Background ER-α36 is a novel 36 kDa isoform of the full-length oestrogen receptor alpha (ER-α66). ER-α36 primarily localises to the cytoplasm and the plasma membrane, and responds to membrane-initiated oestrogen and antioestrogen signalling pathways. Aim To examine the expression of ER-α36 in apocrine and adenoid cystic carcinoma of the breast, both of which are consistently ER-α66 negative and currently lack effective targeted therapeutic options. Methods 19 pure apocrine carcinomas (17 invasive and two in-situ carcinomas) and 11 adenoid cystic carcinomas of the breast were evaluated for ER-α36 expression, along with expressions of ER-α66, progesterone receptor (PR) and androgen receptor (AR) using immunohistochemical methods. Results All pure apocrine carcinomas showed a characteristic steroid receptor expression profile (ER-α66 and PR negative, AR strongly positive). ER-α36 expression was detected in 18/19 pure apocrine carcinomas (94.7%, 95% CI 75.1 to 98.7) in predominantly membranous and cytoplasmic distribution. When positive, pure apocrine carcinomas uniformly (100% of cells) expressed ER-α36. All adenoid cystic carcinomas were uniformly negative for all three classic steroid receptors, but ER-α36 was detected in 8/11 cases (72.7%, 95% CI 42.8 to 90) with the similar sub-cellular pattern of expression as in the pure apocrine carcinomas. When positive, adenoid cystic carcinomas expressed ER-α36 in the majority of cells (average 76%). Conclusion ER-α36, a novel isoform of ER-α66, is frequently over-expressed in apocrine and adenoid cystic carcinomas of the breast. These results indicate a potential for a novel targeted treatment in these cancers.

PIH12 GOLD STAGE AND DURATION OF HOSPITAL ADMISSION DETERMINES SIZE AND STRUCTURE OF COPD RELATED DIRECT MEDICAL COSTS IN ELDERLY Jakovljevic M, Lazic Z, Jankovic S, Verhaeghe N, Annemans L The Medical Faculty University of Kragujevac, Kragujevac, Serbia; Clinical Center Kragujevac, Kragujevac, Serbia; Ghent University, Ghent, Belgium; Ghent University—Brussels University, Ghent, Belgium OBJECTIVES: COPD cost of illness assessment and its dependence on GOLD stage or duration of hospital admission. METHODS: The sample consisted of 186 elderly COPD patients. Chest physicians conducted follow-up and fi nancial data were obtained from administrative registry. Time horizon was one year and Health Insurance Fund perspective was selected. Included clinical endpoints were disease exacerbation and hospital admission. Economic data included all inpatient COPD-related medical goods and services consumption, and outpatient drug utilization. We excluded medical costs which did not arise from COPD. RESULTS: An average elderly COPD patient imposed c1745.41 of costs annually to the national health care budget. Severity grade (GOLD stage) and duration of all hospital admissions were signifi cantly and directly correlated with overall cost. Expenses structure per year was: c14.54 outpatient care, c126.97 inpatient drug consumption, c377.98 hospital admission (Intensive Care Unit admissions and specialist consultations included in daily price), c133.5 imaging diagnostics, c111.43 laboratory analysis, c26.67 therapeutic interventions, c70.32 consumables, c884 outpatient drugs consumption. Most expenses originating from drug acquisition were due to antibiotics prescribed for curing infections and mucolitics and antihistamine drugs consumption. Average number of hospitalizations per person was 1.45 with a duration of 12.84 days. Fifteen persons deceased. Average number of outpatient visits was 2.71 per person. CONCLUSIONS: Overall burden of COPD is mostly driven by outpatient drug consumption and exacerbations leading to hospital admissions. Relative relevance of drug acquisition expenses in our country is higher than in high-income societies, because of still signifi cantly lower human labour wages in the area. Pattern of diagnostic procedures requested and ATC drug classes consumed remains similar and comparable in most countries. More in-depth research of indirect COPD attributable costs e.g. lost productivity, absentism, premature death etc, will be needed in the future.