A standardized approach to mastitis and breast abscess reduced undesirable practice variation, with sustained improvements in process and patient outcomes.

e12515 Background: Traditionally, breast cancer (BC) is considered human epidermal growth factor receptor-2 (HER2) positive based on HER2 overexpression or amplification (HER2 3+ or ISH positive HER2 2+). However, an emerging subgroup of HER2 negative (HER2 1+ or 2+ and ISH negative) known as HER2-Low is associated with poor prognosis than HER2-normal (HER2 0). Currently, there is an increased interest in developing new drugs targeting HER2-Low BC to improve survival. The fact that BC in young constitutes a significant minority outside the western world but is underrepresented in clinical trials, it is worth conducting a dedicated study of HER2-low in this population to determine whether it affects their outcome. Methods: Confirmed HER2 negative BC patients aged ≤40 diagnosed in 2012-2017 were retrospectively reviewed in two centers in Alexandria, Egypt. Patients were classified as HER2-low (1+, 2+) and HER2-normal. The clinicopathological characteristics and survival outcome were determined and compared. Results: There were five hundred HER2 negative BC patients; 82% were hormone receptor-positive (HR+) vs.18% triple-negative (TNBC). Among the HER2 negative, only 31% were HER2-Low (n = 155), of which 20% was HER2-Low 1+ while 11% was HER2-Low 2+. In comparison, HER2-Low was significantly more HR+ than HER2-normal (89% vs. 79% respectively, p = 0.009). Other tumor characteristics (T-size, nodal status, Ki-67, lymphovascular invasion - LVI, extracapsular extension - ECE) were similar in HER2-Low and HER2-normal. So were the disease-free survival (DFS) and overall survival (OS). Nevertheless, sub-grouping HER2-Low into 1+ and 2+ showed significant differences in tumor characteristics between HER2-normal, HER2-Low 1+, and HER2-Low 2+, in nodal status, tumor stage, ECE, and HR status. Moreover, DFS was significantly lower in HER2-Low 2+ (63.5%) compared to HER2-normal (70%) and HER2-Low 1+ (75%); p = 0.039. Also, the OS was also significantly lower in HER2-Low 2+ compared to HER2-normal, 90% vs 96% respectively, p = 0.023. Conclusions: Our results suggest no significant difference in DFS and OS between HER2-Low and HER2-normal in young BC patients. However, subdividing HER-low into HER2-low 1+ and HER2-Low 2+ better discriminates this group; HER2-Low 2+ had significantly poor DFS and OS and this should be considered in the clinical trials.

Background: Healthcare workers, including oncologists, face a higher potential risk of contracting coronavirus disease 2019 (COVID-19) while managing patients. Moreover, the uncertainty that came with COVID-19 and its associated social stigma may worsen what was already a crisis (burnout) among oncologists. Data are scarce on the impact of COVID-19 on the occupational health and safety of oncologists in low and middleincome countries.Methods: We conducted a cross-sectional survey in February 2021 to evaluate the impact of COVID-19 on practicing oncologists in Alexandria governorate, Egypt. An anonymised self-reporting questionnaire was electronically distributed to 88 participants to collect information on occupational safety at work, the prevalence of COVID-19 among respondents and the impact of COVID-19 on their wellbeing, including perceived burnout and family support.Results: Out of the 88 contacted oncologists, 75% completed the survey. The mean age of participants was 34.79 years (SD ± 10.42), of which 45% were residents, 36% were specialists and 18% were consultants. Most of the oncologists (58% of 66) felt they were not adequately protected against COVID-19. The majority (78% of 66) have managed COVID-19 infected cancer patients, and 76% (out of 66) had experienced COVID-19 like symptoms. A third (n = 21) of the respondents were confirmed COVID-19 infected: 62% of the latter thought they were infected at the workplace, either by a patient or a colleague. The majority of the oncologists (78%) perceived being more overwhelmed or burned out than in the pre-COVID-19 era. Nearly half of the participants (48%) reported their family members and friends had reduced contact with them despite being COVID-19 negative, in fear of being infected. The burnout was significantly higher in those lacking family support than those who had, 52% versus 28% respectively (p = 0.038). Conclusions:One-third of practicing oncologists were diagnosed with COVID-19, and most thought they were infected at the hospital. Occupational safety measures, including Research

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Background: There has been considerable debate on the management of the axilla in breast cancer patients with lymph node metastasis found on sentinel lymph node biopsy (SLNB) following publication of the ACOSOG Z0011 study. This study conclude that axillary lymph node dissection (ALND) does not add any benefit to overall and disease free survival in some patients with positive SLNB. However it is not know if the patient characteristics of this study are transferable to other settings. A previous UK study has suggested that only a minority of patients from an academic specialist centre fit the ASOCOG Z0011 criteria and that the patient populations may not be comparable. The aim of our study was to assess the applicability of the Z0011 study to our patient population of a large District General Hospital in the UK and to what extent it should influence our practice. Methods: The Z0011 eligibility criteria for inclusion in analysis were applied to all patients undergoing SLNB for invasive cancer at West Hertfordshire Breast Unit from 2007–2011. These were: no neo-adjuvant chemotherapy, clinical T1 and T2 tumours, breast conserving surgery followed by whole breast radiotherapy and 1–3 positive nodes on SLNB. Patent characteristics and results were compared using fisher's exact test. Results: In our unit a total of 434 patients underwent SNLB of whom 64(14.7%) met the inclusion criteria of Z0011. Our patient population was comparable to that of Z0011 with regards to lymphovascular invasion, proportion of patients with micro-metastases and those with additional lymph nodes found on completion ALND. Our patients had significantly more T2 tumours. The only other statistically significant difference was in the proportion of estrogen receptor(ER) and progestrogen receptor (PR) positivity. Conclusion: Only a small proportion (14%) of patients undergoing SNLB in our patient population fit the criteria for Z0011. This was a higher proportion than in the previous UK study of this type. Similar to this study we found the proportion of patients with T2 tumours were greater in our patient population compared to Z0011. This is most likely a reflection of this unit not being a screening centre and brings in to question the international generalisability of Z0011. However the only other significant difference in our patients was a lower risk profile in terms of hormone rector positivity with more ER/PR positive and fewer ER/PR negative patients. The implications of Z0011, will in our practice, not make a significant difference to the rate of ANLD. We are however considering changing our patient management based on the result of Z0011 and this current study of our population, to offer no further axillary surgery to patients over 50 with T1 and ER/PR positive tumours who otherwise fit the Z0011 protocol. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-01.