Programma

Background
In up to 72% of HER2-positive invasive breast cancer (IBC), a ductal carcinoma in situ (DCIS) component is present. In patients primarily treated with breast-conserving surgery (BCS), the presence of a DCIS component is associated with a higher rate of positive resection margins. The aim of this nationwide retrospective study was to assess the rate of positive resection margins and prognosis of HER2-positive IBC with versus without a DCIS component, treated with neoadjuvant systemic therapy (NST) and BCS.

Materials and methods
All women diagnosed with HER2-positive IBC treated with NST and BCS, between 2010-2020, were selected from the Netherlands Cancer Registry. Pathology reports were obtained from the Dutch Nationwide Pathology Databank to assess the presence of DCIS and resection margins. Locoregional recurrence (LRR) was defined as a biopsy proven recurrence (in situ/invasive) in the ipsilateral breast and/or regional lymph nodes. Kaplan-Meier analyses were performed to determine locoregional recurrence free survival (LRFS) and overall survival (OS) for patients with IBC+ DCIS versus IBC within 5 years after diagnosis.

Results
In total, 3137 HER2-positive IBC patients were included, of which 1868 with IBC and 1269 with IBC+DCIS. Patients with IBC+DCIS had significantly more often positive resection margins compared to IBC (13.5% versus 5.2%, p<0.001). Overall, 103 patients had a LRR within 5 years after primary diagnosis, 59 (4.6%) in the IBC+DCIS group and 44 (2.4%) in the IBC group. Five-year LRFS was significantly lower in IBC+DCIS compared to IBC (91.3% versus 94.4%, p<0.001, Figure 1). Five-year OS did not significantly differ between IBC+DCIS and IBC (95.1% versus 96.1%, p=0.149, Figure 2).

Conclusion
Patients with HER2-positive IBC+DCIS had a significantly higher rate of positive resection margins, after treatment with NST and BCS, compared to IBC only. Five-year LRFS is lower in IBC+DCIS patients compared to IBC, but OS does not significantly differ.

Background Patients with imaging findings suspicious for breast cancer with axillary lymph node (LN) metastasis, either fine-needle aspiration cytology (FNAC) or core needle biopsy (CNB) is used for pathological confirmation. Differences exist regarding sensitivity, cost and patient impact. LN status is important for treatment decisions and de-escalating studies on omitting surgical LN removal of clinically node negative patients are forthcoming. This demands good LN staging at primary presentation. In this study the use of FNAC and/or CNB for the diagnosis of clinically suspicious breast cancer patients with axillary LN metastasis in the Netherlands is explored.
Methods Data from the year 2019 was retrospectively retrieved from PALGA, the Dutch Pathology Registry. Patients with pathological analysis of the breast and LN were evaluated. Differences between FNAC and CNB of the LN are compared with resection results of the LN.
Results From 7169 patients 36750 pathology reports were retrieved. After analysis of 1571 cases, 975 patients with invasive breast cancer are included. The LN is more often examined via FNAC (n=717 74%) then CNB (n=247 25%) or simultaneous (n=11 1%, excluded from further results). There was insufficient diagnostic material in 13% when using FNAC vs 3% when using CNB. Inconclusive results were given in 4% of FNAC vs 0,4% of CNB. 44% of FNAC were malignant vs 65% of CNB. 140 times repeated sampling of the LN was performed after FNAC (18%) vs 15 times after CNB (4%). In patients without neoadjuvant treatment, LN resection show metastasis (≥N1a) in 23% of benign FNAC cases and 13% of benign CNB.
Conclusion In these days of rising possibilities of neoadjuvant therapy and potentially omitting SN resection, great care should be given to axillary LN status at first presentation. LN examination with CNB to rule out metastasis should be considered with low-threshold in clinically suspicious cases.

Achtergrond:
Er is behoefte aan een nieuwe, minder invasieve borstreconstructie optie voor patiënten die een mastectomie ondergaan in hun borstkanker behandeling. Een borstreconstructie met autologe vettransplantatie (AFT) lijkt hiervoor een nieuwe veelbelovende borstreconstructie methode.

Methode:
De BREAST trial is de eerste multicenter gerandomiseerde klinische studie, die plaatsvond tussen 2 november 2015 en 31 oktober 2021 waarbij de kwaliteit van leven (QoL) onderzocht werd bij patiënten die een totale borstreconstructie met AFT hebben ondergaan in vergelijking met een implantaat gebaseerde reconstructie (IBR).

Resultaten:
In totaal werden 193 vrouwelijke patiënten (gemiddelde [SD] leeftijd, 49,2 [10,6] jaar) van 18 jaar of ouder geïncludeerd die een borstreconstructie wensten, waarvan 91 patiënten in de AFT-groep (gemiddelde [SD] leeftijd, 49,3 [10,3] jaar) en 80 in de IBR-groep (gemiddelde leeftijd, 49,1 [11,0] jaar). In totaal voltooiden 64 vrouwen in de AFT-groep en 68 vrouwen in de IBR-groep de follow-up. In de IBR-groep stopten 18 patiënten met het onderzoek, terwijl in de AFT-groep 6 patiënten hun behandeling voortijdig beëindigden. De BREAST-Q scores waren hoger in de AFT-groep in alle 5 domeinen en significant hoger in 3: tevredenheid met de borsten (verschil, 9,9; P = .002), lichamelijk welzijn: borst (verschil; 7,6; P = .007), en tevredenheid met het resultaat (verschil, 7,6; P = .04). Lineaire mixed-effects regressieanalyse toonde aan dat QoL-verandering in de tijd afhankelijk was van de behandelgroep in het voordeel van AFT. Het gemiddelde (SD) bereikte borstvolume verschilde tussen de groepen (AFT: 300,3 [111,4] mL; IBR: 384,1 [86,6] mL). Er werden geen verschillen in oncologische ernstige bijwerkingen gevonden.

Conclusie:
Deze studie vond een hogere QoL en een toename van QoL-scores in de tijd in de AFT-groep vergeleken met de IBR-groep. Er werd geen bewijs gevonden dat AFT onveilig was.

Primary outcome analysis of the phase 3 SONIA trial (BOOG 2017-03) on selecting the optimal position of cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors for patients with hormone receptor-positive (HR+), HER2-negative (HER2-) advanced breast cancer (ABC)

Objective: The phase-3, randomized, investigator-initiated, nationwide SONIA trial is evaluating the efficacy, safety and cost-effectiveness of CDK4/6 inhibition added to either first- or second-line endocrine therapy in patients with HR+, HER2- ABC who have received no prior systemic therapy for advanced disease.

Rationale: The addition of CDK4/6 inhibitors to endocrine therapy improves progression-free (PFS) and overall survival (OS) in HR+, HER2- ABC. CDK4/6 inhibitors are effective as initial treatment (first-line) and after prior endocrine monotherapy (second-line). First-line use is associated with prolonged toxicity and a steep increase in costs compared to second-line use, but evidence of superiority over use in second-line based on a head-to-head comparison is lacking.

Methods: Pre- and postmenopausal women (N=1050) in 74 Dutch hospitals who received no prior therapy for ABC, with measurable or evaluable disease, WHO performance status 0-2, and adequate organ function were enrolled. (Neo)adjuvant therapy was allowed (disease-free interval after non-steroidal aromatase inhibitor (NSAI) >12 months). Patients were randomized 1:1 to receive strategy A (first-line treatment with a NSAI plus CDK4/6 inhibitor, followed on progression by fulvestrant (F)) or strategy B (first-line treatment with a NSAI, followed on progression by F plus CDK4/6 inhibitor). Choice between one of the available CDK4/6 inhibitors (abemaciclib, palbociclib, ribociclib) was a stratification factor and was left to the discretion of the treating physician. The primary endpoint is time from randomization to second objective disease progression (PFS2), as assessed by local investigators and will be compared using a log rank test and a cox proportional hazards model. Secondary endpoints include OS, safety, quality of life, and cost-effectiveness.

Results: Final results from the event-driven primary endpoint analysis will be presented. The SONIA trial (NCT03425838) is funded by The Netherlands Organisation for Health Research and Development and Dutch Health Insurers.

Biography
Prof. Dr. med.Christiane KatharinaKuhl was born in Bonn, Germany, in 1966. She studied medicine at the University of Bonn, Germany, and did her Ph.D. thesis on 31P MR spectroscopy in patients with mitochondrial encephalomyopathies with “summa cum laude” in 1992. She completed her residency training at the Department of Radiology, University of Bonn, in 1998. She is a board certified radiologist, neuroradiologist and interventional radiologist. She is certified and licensed to training the entire field of Interventional Radiology. She became associate professor in 1999, and full professor of Radiology and vice chairman of the Department of Radiology of Bonn University in 2004. In 2008, she was elected as member of the presidency of Bonn University (Pro-Rektor). In 2010, she joined the Technical University of Aachen (RWTH) to become Chairman and Director of the Department of Diagnostic and Interventional Radiology at the RWTH University Hospital Aachen. RWTH belongs to one of the few “excellence universities” in Germany. Prof. Kuhl is an internationally recognized expert in the field of breast  cancer imaging with a special emphasis in breast MRI. She has a long-standing track record in the diagnosis as well as the interventional treatment of cancer, and authored or co-authored well over 1000 papers and conference abstracts, including several highly-cited landmark papers on the use of MR imaging for breast cancer diagnosis. She served as Principal Investigator of several large single- and multi-institutional clinical trials studies. She has received numerous awards, including e.g. the Mare-Curie-Ring (Holthusen Ring) of the German Roentgen Ray Society, the European Magnetic Resonance Award, the American College of Radiology Imaging Network (ACRIN) award, the Gold Medal of the ISMRM and of the European Society of Breast Imaging. She has been invited to lecture as Visiting Professor in numerous prestigious international institutions, and was invited to hold numerous named lectures at international conferences. She served as member of the working Group on Breast MRI of the United States Health Service’s Office on Women’s Health, Commission on Standards and Accreditation, and on the BI-RADS-Committee of the ACR. She has been elected as member ofLeopoldina,the National Academy of Sciences of Germany. She is Honorary Fellow of the Royal College of Radiologists, and member of a number of international societies such as Radiological Society of North America (RSNA), the American Society of Clinical Oncology (ASCO), the American College of Radiology (ACR), the Society of Breast Imaging (SBI), the European Society of Breast Imaging (EUSOBI), the Society of Cardiovascular and Interventional Radiology (CIRSE).

Biography
Ritse Mann is breast radiologist at the Radboudumc and The Netherlands Cancer Institute. He leads the breast imaging group doing research at both locations, and he is chair of the scientific committee of EUSOBI.

Summary presentation
This presentation will highlight the possibilities as well as the limitations of AI in breast imaging. It will discuss the likely role AI will achieve within breast cancer screening, and also highlight the possibilities in the diagnostic and therapeutic pathway of breast (cancer) patients. AI applications will be discussed for multiple imaging modalities.

Biography
Paul J van Diest studied Medicine, did his PhD and pathology residency at VU University Medical Center in Amsterdam; after obtaining his Board certification (1996) he became Consultant Pathologist, Associate Professor (1999) and full Professor (2001). Since 2003 he is Head of the Department of Pathology at University Medical Center Utrecht, this department has gone fully digital; and at the moment is involved in AI-research. He is Adjunct Professor of Oncology at the Sidney Kimmel Oncology Center at Johns Hopkins, Baltimore, USA, serves on the editorial board of international journals, and has been active in several international societies. He published >900 papers in peer reviewed journals, supervised 87 PhD theses; his H-index is 97.

Samenvatting presentatie
Op een aantal deelgebieden zijn pathologie bepalingen niet optimaal nauwkeurig en reproduceerbaar. Artificiele intelligentie (AI) heeft op meerdere terreinen bewezen van waarde te kunnen zijn en ook in de pathologie is er grote voortgang met het ontwikkelen van algoritmes voor bv het beter vinden, graderen en classificeren van tumor, en interpreteren en kwaliteitscontrole van kleuringen voor therapeutische targets. In deze voordracht zal een overzicht worden gegeven van de stand van zaken betreffende ontwikkeling en implementatie van AI in de mammapathologie.

Biography
Judy C. Boughey, M.D., is a consultant and chair of the Division of Breast and Melanoma Surgical Oncology, Department of Surgery at Mayo Clinic in Rochester, Minnesota.
Dr. Boughey joined the staff of Mayo Clinic in 2006 and holds the academic rank of professor of surgery, Mayo Clinic College of Medicine and Science. Dr. Boughey is recognized with the distinction of the W.H. Odell Professorship in Individualized Medicine.

Dr. Boughey earned her B.A. and M.A. in physiology and her medical M.B. B.Chir. at the University of Cambridge. She was house officer in general surgery at the Norfolk and Norwich Hospital, house officer in general medicine at West Suffolk Hospital, and senior house officer in accident and emergency at the Whittington Hospital in London. She further trained in general surgery residency at Palmetto Health Richland Memorial Hospital at the University of South Carolina. She completed a fellowship in breast surgical oncology at University of Texas M.D. Anderson Cancer Center.

As a surgeon, Dr. Boughey primarily treats patients with breast disease, most commonly breast cancer and also benign breast disease. She is involved with many breast cancer research projects spanning the full spectrum. including benign breast disease and atypia, prophylactic mastectomy, breast imaging, sentinel lymph node surgery and neoadjuvant chemotherapy. Her work has focused on minimizing the extent of surgery for women treated with neoadjuvant chemotherapy and advancing individualized medicine and drug development in breast cancer. Dr. Boughey is principal and co-investigator on multiple research grants funded by the National Institutes of Health and American College of Surgeons Oncology Groups/Alliance for Clinical Trials in Oncology, including three national clinical trials. Dr. Boughey is co-principal investigator of the Breast Cancer Genome-Guided Therapy Study (BEAUTY) at Mayo Clinic evaluating genetic signatures and patient-derived xenografts in the treatment of women with breast cancer being treated with neoadjuvant chemotherapy to advance therapeutic developments for breast cancer.

Dr. Boughey has authored over 375 papers as well as numerous book chapters and regularly presents at national meetings. Her work has been published in prominent peer-reviewed journals. She serves on the editorial board for Current Breast Cancer Reports and holds reviewer responsibilities for multiple scientific publications.

Dr. Boughey serves as chair of the Breast Cancer Disease-Oriented Group in Mayo Clinic Comprehensive Cancer Center, where she also serves on the Cooperative Group Clinical Trials Steering Committee, and she is a member of the Breast Cancer SPORE Executive Committee. She is the program director for the Breast Surgery Fellowship at Mayo Clinic and serves on the Mayo Clinic Medical-Industry Relations Committee.

Dr. Boughey is a fellow of the American College of Surgeons and the American Surgical Association. She is an active member of the Alliance for Clinical Trials in Oncology, vice chair of the Breast Disease Site Working Group of the Society of Surgical Oncology, and chair of the American College of Surgeons Clinical Research Program.

Biography
Astrid Scholten is radiotherapeut-oncoloog, werkzaam in het Antoni van Leeuwenhoek (AVL) in Amsterdam. Zij rondde haar opleiding in het LUMC in 2006 af, en bleef daar tot 2013 als radiotherapeut-oncoloog werken, waarna zij de overstap maakte naar het AVL. Haar aandachtsgebieden zijn het mammacarcinoom en sarcomen. Na haar promotie in 2005, richt haar onderzoek zich vooral op de-escalatie studies bij borstkanker.

Summary presentation
Bij multifocale of multicentrische mammacarcinomen bestaat de chirurgie meestal uit een oncoplastische mammasparende procedure of een ablatie. Welke consequenties heeft dit wanneer er een indicatie is voor postoperatieve radiotherapie?

Biografie
Opgeleid tot plastisch-, reconstructief & handchirurg in het ErasmusMC Rotterdam. Sinds 2018 werkzaam in het Jeroen Bosch Ziekenhuis met als specialisatie de reconstructieve mammachirurgie in het bijzonder de partiele borstreconstructies.

Biography
Prof. Dr. med.Christiane KatharinaKuhl was born in Bonn, Germany, in 1966. She studied medicine at the University of Bonn, Germany, and did her Ph.D. thesis on 31P MR spectroscopy in patients with mitochondrial encephalomyopathies with “summa cum laude” in 1992. She completed her residency training at the Department of Radiology, University of Bonn, in 1998. She is a board certified radiologist, neuroradiologist and interventional radiologist. She is certified and licensed to training the entire field of Interventional Radiology. She became associate professor in 1999, and full professor of Radiology and vice chairman of the Department of Radiology of Bonn University in 2004. In 2008, she was elected as member of the presidency of Bonn University (Pro-Rektor). In 2010, she joined the Technical University of Aachen (RWTH) to become Chairman and Director of the Department of Diagnostic and Interventional Radiology at the RWTH University Hospital Aachen. RWTH belongs to one of the few “excellence universities” in Germany. Prof. Kuhl is an internationally recognized expert in the field of breast  cancer imaging with a special emphasis in breast MRI. She has a long-standing track record in the diagnosis as well as the interventional treatment of cancer, and authored or co-authored well over 1000 papers and conference abstracts, including several highly-cited landmark papers on the use of MR imaging for breast cancer diagnosis. She served as Principal Investigator of several large single- and multi-institutional clinical trials studies. She has received numerous awards, including e.g. the Mare-Curie-Ring (Holthusen Ring) of the German Roentgen Ray Society, the European Magnetic Resonance Award, the American College of Radiology Imaging Network (ACRIN) award, the Gold Medal of the ISMRM and of the European Society of Breast Imaging. She has been invited to lecture as Visiting Professor in numerous prestigious international institutions, and was invited to hold numerous named lectures at international conferences. She served as member of the working Group on Breast MRI of the United States Health Service’s Office on Women’s Health, Commission on Standards and Accreditation, and on the BI-RADS-Committee of the ACR. She has been elected as member ofLeopoldina,the National Academy of Sciences of Germany. She is Honorary Fellow of the Royal College of Radiologists, and member of a number of international societies such as Radiological Society of North America (RSNA), the American Society of Clinical Oncology (ASCO), the American College of Radiology (ACR), the Society of Breast Imaging (SBI), the European Society of Breast Imaging (EUSOBI), the Society of Cardiovascular and Interventional Radiology (CIRSE).

Biography
Dr. Esther Lips is a staff scientist at the Netherlands Cancer Institute (NKI-AVL) in the research group of Prof. Jelle Wesseling, department of Molecular Pathology. She did her training in molecular biology and epidemiology and obtained a PhD on rectal cancer at Leiden University. After a postdoc at the International Agency for Research on Cancer, Lyon, France, she started to work at NKI-AVL. The main aim of her research is to develop prognostic and predictive tests for ductal carcinoma in situ (DCIS) and invasive breast cancer. Using molecular techniques, such as immunohistochemistry, RNAseq and copy number analysis, her team successfully stratified DCIS and breast cancer patients in prognostic subgroups.

Summary presentation
Ductal carcinoma in situ (DCIS) is regarded as a precursor of invasive breast cancer (IBC). Despite treatment, a small fraction (5-10%) of DCIS patients present with invasive disease many years later. A fundamental biologic question is whether the invasive disease recurring in the same breast is a true recurrence or represents new unrelated disease. To address this question, we performed genomic analyses on the initial pure DCIS lesion and paired invasive recurrent tumors in 95 patients. In 75% of the invasive recurrence we saw a clear clonal relationship to the initial DCIS, suggesting that these were true invasive recurrences. However, in 18% we did not observe a shared genetic origin, indicating secondary primary tumors. Our findings show that although DCIS is often the precursor of invasive recurrence, a significant fraction of invasive recurrences are unrelated to the initial DCIS. This knowledge is essential for accurate risk prediction of DCIS treatment for de-escalation strategies and the identification of predictive biomarkers.

Biography
Frederieke van Duijnhoven is a surgical oncologist at the Netherlands Cancer Institute. She is co-PI on the LORD study (watchful waiting in low-risk DCIS), the RT-HYPE study and project leader of the DESCARTES trial (omitting radiotherapy in pCR patients). She is Secretary of the EORTC Breast Cancer Group.

Biography
Dr. T. van Nijnatten is a final-year resident in radiology and nuclear medicine physician with specific focus on breast imaging and nuclear medicine physician at the Maastricht UMC+ hospital. In addition, he is assistant professor at GROW School for Oncology and Reproduction at Maastricht University. His research includes optimization of imaging and diagnostic strategies in breast cancer patients. He is principal investigator of the ongoing REFINE-trial, a multicenter study among fourteen hospitals in the Netherlands that aims to provide an accurate non-invasive axillary staging method based on different imaging modalities (including 18F-FDG PET/CT) and histopathologic information in clinically node positive patients treated with neoadjuvant systemic therapy. Next, in the last few years he performed different studies on the topic 18F-FDG PET in breast cancer, including patients treated with neoadjuvant systemic therapy and 18F-FDG PET/MRI.

Summary presentation
In the Netherlands, 18F-FDG PET/CT is frequently performed in recently diagnosed breast cancer patients prior to treatment. First of all, it is important to verify whether distant metastases are present or not at breast cancer diagnosis. Next, 18F-FDG PET/CT might provide relevant information regarding the number of hypermetabolic axillary lymph nodes in clinically node positive patients in order to de-escalate axillary treatment afterwards. Finally, a recent protocol for 18F-FDG PET/MRI in breast cancer staging has been developed in Maastricht UMC+. According to this proposed imaging protocol, locoregional and distant staging can be performed within a single session by performing 18F-FDG whole body PET/MRI including an integrated breast MRI within a single protocol.

Biography
Judy C. Boughey, M.D., is a consultant and chair of the Division of Breast and Melanoma Surgical Oncology, Department of Surgery at Mayo Clinic in Rochester, Minnesota.
Dr. Boughey joined the staff of Mayo Clinic in 2006 and holds the academic rank of professor of surgery, Mayo Clinic College of Medicine and Science. Dr. Boughey is recognized with the distinction of the W.H. Odell Professorship in Individualized Medicine.

Dr. Boughey earned her B.A. and M.A. in physiology and her medical M.B. B.Chir. at the University of Cambridge. She was house officer in general surgery at the Norfolk and Norwich Hospital, house officer in general medicine at West Suffolk Hospital, and senior house officer in accident and emergency at the Whittington Hospital in London. She further trained in general surgery residency at Palmetto Health Richland Memorial Hospital at the University of South Carolina. She completed a fellowship in breast surgical oncology at University of Texas M.D. Anderson Cancer Center.

As a surgeon, Dr. Boughey primarily treats patients with breast disease, most commonly breast cancer and also benign breast disease. She is involved with many breast cancer research projects spanning the full spectrum. including benign breast disease and atypia, prophylactic mastectomy, breast imaging, sentinel lymph node surgery and neoadjuvant chemotherapy. Her work has focused on minimizing the extent of surgery for women treated with neoadjuvant chemotherapy and advancing individualized medicine and drug development in breast cancer. Dr. Boughey is principal and co-investigator on multiple research grants funded by the National Institutes of Health and American College of Surgeons Oncology Groups/Alliance for Clinical Trials in Oncology, including three national clinical trials. Dr. Boughey is co-principal investigator of the Breast Cancer Genome-Guided Therapy Study (BEAUTY) at Mayo Clinic evaluating genetic signatures and patient-derived xenografts in the treatment of women with breast cancer being treated with neoadjuvant chemotherapy to advance therapeutic developments for breast cancer.

Dr. Boughey has authored over 375 papers as well as numerous book chapters and regularly presents at national meetings. Her work has been published in prominent peer-reviewed journals. She serves on the editorial board for Current Breast Cancer Reports and holds reviewer responsibilities for multiple scientific publications.

Dr. Boughey serves as chair of the Breast Cancer Disease-Oriented Group in Mayo Clinic Comprehensive Cancer Center, where she also serves on the Cooperative Group Clinical Trials Steering Committee, and she is a member of the Breast Cancer SPORE Executive Committee. She is the program director for the Breast Surgery Fellowship at Mayo Clinic and serves on the Mayo Clinic Medical-Industry Relations Committee.

Dr. Boughey is a fellow of the American College of Surgeons and the American Surgical Association. She is an active member of the Alliance for Clinical Trials in Oncology, vice chair of the Breast Disease Site Working Group of the Society of Surgical Oncology, and chair of the American College of Surgeons Clinical Research Program.

Biography
Marcel Soesan was a general oncologist up to 2018 and now treating breast cancer patients only. And even then I could say a general breast cancer oncologist, while I learned in the Antoni van Leeuwenhoek hospital that you can even be a triple negative specialist, a hormone positive specialist, a Her2 specialist or a rarity specialist.

Summary presentation
Since the beginning of the nineties of the former century the breast cancer world is ruled by the dogma, that (neo)adjuvant concurrent chemotherapy and endocrine treatment do not match together. How come? And does it still hold with the nowadays knowledge? We’ll see…

Biography
Shirley Go completed her radiology residency at the AMC in 2004. Since 2005, she has been working as a radiologist at the Medical Center Alkmaar, now known as the Northwest Clinics (NWZ) with a special focus on breast radiology. The NWZ provides much of the care in the upper part of North Holland, including breast pathology. At the NWZ, radiology has traditionally been the gateway to the hospital for breast patients: all patients with breast complaints first visit the Radiology Department. There, the required investigations are carried out and then, if necessary, patients are referred to the Breast Clinic, as the ‘mammapoli‘ in the NWZ is called.
Shirley is also active in breast care outside the hospital. She is a member of the board of the breast cancer expert group of the IKNL (Integral Cancer Centre Netherlands) in Amsterdam. Furthermore, she organises the national breast radiology conference of the NVvR (Dutch Society of Radiology), which also results in a position as a board member of the breast radiology section, the DCBI (Dutch College of Breast Imaging). Another important part of her work is her role as a lecturer, in which she has been teaching residents to become radiologists for more than 10 years.

Summary presentation
Imaging has become an integral part of our diagnostic workflow, but unfortunately not all examinations are always necessary or clinically indicated. When a patient is pregnant, extra attention is needed. Does an examination have clinical implications or not? We are not only dealing with a young woman, but also with the unborn child.

But what is actually true about the harmfulness of radiological examinations? What do we know about the effects of ionising radiation, contrast agents and high-energy studies? The presentation explores these questions and answers. This knowledge is directly applicable in daily practice.

Biografie
Carsten Bakhuis is a PhD-student at the University Medical Center (UMC) Utrecht in the group of prof. dr. Elsken van der Wall (Medical Oncology) and prof. dr. Paul van Diest (Pathology).
Our research focusses on the molecular and genetic composition of breast cancer during pregnancy or shortly after childbirth (Pregnancy-Associated Breast Cancer, PABC). Carsten graduated as BSc in Medicine in 2021 and is currently persuing his Masters’ degree.

Samenvatting presentatie
Every year, between 100 and 200 women in the Netherlands receive a breast cancer diagnosis during pregnancy or shortly after childbirth. Breast cancer during pregnancy (PrBC) or in the postpartum period (PPBC) is often described to be more aggressive and to have a worse prognosis, even when compared to other your breast cancer patients. In this presentation, we will discuss the results of a large nationwide study in the Netherlands on the histopathological and clinical characteristics of PrBC and PPBC.

Biography
Ingeborg Vriens is a medical oncologist from Maastricht UMC+. She is involved in the the treatment of young patients with breast cancer and cancer during pregnancy. Since 2020 she is involved in the Advisoryboard of cancer in pregnancy and since 2022 she is secretary of this board.

Summery presentation
The Netherlands Breast cancer association (BVN) presents the result of a 2 years sructured proces to create a patient driven research agenda by patients. This patient driven research agenda fits in BVN’s future mission:

1. Access to the best (after)care and expertise (national) ​
2. No over- and under-treatment ​
3. Conscious choices through (among other things) time and attention in the care path ​
4. Metastatic breast cancer ​
5. Early detection and hereditary/familial predisposition

In the presention future challenges, like access to medication and patient differentiation (disease and patient preference) will be discussed.

Biography
Marjolein Scholten has been a patient advocate since April 2022 at the Dutch Breast Cancer Foundation. She started her career as a Nurse in 1983. Afterwards she received a master’s degree in Health Policy and Management in 1995 at Erasmus University Rotterdam followed by a post doc course in epidemiology at Amsterdam UMC. Before joining the Breast Cancer Foudation she worked as a senior program manager at ZonMw (the Dutch Reseach Funding Organisation on Health and joined several call steering committee’s. Her mother died at the age of 38 from BC ans she herself was diagnosed with DCIS at age 34. Currently she is member of the scientific advisory board of the Parksinson Patient Organisation. Since COVID she started working as a nurse again on a irregual base in a hospice.

Biografie
Janine Simons is in opleiding tot radiotherapeut-oncoloog in het Erasmus MC en als post-doc onderzoeker betrokken bij de MINIMAX studie. Dit is een landelijke registratie-studie voor patiënten met klinisch klier-positieve borstkanker die behandeld worden met neoadjuvante systemische therapie. Het doel van deze studie is om de verschillende “okselstrategieën” die momenteel in de dagelijkse praktijk worden toegepast te vergelijken op lange termijn uitkomsten, zowel wat betreft overleving als kwaliteit van leven.

Samenvatting presentatie
Het is op dit moment niet duidelijk wat de meest optimale axillaire strategie is na behandeling met neoadjuvante systemische therapie. Dit leidt wereldwijd tot praktijkvariatie. In deze presentatie zal ik ingaan op de huidige praktijkvariatie en op factoren die van belang zijn bij besluitvorming rondom axillaire stadiering en behandeling na neoadjuvante systemische therapie.

Biography
Desirée van den Bongard is a radiation oncologist at the Amsterdam UMC. Her main specialization is treatment of breast cancer patients. Her research topics focus on optimization of radiation treatment aiming to decrease radiotherapy-related morbidity in breast cancer patients to optimize the quality of life after treatment. These topics are single-dose preoperative partial breast irradiation (instead of standard multiple-sessions of postoperative breast irradiation), MR-guided radiotherapy, online adaptive radiotherapy on CT-guided radiotherapy in (recurrent) breast cancer patients. Besides clinical care and research, Desirée is chair of the LPRM (Landelijk Platform Radiotherapie Mammacarcinoom), board member of NABON, member of the steering committee of the Dutch guidelines of breast cancer treatment, member of the BOOG locoregional working group, and faculty member of the ESTRO course Advanced treatment planning.

Summary presentation
Since 2010, radiotherapy fractionation schedules have been shortened from 25(-35) fractions to 15(-22) fractions, according to the results from several international trials. In 2020, an ultra-hypofractionated radiotherapy schedule has been implemented in the Netherlands according to the results from the Fast Forward and partial breast irradiation trials. This has resulted in five fractions in whole/partial breast and post-mastectomy irradiation.

However, in patients with an indication for radiotherapy boost, axillary or internal mammary lymph node irradiation, hypofractionated schedules are still used consisting of 15, and sometimes even 20 or 22 fractions. In addition, several trials are investigating to reduce the number of radiotherapy fractions to one-single dose. In my presentation I will focus on these trends including the future directions of (ultra)hypofractionated radiotherapy.

Biography An-Sofie Verrijssen
An-Sofie Verrijssen completed her residency in 2019 in Maastricht and is currently working as a radiation oncologist at Catharina Hospital in Eindhoven. Her main areas of specialisation are breast, gynaecological, and gastrointestinal cancers. Regarding breast cancer treatments, An-Sofie is involved in external beam radiation treatments as well as intraoperative radiotherapy treatments.

Biography Daphne Jacobs
My name is Daphne Jacobs, currently a radiotherapy resident at the Leiden University Medical Center and Haaglanden Medical Center. I recently successfully defended my PhD thesis on Accelerated Partial Breast Irradiation, which covers results of the APBI study initiated from the Haaglanden Medical Center.

Summary presentation
This presentation summarizes the evolving landscape of partial breast irradiation, starting with the background and rationale for breast intraoperative radiotherapy, followed by an introduction into its newer (and perhaps better?) alternative: accelerated partial breast irradiation. The presentation will cover Accelerated Partial Breast Irradiation, with special focus on Intraoperative Electron Radiotherapy, and how it has evolved and been incorporated in clinical practice throughout the past years.

Biografie
Opgeleid in het Erasmus MC en sinds 2010 werkzaam in VUmc, thans Amsterdam UMC, als internist-oncoloog met specifieke aandacht voor de behandeling van patiënten met borstkanker. Tevens hart voor onderwijs en opleiding in de functie van opleider en Principal Educator.