Report on the Sir Lester Bird Medical Center (SLBMC) Breast Cancer Symposium

The 4^th SLBMC annual breast cancer symposium was a one-day event which drew many participants from the Medical fraternity in Antigua, advocates for breast health and survivors of breast cancer. The event held at the Sandals Grande Resort & Spa in Antigua with the objective of;

1. Providing a platform for upscaling knowledge and skills through discussion and debate among healthcare practitioners who contribute in a multidisciplinary approach towards the care of patients with breast cancer.
2. Enhancing care options to all patients who present with breast cancer
3. Improve the educational armamentarium, thereby facilitating the incorporation of advanced approaches in patient care.

The Medical Director; Dr Albert Duncan in his opening remark reminisced on the journey he started 9 years ago with the mission to modernize surgical principles in breast cancer treatment and the introduction of comprehensive educational component which birthed the yearly symposium. He stated that breast cancer remains the second leading cause of cancer death for women globally and the primary cause for young Black females, highlighting recent U.S. data projecting 310,720 new cases of invasive breast cancer in females, 55,500 non-invasive cases, and 43,200 deaths annually. Expected diagnosis of 2,800 men with invasive breast cancer, resulting in 520 deaths. He noted that Antigua and Barbuda is experiencing a similar trend in case numbers.

Metropolitan University College of Medicine, a Pink Sponsor of the symposium had 6 representatives in attendance including Instructors and Students.

The speakers were drawn from diverse field and included discussions on prostate cancer. The topics included;

1. Evaluation of Breast Mass by Dr Shanele Chase-St.Hill
2. The Common Law Relationship: Breast Cancer and its relation to Gynecological Malignancies delivered by Dr Wayne Quinland, a Gynecological Oncologist
3. Immune Therapy in Breast Cancer by Dr. Theodore Turnquest a Medical Oncologist
4. Management of Lymph Node in Breast Cancer by Dr. Wesley Francis, a Surgical Oncologist
5. Prostate Cancer – A SLBMC View by Dr. Adrian Rhudd

In the first Presentation, Dr. St. Hill began by giving a brief overview of the breast anatomy, and the importance of a detailed history. She also showed some techniques on how to perform an exhaustive physical exam on the breast. Later on, we were reminded about the important imaging studies and the techniques for obtaining tissue diagnosis like fine needle aspiration and core needle biopsy. The presentation ended with a detailed overview on the major breast mass disorders. The major takeaway point from this presentation was that improving breast screening through various methods will greatly increase morbidity and mortality.

The second presentation of the day was given by Dr. Wesley Francis. He spoke about systemic therapy, pathological staging, genetic profiling and immunotherapy as vital parts of breast mass management. He stressed that axillary management in Breast cancer is a staging tool. We went through many different studies like the ACOSOG Z0011 trial, and the AMAROS trial amongst others. The results from this trials led to 2 conclusions: 

1. Axillary Lymph Node Dissection is not absolutely necessary especially when there is early detection
2. The omission of complete Axillary Dissection was non inferior to more extreme survey in patients with clinically node negative breast cancer who had sentinel node micrometastases

The next presentation was Immune therapy in Breast Cancer by Dr Theodore Turnquest

He kicked off this presentation by remind the attendees of the basic fundamentals of the Human Immune system. He then talked about historical breakthroughs in the field of Immunotherapy. He explained that the promise of immunotherapy is no chemotherapy, less toxicity for the patient, and training the Immune system to fight for itself”

He explained that for physicians, the important questions to ask when considering Immunotherapy are the mass receptors and biomarkers, and also if the pathology is hormone driven. We were reminded that Immune checkpoint inhibition is now standard of care in Triple Negative Breast Ca (TNBC)

The final two presentations were given by Dr Wayne Quinland and Dr. Adrian Rhudd. Dr Quinland stressed on the links between Breast Ca and other gynecological cancer. He explained that there are established links between breast cancer and ovarian cancer and new links between breast and endometrial cancer as well.

Dr. Rhudd gave a very detailed presentation on the current state of Prostate Ca in SLBMC and Antigua as a whole. He went through the diagnostic steps for Prostate disease and stressed that the best defense is early detection. In his words, “Detection without clinical presentation is highly correlated with good prognosis”

He also explained that Prostate Ca affects black males more than other races and one of the reasons for increased mortality is due to reduced access to care and genetic differences. He concluded by stressing that going forward, greater impact has to be placed on data-driven decision making

Following the presentations, the question-and-answer session revealed wide interest in immunotherapy and the need to establish a cancer registry for Antigua and Barbuda.

The Governor General of Antigua and Barbuda; His Excellency Sir Rodney Williams in his remark commended the organizers, presenters, and participants for their dedication to enhancing breast cancer care and the commitment to advancing healthcare on the Island.