosis and treatment—with long wait times. Women age 20 years or older visiting one of the five participating centers were evaluated in a cross-sectional study, which included a data entry form questionnaire of risk factors for BC, including a family history of cancer, and the presence of breast symptoms, and breast examination by a trained professional—nurse or medical doctor. All patients with breast complaints or an abnormal physical exam were referred to the National Cancer Institute, MISR Cancer Center, Kasr El Aini, Agouza, and Bahia Hospital for additional evaluation. Women age 40 to 69 years were invited to participate in the screening both actively (digital invitations, Facebook groups, brochures distributed in governmental buildings, and WhatsApp groups) and passively (women who visited other hospitals in the region for any reason were called and delivered brochures and vouchers to join the project). The screening program was based on annual mammographies in women age 40 to 69 years, which are always preceded by physical examination by a breast surgeon or trained nurse. Close control of the frequency of visits was kept using a simple computer program with patient listing and reminder. Close contact and continuous feedback that helped adherence to the screening program. The proposal of the project includes the performance of all clinical, imaging, and pathology exams, as well as clinical visits and surgical treatment, in the same center, in the shortest time, and with the highest standards of care. The health care approach is multidisciplinary and includes nurses, breast surgeons, and a nutritionist. Results A high rate of compliance is the main strength of project. We achieved this with patient education on the importance of screening, intense contact with the primary trained staff with the provision of patient lists of those who should be screened next, and free transportation for women with low income. Every 3 to 4 months, we established jointly a charity workshop and projects of handmade cloths and bags for patients with BC and encouraged social clubs and societies to host parties and educational BC advocacy campaigns. Conclusion A simple project was successful and its cost effectiveness is balanced in Egypt as a developing country where mortality associated with BC is high. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

Study of prognostic and predictive factors in locally advanced breast cancer in Egypt

Objective We aimed to evaluate the prognosis in locally advanced breast cancer (LABC), and the efficacy of neoadjuvant chemotherapy in inducing pathological response in LABC. Background Despite efforts at early detection, LABC remains a clinical challenge, as distant metastasis develops in most patients, and they will experience disease relapse and eventual death. Patients and methods To study the hematoxylin and eosin-stained slides of pretreatment and post-treatment specimens and correlate them with prognostic and predictive factors. Results LABC in Egypt showed poor prognostic factors such as a high proportion of the cases have a large tumor size (46%) and axillary lymph node (LN) metastasis (87%) and younger age at time of presentation (median = 53 year). These results indicate a more aggressive biology of LABC in Egypt compared with the same group in developed countries. Negative preoperative LN predicts complete response in postoperative LN. Prolonged survival was observed within the triple-negative (P = 0.004) and progesterone receptor negative groups (P = 0.02). The disease-free survival was shortened in positive lymphovascular invasion (P = 0.04) and high histologic grade (0.03). Conclusion LABC in Egypt showed poor prognostic outcome. Triple-negative and progesterone-negative cases that received neoadjuvant therapy showed significant prolonged survival.