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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.

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.

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.

A 45-year-old female developed neurological symptoms and elevated diastolic blood pressure while on bevacizumab (Avastin) and gemcitabine for recurrent carboplatin-resistant high-grade serous ovarian cancer. A brain MRI diagnosed our patient with posterior reversible encephalopathy syndrome. We are discussing her presenting symptoms in this paper as well as the management and the outcome. We emphasize the importance of keeping this rare but very serious complication in all patients receiving bevacizumab.

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.

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.

Background: Breast cancer is the most common cancer among women in the State of Qatar, and the incidence rate is rising. Previous findings indicate women in Qatar are often diagnosed with breast cancer at advanced stages and their participation rates in screening activities are low. Purpose: To investigate within the State of Qatar Arabic women’s knowledge regarding breast cancer and breast cancer screening (BCS) methods and their participation rates in BCS. This paper reports on the results of a cross-sectional survey. Methods: A quantitative, cross-sectional interview survey was conducted with 1,063 Arabic women (Qatari citizens and non-Qatari Arabic-speaking residents), 35 years of age or older, from March 2011 to July 2011. Results: Of the 1,063 women interviewed (87.5% response rate), 90.7% were aware of breast cancer; 7.6% were assessed with having basic knowledge of BCS, 28.9% were aware of breast self-examination (BSE), 41.8% were aware of clinical breast exams (CBE), and 26.9% were aware of mammograms. Of the women interviewed, 13.8% performed BSE monthly, 31.3% had a CBE once a year or once every two years, and 26.9% of women 40 years of age or older had a mammogram once a year or once every two years. Participation rates in BCS activities were significantly related to awareness and knowledge of BCS, education levels, and receiving information about breast cancer, self-examination or mammography from any of a variety of sources, particularly physicians. Conclusions: Study results demonstrate that despite the existent breast cancer screening recommendations, less than one-third of Arabic women living in Qatar participate in BCS activities. Public health campaigns encouraging more proactive roles for health care professionals regarding awareness and knowledge of breast cancer, BCS, and the benefits of early detection of breast cancer will help increase screening rates and reduce mortality rates among Arabic women living in the State of Qatar.

Breast cancer is a public health threat in the State of Qatar. It is the most common cancer and the incidence rate is increasing. It has been found that women often present with breast cancer at advanced stages in Qatar. Early detection of breast cancer is an important prognostic factor and breast cancer screening has been found successful in decreasing mortality rates. The percentage of women in Qatar engaging in screening activities is alarmingly low. A study has been designed to examine barriers and facilitators that are potentially influencing women in participating in breast cancer screening activities. Understanding these barriers and facilitators is essential in order to create a culturally appropriate and effective intervention that can encourage women in Qatar to participate in screening activities. In this paper the background to the study is presented which highlights the magnitude of the breast cancer problem in Qatar and offers the rationale and information for this potentially groundbreaking study.

Background 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, for Qatari and non-Qatari patients, was 40-50 years old. This suggests that the age-specific incidence of breast cancer in Qatari women is unlike the pattern usually seen in Western nations where median age at diagnosis is 61 years, moreover the diagnosis is often at advanced stages of breast cancer. These factors led to establishment the first hospital based (BCSP) in Qatar. It uses a distributed model of mammography service. The program launched 2008, accepts eligible asymptomatic women at ages 40 - 69 years. Methods A retrospective study was done during the period from April 2008 –December 2013. Our aim is to describe our experience of (BCSP) in Qatar and to monitor performance indicators. Our (BCSP) includes an office call and recall as well as triple assessment. We also discuss positive cases in multi-disciplinary meeting. 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 cases was (43-51). Total breast biopsies were 82, 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 (BCSP) in Qatar gradually increased and detection rates are higher than western countries. We’re detecting biologically aggressive tumors at younger age groups. We’ve a unique population and we need to utilize our data and evidence based medicine to guide policy makers and women to make the correct decision towards (BCSP). Citation Format: Salha Bujassoum, Reena Alassam, Hekmat Bugrein, Mufid Elmistiri. Qatar experience of Standard risk breast cancer screening program (BCSP) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-02-05.

18 Background: 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 to 2007.These higher incidence rates in Qatar are mainly due to the growing population. The prevalent age group, for Qatari and non-Qatari patients, was age 40 to 50. This suggests that the age-specific incidence of breast cancer in Qatari women is unlike the pattern usually seen in Western nations where median age at diagnosis is 61 years, moreover the diagnosis is often at advanced stages of breast cancer. These factors led to establishment the first hospital based (BCSP) in Qatar. It uses a distributed model of mammography service. The program launched 2008, accepts eligible asymptomatic women at ages 40 to 69. Methods: Retrospective study was done during the period from April 2008 to December 2013. Our aim is to describe our experience of (BCSP) in Qatar and to monitor performance indicators. Our (BCSP) includes an office call and recall as well as triple assessment. We also discuss positive cases in multidisciplinary meeting. Results: Total number of screened women was 4,264 with an increasing participation, year by year. Out of these, Qatari patient’s accounts for 1,145, and non Qatari for 3,119. The age group of cases was (43 to 51). Total breast biopsies were 82, 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. Conclusions: Public acceptance of (BCSP) in Qatar gradually increased and detection rates are higher than western countries. We’re detecting biologically aggressive tumors at younger age groups. We’ve a unique population and we need to utilize our data and evidence based medicine to guide policy makers and women to make the correct decision towards (BCSP).

Background: Breast cancer is the most common cancer among women in Qatar, incidence rate is rising and it is often diagnosed at advanced stages. Early detection of breast cancer through regular screening activities has been found to decrease morbidity and mortality rates. Although research on breast cancer screening in the Middle East is scarce, low levels of knowledge and poor participation rates have been found to act as barriers towards breast cancer screening activities such as breast self-examination, clinical breast examination and mammography. Various other barriers have been described in the literature. Identification of these potential barriers and facilitators is urgently needed in order to develop culturally appropriate interventions aiming to improve awareness and breast cancer screening participation rates. Objectives: A three-phase research program for which the goals are to (1) Understand breast health issues in Qatar; (2) Identify and implement strategies that assist Arabic women's participation in breast cancer screening activities (3) Evaluate, facilitate and sustain these strategies. Methods: In Phase 1 two studies are conducted. Study 1: this quantitative study examines data from a convenience sample of 1063 Arabic women in Qatar on a cross sectional community based survey. Face to face interviews are used to investigate knowledge, attitudes, practices, barriers and facilitators regarding breast cancer screening activities. Study 2: Using an ethnographic qualitative methodology, this study will capture the complexity and diversity of reasons of health behaviour choices on a purposive sample of 50 women, 50 men and 30 health care providers. Results: Preliminary results from study 1 will be presented. These will include: participation rates of breast cancer screening activities of Arabic women in Qatar such as breast self-examination, clinical breast examination and mammography; levels of knowledge of breast cancer and its screening; identified barriers and facilitators to breast cancer screening as experienced by these women. Conclusion: Combined results will enable development of culturally appropriate intervention strategies to raise awareness and participation rate in breast cancer screening among Arabic women living in Qatar and the Gulf region.

Breast cancer is frequently diagnosed in Arab women living in Qatar. Al Amal Hospital in Doha reported that 20% of cancer cases receiving treatment in 2007 involved the treatment of breast cancer among women. Early detection and treatment can reduce breast cancer morbidity and mortality rates significantly. However, Arab women are often diagnosed at advanced stages of breast cancer. Funded by the Qatar National Research Fund - National Priorities Research Program, we are undertaking a three-phase research program for which the goals are; (1) to understand the breast health experience of Arab women in Qatar, (2) identify and implement strategies that assist women to participate in breast cancer screening activities, and (3) evaluate, facilitate, and sustain the participation of Arab women in breast cancer screening. In phase I of the research program we will conduct two studies. Study 1: This quantitative cross-sectional survey will investigate the participation rate of Arab women in breast cancer screening, their knowledge about breast cancer, barriers and facilitators to participation. Using a structured questionnaire, we will conduct face-to-face interviews with Arab women aged 35 and over in three different cities in Qatar (Doha, Al Wakrah, and Al Khor). Convenient sampling will be used to recruit 753 participants. Descriptive and inferential statistics will be performed using SPSS. Study 2: This qualitative study will gain insight on; 1) how Arabic women view and participate in breast cancer screening activities, 2) how social, cultural, historical, and economic influences affect breast cancer screening for Arab women, the access to screening services, and social support networks in place, and 3) what intervention strategies will increase awareness of early detection and participation in breast cancer screening among Arab women. Purposive sampling will be used. Qualitative in-depth interviews will be individually conducted with Arab women, men, and healthcare providers. Qualitative data analysis will be performed. Although the results are not available at the present time, we will discuss how the information obtained from both the quantitative and qualitative studies will be used to develop culturally appropriate and effective intervention strategies and services to meet the preventative care needs of Arab women living in the State of Qatar with the aim of decreasing the seriousness and prevalence of breast cancer among them.

Background Despite rising breast cancer incidence and mortality rates, breast cancer screening (BCS) rates among women in Qatar remain low. Previous studies indicate the need to better understand the many complex beliefs, values, and attitudes that influence Arab women’s health seeking behavior for the development of culturally appropriate and effective intervention strategies to address breast cancer in the Middle East. This study investigates beliefs, attitudes, and BCS practices of Arabic-speaking women in Qatar. Methods A multicenter, cross-sectional quantitative survey of 1,063 (87.5% response rate) Arabic-speaking female Qatari citizens and non-Qatari residents, 35 years of age or older, was conducted in Qatar from March 2011 to July 2011. Associations between beliefs and BCS practice were estimated using chi-square tests and multivariate logistic regression analyses. Participants who adhered to BCS guidelines (BCS practice = Yes) were compared to those who did not (BCS practice = No). Results In addition to low levels of awareness and low participation rates in BCS, one quarter of the participants stated their doctors talked to them about breast cancer, and less than half of the women interviewed believed breast cancer can be prevented. Women who engaged in BCS practice were more likely to have a doctor who talked to them about breast cancer, to believe they were in good–excellent health, that cancer can be prevented, or that cancer might be hereditary. The majority wanted to know if they had cancer and felt their health care needs were being met. The main reasons given for not planning BCS were lack of a doctor’s recommendation, fear, and embarrassment. Conclusions These findings indicate that a variety of channels (health care providers, media, breast cancer survivors, community leaders) should be utilized to create culturally appropriate breast cancer intervention programs and increased awareness of breast cancer, BCS, and the benefits of early detection of breast cancer. Employment of these measures will reduce breast cancer mortality rates among Arabic-speaking women living in the State of Qatar.