Sunday 6th - Tuesday 8th November 2022
Cutlers Hall, Sheffield
Speakers
Please scroll down to view the speakers information for Monday and Tuesday Speakers.
Linda Moy, M.D
Dr Moy is a professor of radiology at New York University. She is the senior deputy editor for Radiology and the deputy editor of breast imaging for Radiology. Her research focuses on diagnostic oncologic imaging with an emphasis on breast cancer. She is a National Institutes of Health–funded investigator with applications on multiparametric breast MRI and artificial intelligence. She collaborates with the New York University (NYU) Center for Data Science to investigate deep learning tools for multitask learning across modalities.
Pascal Baltzer
Pascal A.T. Baltzer is a consultant radiologist and associate professor at the Department of Biomedical Imaging and Image-guided Therapy at the Medical University of Vienna Vienna, Austria. He holds the Austrian screening certificate and is an active breast radiologist including reporting of >2500 breast MRI per year. His enthusiasm for breast imaging started when he entered radiology as PhD student of the late Dr. Werner A. Kaiser, one of the early pioneers of breast MRI and has since then a clinical and scientific focus on this method. He has published >250 articles and has contributed to several books and other publications. Dr. Baltzer serves as the Editor in Chief of the European Journal of Radiology, the secretary general of the EUSOBI, the steering board of the Medical Imaging Cluster of the Medical University of Vienna, the international EUSOBI DWI working group, the Austrian Röntgen-society urogenital imaging working group and the German Röntgen-society breast imaging working group. He heads the scientific subcommittee breast for the ECR 2022.
Dr Matthew G Wallis, MB ChB FRCR
Consultant Radiologist, Cambridge Breast Unit
His main research interests is optimisation of all stages of the breast cancer pathway from mammographic image production and display to trials to investigate limiting the side effects of current treatment of lower risk disease. He has 137 peer review publications and he has used these to identify and optimise good clinical practice. This work has been pivotal to standard setting in image quality, radiology and surgery across the world. He has a long-standing interest in DCIS and is the Chief Investigator of Low risk DCIS trial.
Title: Male Breast Imaging
Clinical examination is far from perfect at distinguishing unilateral gynaecomastia from breast cancer. Mammography has high sensitivity and specificity for distinguishing simple gynaecomastia from breast cancer. Whereas ultrasound, with a lower specificity and can precipitate biopsy of gynaecomastia. I would therefore recommend MLO only views for distinguishing gynaecomastia from breast cancer. However, both are less accurate for other disease of the ‘chest wall’ so in these circumstances both are advisable, starting with ultrasound in the younger patient.
Male breast cancer is uncommon and a disease of older men. This means that nationally and locally we have developed restrictive referral and imaging guidelines essentially designed to protect breast services, which are subject to unrealistic targets designed to improve early diagnosis of breast cancer and reduce mortality.
General Practice and imaging departments are overwhelmed by public demand for ‘an answer’ or ‘diagnostic label’ and the political imperative for rapid diagnosis. So, the definition of both male and female ‘breast’, with access to rapid diagnosis and reassurance, has become increasingly elastic.
Is it time to abandon the out dated idea that our role is solely the diagnosis, or exclusion, and staging of breast cancer? By accepting and embracing that our role is the provision of reassurance and therapeutic ultrasound gel the clinics might not be smaller but our professional standing and status with the general public might rise, and we (I) might just become a bit less grumpy.
Jonathan James
Jonathan James is Consultant breast radiologist and the director of education and training at the Nottingham Breast Institute
Title: Set up a CESM service
The use of contrast enhanced spectral mammography (CESM) can lead to improvements in diagnostic accuracy in the breast clinic with increased sensitivity and specificity compared to standard 2D mammography, particularly in women with denser parenchymal background patterns. Current evidence suggests that CESM can deliver a similar diagnostic performance to breast MRI and may have a role to play in the local staging of primary breast cancer, monitoring response to neoadjuvant chemotherapy and breast cancer screening. CESM is potentially more available, faster and less expensive than breast MRI. Women achieve the greatest benefits from CESM when it is integrated into the standard diagnostic workflow and so this talk will review how this can be achieved.
As the use of CESM increases, lesions are inevitably identified that require biopsy but remain occult with standard mammography and ultrasound. The lack of a CESM guided breast biopsy capability has been cited as a barrier to more widespread adoption of the technique. CESM guided biopsy is now available for use in clinical practice. How to do a CESM guided biopsy will be explained with clinical examples and its potential role as an alternative to MRI guided breast biopsy will be discussed.
Prof Chris Holcombe
Prof Chris Holcombe is a Consultant Oncoplastic Breast Surgeon in Liverpool and President of the Association of Breast Surgeons.
Chris is an active researcher with interests in the psychology of breast cancer diagnosis and treatment, the testing of new treatments in the POETIC and Impact Studies, and the treatment of the older patient in the Bridging the Age Gap Study. More recently he has been involved in the safe introduction of new techniques and devices in breast surgery and set up iBraNet – a network of research active surgeons committed to safe rapid introduction of new techniques and devices. ‘No innovation without evaluation, has become an ABS mantra. Chris is a past chair of the ABS Academic and Research Committee.
Currently Chris has been working with NHS England on an exemplar breast pathway for the Faster Diagnosis Standard, and is helping set up a prospective cohort platform study to test and evaluate new pathways for the management of breast pain.
Out of work Chris is married and has four grown up children and seven grandchildren. He is very involved in his local church and likes to get to the mountains as often as possible.
Title: Breast Pain – Managing the tsunami
There has been an inexorable increase in young women attending the one stop breast clinic, but without a concomitant increase in breast cancer diagnoses.
There have been large increases in referrals with breast pain which is not a sign of breast cancer, but which for many is a worrying symptom.
This talk will look at the latest advice from NHS England and look at new pathways for managing breast pain that take pressure off the one stop clinic, and how best these might be evaluated to be sure they are safe and provide good quality patient care.
Dr Jim Steel
Dr Jim Steel qualified from Guy’s Hospital, London, in 1990. He has been a Consultant Breast Radiologist since 2000, a regional advisor, a member of the Clinical Professional Group for Breast Screening, and an ardent enthusiast for all things computer related. This extended to NBSS which he has been involved with for probably rather too long and is currently engaged in assisting with the redesign, the Digital Transformation of Breast Screening. Both as a Unit Director and Service Line Director he has served in pseudo-management roles but despite this has not lost his love of the NHS and of the core job. He hopes to teach and to improve things for readers for many years to come.
Title: BSIS: The Interval Cancer Module
This talk will give a brief overview of the interval cancer module within BSIS, a new aspect of this data viewing tool. What is it for? How does it work? What could you learn from having a look yourself?
Professor Abeer Shaaban
Prof Shaaban is a Consultant Pathologist at Queen Elizabeth Hospital Birmingham and Professor of Cancer and Genomic Sciences, University of Birmingham, UK. At CRUK Birmingham Centre, she supported translational and digital pathology & multiplex immunofluorescence studies.
She has led a number of research studies and contributed to breast cancer trials as co-investigator, member of a Trial Management Group and as a central pathology reviewer. Her research interest includes profiling tumour microenvironment, tissue microarrays, predictors of response/resistance to therapies and ethnic differences in cancer.
She was member of the NCRI Breast CSG for two terms and acted as chair of the NCRI Breast CSG Translational Subgroup for 5 years. She published over 160 peer reviewed papers and contributed a number of book chapters including in the WHO Blue Book for Breast tumours 2019 and the International Collaboration on Cancer Reporting (ICCR) DCIS dataset 2021. She co-edited a textbook of molecular pathology entitled “Molecular pathology for the practising surgical pathologist and cytopathologists”. She lectured on a number of UK and international courses/conferences including San Antonio Breast Cancer Symposium, BDIAP, ESSO, EBBC, Pathological Society of Great Britain and Ireland meetings and other. Prof Shaaban organises an annual multidisciplinary breast pathology update course http://birminghambreastpathology.org/bbpuc-2021.
Prof Shaaban led the NCRI Cellular and Molecular Pathology initiative (CM-PATH) Workstream 2 (Clinical Trials). She served as member of the International Committee of the Royal College of Pathologists, member of the Scientific Advisory Board of Breast Cancer Now and is Breast Screening Advisor for Public Health England.
Title: B3 lesions-pathology update
Dr Caroline Rubin
Dr Caroline Rubin trained in Medicine at King’s College London and Westminster Hospital Medical School, qualifying in 1979. She was appointed as Consultant Radiologist with a special interest in breast imaging in Southampton in 1988, at the start of the National Screening Programme. She was Director of the Southampton and Salisbury Breast Screening Programme for 25 years and a Member of the Advisory Committee for Breast Cancer Screening for 12 years.
With a lifelong interest in education and training she has undertaken many roles including College Tutor for 9 years, Head of Training for 7 years and Head of the Wessex School of Radiology for 5 years. Awarded Masters in Education from the University of Winchester in 2005.
Roles within the Royal College of Radiologists include Medical Director Education and Training for Clinical Radiology 2013-16 and Vice President for the Faculty of Clinical Radiology 2017-2020.
Title: Burnout and Strategies to Prevent
In an online survey of 13,000 physicians across 29 specialties, undertaken in 2021 by Medscape, 41% of men and 56% of women reported burnout. The same survey investigated the drivers for stress and burnout and a further survey explored Lifestyle and Happiness.
Workplaces have significantly increased the offers of support for wellbeing, stress, and burnout but how likely are you to access it if you are feeling burnt out? Thus, it is Important to look out for and support each other. Work as imagined is rarely equivalent to work as done, workarounds abound, and workload exceeds capacity. It is easy to become overwhelmed.
Compassionate leadership goes some way to mitigate against stress and burnout. Supporting each other within breast imaging units, as well as being ‘kind’ to yourself and others, goes a long way to mitigate against some of the negative impact of the relentless increase in workload and expectations of the public and patients.
Support may be given by focussing on one-to-one interaction, ensuring health and wellbeing are an everyday function and half hour daily meetings as part of DCC to discuss cases or frustrations. It is the little things that count.
Dr Teik Choon See
Title: RCR Support and Wellbeing
Dr Susie Hunt
Susie Hunt, BSc MB BChir MRCGP(dist) DRCOG DCH, studied medicine, and trained in General Practice, in Cambridge with 20 years as local GP. An MRCGP exam teacher, she represented colleagues on the Cambridge Commissioning Group executive and worked as a GP Appraiser. A strong call into hospital chaplaincy led her back into Cambridge University Hospitals(CUH) where, recognising the increasing pressures on clinical staff, she has introduced facilitated ‘reflective debrief’ groups for consultants and trainees across a number of CUH specialties, and other staff groups - nurses, Allied Health Professionals1,2 .
Prior to Covid-19, she became a staff bank consultant in the Trust developing the provision of 1:1 pastoral care for all medics, as well as mediation and team/serious incident debrief. With the pandemic onset, a Doctors-for-Doctors team providing wider pastoral supervision for medics has developed under her lead now providing support for over 10% of the CUH medical workforce – including 1 in 6 consultants, 1 in 4 specialty leads. Susie is passionate to share what she has learnt about resilience and wellbeing during this journey alongside struggling colleagues, with various audiences – be they local, national or international.
1. Lightowlers S, Thompson M, Hunt SL. Not all interventions for burnout cost money: the value of debrief groups. BMJ 2017;358:4377.
2. Hunt SL, Reflective debrief and the social space: offload, refuel, and stay on course, Clinical Radiology, https://doi.org/10.1016 / j.crad. 2019.12.012
Title: "It's good to talk" - Snapshot of Cambridge University Hospitals' Doctors-for-Doctors team
Dr Susie Hunt takes time to ask a few direct questions about self-care, moving on to look at the power of connectivity in maintaining personal and professional sustainability. She describes transferrable aspects of her work developing facilitated ‘reflective debrief’ groups for consultants and trainees across a number of CUH specialties, and other staff groups. With the pandemic onset, a Doctors-for-Doctors team providing wider pastoral supervision for medics has developed under her lead now providing support for at least 10% of the CUH medical workforce. Principles and practice are described with a view to stimulating ideas in the audience for their own workplaces.
Dr Gary Rubin
Dr Rubin studied at medicine at University College and St George’s, London, qualifying in 1979. After radiology training in London he became a consultant radiologist at the Royal Sussex County Hospital in Brighton in1989. He became breast screening director of the local screening programme. He was Meetings Secretary for the British Society of Breast Radiology. He retired from full time work in 2017 but still works part-time in breast imaging in Worthing and Brighton.
Brighton is known for its bohemian and minority friendly atmosphere and Dr Rubin has lectured previously on breast screening and trans and non-binary TNB) people. He will present recent work that should make it easier and more comfortable for those at similar risk of breast cancer to cis-women to access screening mammography.
Title: Transgender breast imaging
Symptomatic patients should be imaged with mammography and/or ultrasound according to their age, clinical findings, and whether they have had top surgery to remove breast tissue.
Screening:
1) Trans and non-binary people may not want to be defined by their sex at birth. However, the NHS identity number is binary. Those with a male number do not receive a routine NHS England breast screening invitation if they are also registered with their GP as male.
2) This means there needs to be a workaround for some people registered as male, so that if their breast cancer risk is similar to women invited for screening, they can access an equivalent screening service.
3) The proposed workaround is to advise GPs to request screening type mammography at local symptomatic breast units for people in two transgender groups, if they are registered as male with their GP. One is people registered male at birth, still with their original NHS number, taking feminising hormones for at least 5 years. The other is a subset of trans-males, assigned female at birth, but re-registered as male with a new ‘male’ NHS number. The subset is those who have not had ‘top’ surgery.
Dr Yan Chen
Dr Yan Chen is Associate Professor of Cancer Screening at School of Medicine, University of Nottingham. Her research involves exploring novel technologies and techniques that enhance screening programme, whilst minimising risk to the patient. She runs the PERFORMS scheme, an internationally well-known quality assurance scheme for breast screening readers to improve their mammographic imaging interpretation skills and remain up to date in their specialities. It is the UK mandated self-assessment scheme for over 34 years.
Title: The performance of breast screening readers in a specificity focused PERFORMS case set.
All breast screening readers in the UK are required to participate in an external quality assurance scheme using test sets, known as PERFORMS. Recent work has shown that PERFORMS accurately reflects real-life mammography reading performance, indicating that it can be a useful tool in maintaining the high reading standards of the NHS breast screening programme. The sixty case test sets are typically enriched with challenging cancers as well as normal and benign studies and are made available twice per year.
In October 2021, an innovative change was made to the scheme with a case set designed to test and assist the readers in identifying mammographic features that do not need recall for further investigation, aimed at tackling a growing number of false positive recalls. This novel 'specificity set' was delivered in the same way as a traditional PERFORMS set with performance metrics and case feedback available to each participant immediately after completion of the set. Although this PERFORMS set had been designated as optional, 409 readers across the UK examined the cases and submitted their answers. The results will be presented in this year’s BSBR Annual Scientific Meeting.
British Society of Breast Radiology is supported by:
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