Search

Introduction: Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors are indicated in the first-line treatment of hormonal receptor positive and HER-2 negative (HR+/HER2- negative) metastatic breast cancer (MBC). Although phase III randomized controlled trials (RCTs) proved their clinical efficacy, they can increase healthcare expenditure. To date, there are no observational studies to validate the clinical findings of the existed RCTs. In addition, only a few pharmacoeconomic evaluations were published regarding the two common CDK4/6 inhibiting agents, palbociclib and ribociclib to evaluate their financial burden. Objectives: To evaluate the clinical efficacy of palbociclib and ribociclib in the local settings in Qatar. Moreover, to conduct a thorough pharmacoeconomic analysis for the two medications and compare them in terms of their cost-effectiveness and cost-utility. Methodology: A retrospective observational study on HR+/HER-2 negative stage IV breast cancer patients receiving palbociclib or ribociclib in Qatar was conducted, followed by a comparative pharmacoeconomic analysis. The primary outcomes were progression-free survival (PFS) and overall-survival (OS). Safety profiles of both medications were also evaluated. Clinical data of all MBC in Qatar were collected from the National Center for Cancer Care and Research (NCCCR) from January 2017 to December 2019 using Cerner ® system. To evaluate the long-term costs-effectiveness, a 10-year within-cycle corrected Markov’s model was developed. The Markov’s model consisted of three main health states: progression-free (PFS), progressed disease (PD), and death. Incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were generated and compared to a three gross-domestic-product (3 GDP) per capita. Model costs were obtained from the department of accounting and finance in the NCCCR, transition probabilities were calculated from individual patient data obtained in the clinical phase, and utilities were summarized from the published literature. Deterministic and probabilistic sensitivity analyses were carried out. Modeling was conducted via TreeAge Pro ® software. Results: There was no statistically significant difference between palbociclib and ribociclib in PFS; median PFS time was 17.85 versus 13.55 months respectively; p> 0.05. Similarly, there was no statistically significant difference in OS (29.82 versus 31.72 months; p>0.05). For the pharmacoeconomic analysis, ribociclib dominated palbociclib in yielding an ICER of - 83,090.88 QAR per life-year gained, and ICUR of -31,868.06 QAR per quality-adjusted life-year gained. The results remained robust in all cases of the deterministic sensitivity analyses suggesting ribociclib is more cost-effective than palbociclib. Taking all combined uncertainties into account, the overall confidence in the base-case conclusion was around 60%. Conclusions: Both treatment strategies have similar efficacy and safety profiles. Nonetheless, ribociclib is a more cost-effective option than palbociclib based on the base-case results and based on the addressed uncertainties related to the model inputs. Citation Format: Nour Hisham Al-Ziftawi, Shereen Elazzazy, Mohammed Fasihul Alam, Asrul Akmal Shafie, Anas Hamad, Salha Bujassoum, Mohamed Izham Ibrahim. Clinical and pharmacoeconomic analyses of CDK4/6 inhibitors use in stage IV breast cancer females in the state of Qatar: A comparative retrospective observational study with cost effectiveness and cost utility analyses [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-16-03.

Background & Aim: Since The emergence of the COVID-19, patients with cancer have been among the most vulnerable patients, as this infection can be severe and mostly requires intensive care therapy. Literature discussing the risk factors and the outcome of these patients in intensive care units (ICU) is accumulating. Our study aims to search for the incidence of COVID-19 infection in cancer patients and analyses their associated comorbidities, possible risk factor for infections, and their outcomes. Methods: Patients with active cancer under treatment and those recently diagnosed with cancer and had confirmed COVID-19 infection requiring ICU admission were included in our study over 8 months, from March to October 2022. Patient demographic data, comorbidities, ICU stay, duration of hospital stay, oxygenation/ventilatory requirements, treatment, secondary bacterial infection, and outcome were collected from the COVID-19 patients' registry in the ICU. Data were entered into the SPSS program version 23, and results were considered statistically significant at p ≤ 0.05. Results: A total of 24 patients with cancer and COVID-19 infection required intensive care therapy. The most common type of malignancy in those patients was solid organ tumor (13 vs. 11 patients), and most of the study sample were males (20/ 83.3%). Seventy-five percent (18 patients) required intubation and invasive ventilation. Twenty-nine percent (7 patients) had secondary bacterial pneumonia and bacteremia. In addition, 70% had septic shock and required vasopressors. Acute kidney injury (AKI) due to rhabdomyolysis (P Overall mortality was 45%.8, there was no significant difference in mortality rate between patients with solid organ tumors and hematological malignancy with COVID-19 infection requiring intensive care therapy (PConclusion: Cancer patients requiring ICU were more prone to develop AKI, rhabdomyolysis, secondary infection, requiring ventilation and prone position, and septic shock. These patients had a significantly high mortality rate and were severely ill, requiring prolonged ventilation and ICU stays.

Background In line with global trends, cancer incidence and mortality may have decreased for specific types of cancer in Qatar. However, the cancer-related burden on patients, healthcare systems, and the economy is expected to expand; thus, cancer remains a significant public healthcare issue in Qatar. Qatar’s free access to cancer care represents a considerable economic burden. Ensuring the best utilization of financial resources in the healthcare sector is important to provide unified and fair access to cancer care for all patients. Experts from the Qatar Oncology Health Economics Expert Panel (Q-OHEP) aimed to establish a consistent and robust base for evaluating oncology/hematology medications; involve patients’ insights to accelerate access to cutting-edge medications; increase the value of cancer care; and reach a consensus for using cost-effective strategies and efficient methodologies in cancer treatment. Methods The Q-OHEP convened on 30 November 2021 for a 3-hour meeting to discuss cancer management, therapeutics, and health economics in Qatar, focusing on four domains: (1) regulatory, (2) procurement, (3) treatment, and (4) patients. Discussions, guided by a moderator, focused on a list of suggested open-ended questions. Results Some of the salient recommendations included the development of a formal, fast-track, preliminary approval pathway for drugs needed by patients with severe disease or in critical condition; and encouraging and promoting the conduct of local clinical trials and real-world observational studies using existing registry data. The Q-OHEP also recommended implementing a forecast system using treatment center data based on the supply/demand of formulary oncology drugs to detect treatment patterns, estimate needs, expedite procurement, and prevent shortages/delays. Furthermore, the panel discussed the needs to define value concerning cancer treatment in Qatar, implement value-based models for reimbursement decision-making such as health technology assessment and multiple-criteria decision analysis, and promote patient education and involvement/feedback in developing and implementing cancer management guidelines. Conclusion Herein, we summarize the first Q-OHEP consensus recommendations, which aim to provide a solid basis for evaluating, registering, and approving new cancer medications to accelerate patient access to novel cancer treatments in Qatar; promote/facilitate the adoption and collection of patient-reported outcomes; and implement value-based cancer care in Qatar.

Lynch syndrome (LS) is the most common cause of hereditary colorectal cancers (CRC) and is associated with an increased risk for ovarian and endometrial cancers. There is lack of knowledge on the epidemiology of LS in the non-Caucasian populations especially in Qatar. The aim of this retrospective study is to explore the prevalence of LS in a selected high-risk cohort in the State of Qatar in addition to investigating the frequency and genotype-phenotype correlation associated with mismatch repair genes pathogenic variants. Retrospective review of medical records of 31 individuals with LS, 20 affected with colorectal cancer and 11 unaffected with family history of cancers, referred from January 2017 until August 2020. The prevalence of LS among affected and unaffected patients is 22% (20/92) and 2.2% respectively. Among affected individuals, MLH1 and MSH2 genes were highly frequent while for unaffected individuals, a recurrent PMS2 pathogenic variant was reported in several related individuals suggesting a tribal effect. This study highlights the epidemiology of LS in high-risk cohort in Qatar which helps to provide recommendations on genetic testing, and personalize surveillance and management programs

Background:Globally, triple-negative breast cancer (TNBC) is responsible for approximately 15% of all invasive Breast cancer and has been typically associated with poor prognosis. Some retrospective studies have suggested a relatively higher incidence of TNBC in the Middle East and North African Arab countries. Nevertheless, there is complete lack of prospective data, on TNBC in the region, including clinico-pathologic characteristics, treatment patterns and disease outcomes. The TRIPOLI study aims to bridge this information gap.Methods:TRIPOLI is an ongoing prospective multinational, disease registry, designed to recruit 700 newly diagnosed TNBC patients, from 15 institutions within 9 Arab countries: Egypt, Jordon, Morocco, Kingdom of Saudi Arabia, Lebanon, Oman, Kuwait, Qatar and Iraq. This interim analysis includes the patients’ characteristics and treatment approaches of the first 449 cases included in the study from December 2017 to September 2019.Results:All the 449 TNBC patients were females, with a median age of 49 years (range 23.8 - 93.6 years). Premenopausal status was reported in 54.7%, while a positive family history of BC was stated in 25.2% of these cases. 0.2% of patients were below normal (BMI 40 years, patients ≤ 40 years were less likely to be obese (39.4% versus 60.6%; p=0.002), more likely to have grade III tumours (62.3% versus 53.5%; p=0.116), more likely to have T3 or T4 tumours (41.4% versus 32.7%; p=0.038).Conclusion:In this interim analysis, Arab women with TNBC had high parity (≥ 3) and high BMI, compared to existing literature based on western population. High tumor grade, younger age and advanced stages at presentation are in line with similar world-wide reports. Younger women in the Arab region (≤40 years) presented with poor prognostic features, which will be further elucidated in subsequent reports. Citation Format: Hamdy A. Azim, Alaa Kandil, Heba El Zawahry, Hikmat Abdel-Razeq, Hesham Elghazaly, Suad Al Kharusi, Manal M. Abdelwahab, Salah Fayaz, Ahmed Saadeddin, Huda A. Alabdulkarim, Rasha Aboelhassan, Hassan Errihani, Tahseen Al Rubai, Salha Bujassoum Al Bader, Nashwa Mohamed Abdel Aziz, Nagi El Saghir, Giulia Attinà, Ahmed Yosry, Mohamed El Leithy, Loay Kassem, Marwan Ghosn. Triple negative breast cancer prospective registry in middle East and Africa (TRIPOLI) study: Interim analysis of the patients’ characteristics [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-65.

Background:Triple-negative breast cancer (TNBC) has a higher rate of early relapse and mortality compared to other types of breast cancer (BC). CCL5 and its signaling pathway have been linked to TNBC. Methods:We characterized variants in CCL5and that of six other CCL5 signaling genes (CCND1, ZMIZ1, CASP8, NOTCH2, MAP3K21 and HS6ST3) among 1,082 unrelated Arab subjects, including 196 TNBC, accessed their association with BC-specific overall survival (OVS) and progression-free survival (PFS), and correlated CCL5 expression with CCL5genotypes. Results: CCND1 rs614367-TTgenotype was highly associated with the TNBC risk (OR = 5.14; P = 0.004) and the rs614367-Tallele was associated with decreased PFS in TNBC. A decreased risk of lymph node metastasis was associated with the MAP3K21rs1294255-C allele, particularly in rs1294255-GC (OR = 0.47; P = 0.001). CCL5variants (rs2107538and rs2280789) were linked to CCL5 serum and mRNA levels. In the TCGA TNBC/Basal-like cohort the MAP3K21rs1294255-G allele was associated with a decreased OVS. High expression of CCL5in breast tumors was significantly associated with an increased OVS in all BC patients, but particularly in TNBC/Basal-like patients. Conclusion:Genetic variation in CCL5 signaling genes may predict not only TNBC risk but also disease aggression. Citation Format: Salha Bujassoum Al-Bader, Jingxuan Shan, David Bedognetti, Lotfi Chouchane. Genetic variants of CCL5 signaling pathway genes in susceptibility and prognosis of triple negative breast cancers in Arab population [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-09-10.

Additional file 9: Correlation of 3 ir-lncRNA signature with immune subpopulations across tumor types. Pearson correlation heatmap between immune cell subpopulation enrichment scores and 3 ir-lncRNA scores.

Additional file 6: Prognostic value of ICR classifier across solid cancers. Forest plot showing HRs for death (overall survival) and corresponding 95%-confidence interval for the continuous ICR score and number of patients for each TCGA cancer cohort and RAQA breast cancer cohort. Significant positive HRs are visualized in blue and significant negative HRs are visualized in red. ICR enabled (HR < 1, p-value < 0.05) cancer types are indicated with orange asterisks and ICR disabled (HR > 1, p-value < 0.05) cancers are indicated with purple asterisks.

Breast cancer largely dominates the global cancer burden statistics; however, there are striking disparities in mortality rates across countries. While socioeconomic factors contribute to population-based differences in mortality, they do not fully explain disparity among women of African ancestry (AA) and Arab ancestry (ArA) compared to women of European ancestry (EA). In this study, we sought to identify molecular differences that could provide insight into the biology of ancestry-associated disparities in clinical outcomes. We applied a unique approach that combines the use of curated survival data from The Cancer Genome Atlas (TCGA) Pan-Cancer clinical data resource, improved single-nucleotide polymorphism-based inferred ancestry assignment, and a novel breast cancer subtype classification to interrogate the TCGA and a local Arab breast cancer dataset. We observed an enrichment of BasalMyo tumors in AA patients (38 vs 16.5% in EA, p = 1.30E − 10), associated with a significant worse overall (hazard ratio (HR) = 2.39, p = 0.02) and disease-specific survival (HR = 2.57, p = 0.03). Gene set enrichment analysis of BasalMyo AA and EA samples revealed differences in the abundance of T-regulatory and T-helper type 2 cells, and enrichment of cancer-related pathways with prognostic implications (AA: PI3K-Akt-mTOR and ErbB signaling; EA: EGF, estrogen-dependent and DNA repair signaling). Strikingly, AMPK signaling was associated with opposing prognostic connotation (AA: 10-year HR = 2.79, EA: 10-year HR = 0.34). Analysis of ArA patients suggests enrichment of BasalMyo tumors with a trend for differential enrichment of T-regulatory cells and AMPK signaling. Together, our findings suggest that the disparity in the clinical outcome of AA breast cancer patients is likely related to differences in cancer-related and microenvironmental features.Other Information Published in: npj Breast Cancer License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1038/s41523-021-00215-x

Additional file 8: Survival curves of 3 ir-lncRNA signature. Overall survival Kaplan-Meier curves in which the 3 ir-lncRNAs signature did not show any significant prognostic value. Dichotomization cutoff of ‘high’ (red) and ‘low’ (cyan) subgroups was based on the optimal cut-off point as determined by a 5-fold cross-validation analysis. Censor points are indicated by vertical lines. P-values were determined by logrank test.

Additional file 1: Mapping of differentially expressed ir-lncRNAs to protein coding genes. (A) Diagram representation of the random walk with restart global propagation network algorithm. (B) Walkscore distribution of protein-coding genes in TCGA-BRCA, with cutoff set at walkscore ≥ 0.01 to generate a ranked list of protein-coding genes in proximity of differentially expressed ir-lncRNAs.

Aim: The aim of the study was to assess patient preference for the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC) in patients with HER2-positive early breast cancer in PHranceSCa (NCT03674112). Materials and methods: Patients who completed neoadjuvant P + H + chemotherapy + surgery were randomised 1:1 to three intravenous (IV) P + H cycles followed by three cycles of PH FDC SC or vice versa (crossover) and then chose subcutaneous (SC) injection or IV infusion to continue up to 18 cycles (continuation). Assessments were via patient and healthcare professional (HCP) questionnaires. Results: One hundred and sixty patients were randomised (cut-off: 24 February 2020); 136 (85.0%, 95% confidence interval: 78.5–90.2%) preferred SC; 22 (13.8%) preferred IV; 2 (1.3%) had no preference. The main reasons for SC preference were reduced clinic time (n = 119) and comfort during administration (n = 73). One hundred and forty-one patients (88.1%) were very satisfied/satisfied with SC injection versus 108 (67.5%) with IV infusion; 86.9% chose PH FDC SC continuation. HCP perceptions of median patient treatment room time ranged from 33.0–50.0 min with SC and 130.0–300.0 min with IV. Most adverse events (AEs) were grade 1/2 (no 4/5s); serious AE rates were low. AE rates before and after switching were similar (cycles 1–3 IV → cycles 4–6 SC: 77.5% → 72.5%; cycles 1–3 SC → cycles 4–6 IV: 77.5% → 63.8%). Conclusion: Most patients strongly preferred PH FDC SC over P + H IV. PH FDC SC was generally well tolerated, with no new safety signals (even when switching), and offers a quicker alternative to IV infusion.

Background: Dysregulated cancer metabolism is associated with acquired resistance to chemotherapeutic treatment and contributes to the activation of cancer survival mechanisms. However, which metabolic pathways are activated following treatment often remains elusive. The combination of chicken embryo tumor models (in ovo) with metabolomics phenotyping could offer a robust platform for drug testing. Here, we assess the potential of this approach in the treatment of an in ovo triple negative breast cancer with doxorubicin. Methods: MB-MDA-231 cells were grafted in ovo. The resulting tumors were then treated with doxorubicin or dimethyl sulfoxide (DMSO) for six days. Tumors were collected and analyzed using a global untargeted metabolomics and comprehensive lipidomics. Results: We observed a significant suppression of tumor growth in the doxorubicin treated group. The metabolic profiles of doxorubicin and DMSO-treated tumors were clearly separated in a principle component analysis. Inhibition of glycolysis, nucleotide synthesis, and glycerophospholipid metabolism appear to be triggered by doxorubicin treatment, which could explain the observed suppressed tumor growth. In addition, metabolic cancer survival mechanisms could be supported by an acceleration of antioxidative pathways. Conclusions: Metabolomics in combination with in ovo tumor models provide a robust platform for drug testing to reveal tumor specific treatment targets such as the antioxidative tumor capacity.

Cancer is a genetic disease which causes alterations in the cell's makeup and replication system leading to uncontrolled growth. Although most cases of cancers are thought to be sporadic and multifactorial in etiology, about 5%–10% of cancers is hereditary and is due to germline mutations in cancer predisposition genes. These hereditary cancers are often (but not always) observed in families with positive family history of the relevant cancer types, and frequently involve features such as young age at diagnosis in addition to specific histopathological features. With the advances in field of genomics and precision medicine, it is now feasible to identify patients at risk of cancer due to hereditary predisposition and offer appropriate genetic counseling, risk‐reducing strategies, and targeted therapies to decrease their risk of developing cancer and/or improve their treatment management based on the identified cancer syndrome. The recognition of several cancer syndromes and the establishment of management guidelines have led to a model, at least in some medical centers, as standardly incorporating cancer genetics as part of the practice of the medical oncology subspecialty (Burke, Daly, et al., 1997; Burke, Petersen, et al., 1997) This article details an example of such a practice in the State of Qatar, including outcomes to date. The National Center for Cancer Care and Research (NCCCR) is the premier and only cancer hospital in the State of Qatar. It is part of Hamad Medical Corporation (HMC), which is the main governmental hospital, and which is dedicated to providing services to cancer patients who require ongoing treatments such as chemotherapy, targeted and hormonal treatment, and immunotherapy in addition to radiotherapy. The NCCCR also treats benign and malignant hematologic disorders and offers bone marrow transplants in addition to palliative care and pain management. Surgical oncology services are delivered in its partner hospital, Hamad General Hospital.

Background: Breast cancer is the most common cancer among women in the State of Qatar. Due to low participation in breast cancer screening (BCS) activities, women in Qatar are often diagnosed with breast cancer at advanced stages of the disease. Findings indicate that low participation rates in BCS activities are significantly related to women’s low level of awareness of breast cancer screening. The objectives of this study were to: (1) determine the factors that influence Qatari women’s awareness of breast cancer and its screening activities: and (2) to find ways to effectively promote breast cancer screening activities among Arabic speaking women in Qatar. Materials and Methods: A multicenter, cross-sectional quantitative survey of 1,063 (87.5% response rate) female Qatari citizens and non-Qatari Arabic-speaking residents, 35 years of age or older, was conducted in Qatar from March 2011 to July 2011. Outcome measures included participant awareness levels of the most recent national recommended guidelines of BCS, participation rates in BCS activities, and factors related to awareness of BCS activities. Results: While most participants (90.7%) were aware of breast cancer, less than half had awareness of BCS practices (28.9% were aware of breast self-examination and 41.8% of clinical breast exams, while 26.4% knew that mammography was recommended by national screening guidelines. Only 7.6% had knowledge of all three BCS activities). Regarding BCS practice, less than one-third practiced BCS appropriately (13.9% of participants performed breast self-examination (BSE) monthly, 31.3% had a clinical breast exam (CBE) once a year or once every two years, and 26.9% of women 40 years of age or older had a mammogram once every year or two years). Awareness of BCS was significantly related to BCS practice, education level, and receipt of information about breast cancer and/or BCS from a variety of sources, particularly doctors and the media. Conclusions: The low levels of participation rates in BCS among Arab women in this study indicate a strong need to increase awareness of the importance of breast cancer screening in Qatari women. Without this awareness, compliance with the most recent breast cancer screening recommendations in Qatar will remain low. An increased effort to implement mass media and public health campaigns regarding the impact of breast cancer on women’s health and the benefits of early detection of breast cancer must be coupled with an enhanced participation of health care providers in delivering this message to Qatar population.

Objectives In the Middle East, Qatar in particular, the incidence of breast cancer has substantially increased in recent years, and is expected to double by 2030. This diagnosis also occurs at a later stage in the disease. Early detection along with proper treatment reduces radical mastectomy and mortality rates, yet only one-third of Arab women in Qatar participate in breast cancer screening (BCS) activities of any sort. Many women in the conservative Qatari society rely on male family members for support and protection. This study investigates the attitudes and perceptions of Arab men in regards to breast cancer screening and what they see as both incentives and barriers to women's participation in BCS activities. Design A qualitative methodology using purposive sampling technique was chosen in order to explore participant's attitudes, beliefs and health-related actions. Individual in-depth interviews with open-ended questions were conducted with 50 Arab men during October 2011 to May 2012. Data collection, analysis, and interpretation occurred simultaneously. NVivo 9, a qualitative data analysis software program was used to organize themes and subthemes. Results It was found that most men understood the importance of regular BCS in early detection of breast cancer. They felt they had an important role in encouraging the women in their lives to participate in BCS activities, but were adamant that any examination must be done by a female health care professional. Few knew details about screening guidelines in Qatar, but most had a basic knowledge of some screening activities. Most indicated an interest in learning more about BC and screening activities in order to better help and inform their female family members. Conclusion Because Arab men perceive that their opinions and support are a major factor influencing female family members' participation in breast cancer screening, it is important that any program instituted to increase such screening participation be aimed at both men and women. More information is needed by both sexes as to the need for and benefits of regular screening activities, the techniques used, and the newly revised guidelines in Qatar. Such a program needs to be introduced in the near future in order to avert, at least partially, the expected doubling in breast cancer cases by 2030 in the Middle East.

Introduction: Breast cancer is both genetically and histopathologically heterogeneous disease. The biological basis for this heterogeneity is unknown, although there are some distinct phenotype-genotype correlations. Approximately 5% to 10% of breast cancer is hereditary and BRCA1 and BRCA2 genes are responsible for the majority of the hereditary cases of breast cancer. According to the existing literature BRCA1 and BRCA2 associated breast cancer, it has been shown that BRCA associated breast cancers have different clinical, histological and immune-phenotypic features. To validate the effect of BRCA 1 or BRCA 2 germ line mutations on breast cancer aggressiveness and its impact on breast cancer clinical and histological features, we compared the histological, molecular status and clinical variables of 32 breast cancer patients with BRCA gene pathogenic mutations carriers and to the histopathological and molecular characteristics of 50 patients affected with breast cancer in the same age group but with no pathogenic mutations or variants of unknown significant (VUS) in either BRCA1 or BRCA2 genes. Methods: A retrospective study was conducted to study breast cancer cases that were evaluated at the hereditary breast and ovarian cancer clinic at the national center of cancer care and research (NCCCR) in the State of Qatar from 2013 to 2015. Review of medical records was conducted to determine the clinical characteristics, the molecular results of BRCA testing and the tumor characteristics from the histopathology reports in addition to a new review of the tumor blocks to update the molecular data of those patients. Results: (82) patients with breast cancer were diagnosed at a young age (50 years of age and younger). (50) patients were BRCA negative and (32) patients were i positive. (22) Patients were found to have BRCA1 pathogenic mutations, (9) patients had BRCA2 pathogenic mutations and (1) patient carried pathogenic mutations in both BRCA1 and BRCA2 genes. Most patients had mutations in the BRCA1 with most mutations being small frame shift deletion or insertion in one or more exons that caused protein truncation. BRCA mutations was detected among women of younger ages. In terms of histopathology, the majority of BRCA associated breast cancers are invasive ductal carcinoma (IDC) detected in 94% with (74%) high nuclear grade 3/3, have a higher number of mitosis and show a high frequency of necrotic areas, and a higher proliferative rate and lymphocytic infiltration. All of these histopathological features point toward a more aggressive tumor type. In terms of immunohistochemical (IHC) tumor markers, triple negative detected in 56.3% accounted for most of the BRCA associated breast cancers. Triple positive accounted for 9.4%, followed by ER PR positive Her2 negative (34.4%) and ER PR negative Her2 positive (0%). Disease staging of all patients with breast cancer is done according to AJCC staging manual. Patients with BRCA pathogenic mutations diagnosed with stage II 60% followed by stage III 26.6% and stage IV14%. Patients with no pathogenic mutations in the BRCA genes also had IDC as being the most common histopathologcal type IDC 58% but also exhibited other type of histopathology such as ductal carcinoma in situ (DCIS) (10%), invasive lobular carcinoma (ILC) (6%), lobular carcinoma in situ (LCI). BRCA negative breast cancers exhibited 2% nuclear grade 3/3 in 36% of cases and high proliferative rate in 31%. Triple negative breast cancers accounted for 17%, triple positive 13%, ER PR positive Her2 negative 44% and ER PR negative Her 2 positive 13%. In terms of disease stage, those with no pathogenic mutations in the BRCA genes mostly had stage I 39% followed by stage II 61%, stag III 29%, and no cases were diagnosed with stage IV. Conclusion: These results suggest that breast cancers associated with BRCA mutations are more likely to be basal sub-type and exhibits more aggressive behavior, particularly in younger age groups and those patients present with a more advanced stage of disease than those with no pathogenic mutations in the BRCA genes who exhibit a less aggressive disease. We will continue to build our database for better characterization of our hereditary breast cancer cases at a clinical and molecular levels and use this information for future development of targeted anti-cancer agents use.

Qatar has one of the highest age-adjusted breast cancer incidences in the Arab world. Although this is much lower than the incidence in the West. Breast cancer incidence in Qatar was 45 per 100,000 in 2003-2007. 53 per 100,000 in 2008-2011. These higher incidence rates in Qatar are mainly due to the growing population. The prevalent age group, between both Qatari and non-Qatari patients, was 40-50 years old. This suggests that the age-specific incidence of breast cancer in Qatari women is shifting more to a pattern usually not seen in Western nations where median age at diagnosis is 61 years of age, moreover the diagnosis is often at advanced stages of breast cancer. These factors, together with reconfirmed evidence of mortality benefit from breast cancer screening trials, led to establishment the first hospital based mammographic breast cancer screening program in Qatar. It uses a distributed model of mammography service. The program accepts eligible asymptomatic women at age between 40-69 years and was launched in 2008. It adopted international standards of breast screening practice and breast cancer detection.

Breast cancer is both genetically and histopathologically heterogeneous disease, the biological basis for this heterogeneity is unknown, although there are some distinct phenotype-genotype correlations. Approximately 5% to 10% of breast cancer is hereditary and BRCA1 and BRCA2 genes are responsible for the majority of hereditary breast cancers. BRCA1 and BRCA2 mutant cells have defects in the DNA repair and chromosomal instability with marked defects in cell division [9]. In the literatures BRCA1 and BRCA2 associated breast cancers have different clinical, histological, immune-phenotypic features [6]. To validate the effect of BRCA 1 or BRCA 2 germ line mutation on breast cancer aggressiveness and on the clinical features, we analyzed, correlate the genotype, and compared histological and molecular status and clinical variables of 31 breast cancer patients with BRCA gene mutations carriers and histopathological and molecular characters of breast cancer in 50 patients affected in the same age group but with no pathogenic mutations or variants of unknown significant (VUS) in either BRCA1 or BRCA2 genes. This is a retrospective study and involved cases assessed on the hereditary breast and ovarian cancer clinic between 2013–2015 at the National Center of Cancer Care and Research (NCCCR) in the State of Qatar.MethodsA retrospective review of medical records was conducted to determine the clinical characteristics, the molecular results of BRCA testing and the tumor characteristics from the histopathology reports in addition to a new review of the tumor blocks. All of the cases were evaluated at the high risk hereditary breast and ovarian cancer clinic at the national center of cancer care and research (NCCCR) in state of Qatar between 2013–2015.Results(81) patients with breast cancers were diagnosed at ages 50 year and below, (50) patients were BRCA negative, and (31) patients were BRCA positive, (21) were BRCA1 mutation carriers, (8) patients were BRCA2 mutation carriers and (2) carried mutations in both BRCA1 and BRCA2 genes. On BRCA1,2 gene sequencing and MLPA the most detected mutation in BRCA gene is small frame shift deletion or insertion in one or more Exons, and protein truncation. In this study age group carriers and non-carriers are young (50 and below) but BRCA mutation detected with higher incidence in younger ages, Histopathology of invasive ductal carcinoma (IDC) was detected in (93.5%) of BRCA gene mutation carriers with (74%) high nuclear grade 3, and a higher proliferative rate were detected in non carriers control group nuclear grade 3 in 36% of cases and high proliferative rate in 31%. Triple negative (48.6%), Triple positive (16%), ER PR positive. Her 2 negative (26%) and ER PR negative Her 2 positive (9.6%) in BRCA carriers. In non carriers TN in 17%, triple positive 13%, ER PR positive Her 2 negative 44%, ER PR negative Her 2 positive 13%.ConclusionThese results suggest that tumors associated with BRCA mutations are more likely to be basal sub type, has more aggressive behavior (invasive, grade 3, Triple negative) affect younger age group, patient presented in more advanced stage further analysis needed to determined clinical outcomes in BRCA positive compare to control, in regards to local and systemic relapse, overall survival. however will continue to build up our data base for better characterization of our hereditary breast cancer cases at clinical and molecular level and use this information for future development of targeted anti-cancer agents use.

Differences in socioeconomic status (SES) such as income levels may partly explain why breast cancer screening (BCS) disparities exist in countries where health care services are free or heavily subsidized. However, factors that contribute to such differences in SES among women living in well resourced Middle East countries are not fully understood. This quantitative study investigated factors that influence SES and BCS of Arab women. Understanding of such factors can be useful for the development of effective intervention strategies that aim to increase BCS uptake among Arab women. Using data from a cross-sectional survey among 1,063 Arabic-speaking women in Qatar, age 35+, additional data analysis was performed to determine the relationship between socioeconomic indicators such as income and other factors in relation to BCS activities. This study found that income is determined and influenced by education level, occupation, nationality, years of residence in the country, level of social activity, self-perceived health status, and living area. Financial stress, unemployment, and unfavorable social conditions may impede women's participation in BCS activities in well resourced Middle East countries.

Breast cancer (BC) is the most common cancer among Arab women. Early detection of breast cancer through regular screening activities, improvement of the quality of screening activities, and enhanced treatment have been found to decrease mortality rates. However, alarmingly low participation rates in breast cancer screening activities have been reported among Arab women. Drawing on the findings of our recent study in Qatar and a comprehensive literature review of studies, in this paper, we recommend several categories of intervention strategies to promote early detection of breast cancer among Arab populations. These include: (1) Providing public education about breast cancer and cancer screening methods; (2) Encouraging primary care physicians to incorporated BC screening recommendations into their daily practice and routine with their female patients; (3) Deliver interventions that minimize cognitive barriers at the individual level; (4) Incorporate access-enhancing strategies; and (5) More intervention and evaluation studies are needed to develop culturally sensitive interventions and assess the cost-effectiveness and long-term sustainability of the intervention programs.

Objectives Breast cancer incidence rates are rising in Qatar. Although the Qatari government provides subsidised healthcare and screening programmes that reduce cost barriers for residents, breast cancer screening (BCS) practices among women remain low. This study explores the influence of socioeconomic status on BCS among Arab women in Qatar. Setting A multicentre, cross-sectional quantitative survey was conducted with 1063 Arab women (87.5% response rate) in Qatar from March 2011 to July 2011. Women who were 35 years or older and had lived in Qatar for at least 10 years were recruited from seven primary healthcare centres and women9s health clinics in urban and semiurban regions of Qatar. Associations between socioeconomic factors and BCS practice were estimated using χ2 tests and multivariate logistic regression analyses. Results Findings indicate that less than one-third of the participants practised BCS appropriately, whereas less than half of the participants were familiar with recent BCS guidelines. Married women and women with higher education and income levels were significantly more likely to be aware of and to practise BCS than women who had lower education and income levels. Conclusions Findings indicate low levels of awareness and low participation rates in BCS among Arab women in Qatar. Socioeconomic factors influence these women9s participation in BCS activities. The strongest predictors for BCS practice are higher education and higher income levels. Recommendations Additional research is needed to explore the impact of economic factors on healthcare seeking behaviours in the Middle Eastern countries that have a high national gross domestic product where healthcare services are free or heavily subsidised by the government; promotion of BCS and intervention strategies in these countries should focus on raising awareness about breast cancer, the cost and benefit of early screening for this disease, particularly among low-income women.

Qatar experience in Standard Breast Cancer Screening Authers: Dr Salha Bujassoum ,Dr Hekmet Bugrein , Dr Reena ALaSSAM , Dr Mufid Elmistiri Abstract Qatar has one of the highest age-adjusted breast cancer incidences in the Arab world. Although this is much lower than the incidence in the West. Breast cancer incidence in Qatar was 45 per 100,000 in 2003-2007.These higher incidence rates in Qatar are mainly due to the growing population. The prevalent age group, between both Qatari and non-Qatari patients, was 40-50 years old. This suggests that the age-specific incidence of breast cancer in Qatari women is shifting more to a pattern usually not seen in Western nations where median age at diagnosis is 61 years of age, moreover the diagnosis is often at advanced stages of breast cancer. These factors, together with reconfirmed evidence of mortality benefit from breast cancer screening trials, led to establishment the first hospital based mammographic breast cancer screening program in Qatar. It uses a distributed model of mammography service. The program accepts eligible asymptomatic women at age between 45 - 69 years and was launched in 2008. It adopted international standards of breast screening practice and breast cancer detection. Methods A retrospective study was conducted to describe the breast cancer screening program in Qatar and to overview the detection rates, positive predictive values and sensitivity and specificity of mammogram. Results Total number of screened women was 4264 with an increasing participation, year by year. Out of these, Qatari patient's accounts for 1145, and non Qatari for 3119. The age group of breast cancer detected cases from screening program (43-51). Total breast biopsies were 82 core, of which 45 were positive of breast carcinomas, (37) invasive ductal carcinoma, (8) noninvasive ductal carcinoma. The Invasive cancer detection rate was 8.2 % The positive predictive value (PPV) was 46%. Sensitivity value has improved from 51% in 2008 to 70% in 2012 as well as specificity value that has increased from 77% in 2008 to 83% in 2012. Conclusion Public acceptance of the breast cancer screening program in Qatar gradually increased and detection rates were acceptable in this part of the world. We have a unique population of multinationals that merits tailored screening tools.

Breast cancer incidence and mortality rates are increasing in the Arab world and the involved women are often diagnosed at advanced stages of breast cancer. This literature review explores factors influencing Arab women’s breast cancer screening behavior. Searched databases were: Medline, PubMed, Cochrane Database of Systematic Reviews, CINAHL Plus, Google Scholar, Index Medicus for WHO Eastern Mediterranean, and Asian Pacific Journal of Cancer Prevention. Breast cancer screening participation rates are low. Screening programs are opportunistic and relatively new to the region. Knowledge amongst women and health care providers, professional recommendation, socio-demographic factors, cultural traditions, beliefs, religious, social support, accessibility and perceived effectiveness of screening influence screening behavior.

Philadelphia chromosome positive ALL and CML have shown remarkable responses to imatinib (Gleevec, STI571) in phase I, II and III studies. However, imatinib has very poor penetration of the blood brain barrier resulting in subtherapeutic levels in the CNS. We present 2 cases of patients treated with imatinib that achieved complete cytogenetic remission within 3 months who subsequently developed CNS relapses while remaining in complete cytogenetic remission on bone marrow examination. Both patients went on to achieve CNS remission following treatment with intrathecal methotrexate and cytarabine.