Download الشريحة 1 - An-Najah National University

MINISTRY OF HEALTH
EARLY DETECTION OF BREAST CANCER
IN BETHLEHEM
A SIX-MONTHS EVALUATION STUDY
Dr .Yousef Abu Ghosh
M.O.H Consultant Pathologist
INTRODUCTION.
A MOH pilot screening program for breast
cancer was launched at Betlehem governerate by
the directorate of health.
This program is an integral part of a nationwide
multicenter project aimed to reduce breast cancer
related mortality among Palestinian women.
Bethlehem governerate was assigned as a pilot
area.
The project is sponsored by the Italian
Cooperation Office of Jerusalem.
MATHERIALS AND METHODS
This is an analytical study of 678 women who
consulted the screening unit which was set up in
Beit Jala Government Hospital (BJGH).
The Palestinian MOH launched a health
educational campaign to raise public awareness
about the importance of early screening for and
prompt detection of breast cancer .
Women with suspected breast lesions were
referred to the unit for mammography and/or
ultrasound imaging.
On the other hand, some women attended for
opportunistic screening that is for symptoms
and/or breast lumps .
When a lesion was detected by radiology,
further diagnostic procedures and therapeutic
measures were offered at BJGH screening unit:
Fine needle aspiration cytology (FNA)
-at times U/S guided.
Core needle biopsy.
Fresh frozen sections.
BJGH departments of surgery & oncology offer:
Surgical management & oncological treatments.
A database that collects all information about
patients is under way and data will soon be
available to all BJGH departments concerned viz:
radiology, pathology, oncology, and surgery through
an internal network.
In addition to that, an external network will link all
together all other units in the Palestinian territory.
BJGH based unit will in the foreseeable future offer
telemedicine consultations to all other screening
units in Palestine.
Telecommunication will be established by a
professional team from Germany gratis.
RESULTS
During six months of screening 678 women
were screened:
9 of them were inflicted with breast cancer,
35 (4.6 %) were suspicious or positive on
mammography and FNA was suggested for
them.
FNA was perfofmed for 23 of them.
Eight mammographies (1.0%) were
unsatisfactory for technical reasons.
FNA was performed for 23 women:
Six of which were positive (0.8%).
Two were diagnosed as benign but of
uncertain malignant potential (0.3%).
Nine were negative.
Six were unsatisfactory.
In 15 out of 23 it was possible to establish a
correlation between radiology and cytology
results. There was a 93.3% concordance of
diagnoses (14 out of 15(.
DISCUSSION
Turn up for screening was relatively high .
Equipment and staff available allow reliable
diagnoses .
Nevertheless ,specialized training courses
and in-service teaching were organized to
enhance proficiency of the staff in early
detection, accurate diagnosis and effective
treatment .
The discovery rate was relatively high
because some attendees were symptoatic.
CONCLUSIONS:
The relatively large number of women who
turned up for screening denotes adequacy
of the awareness campaign.
The remarkable radiological: cytological
correlation indicates adequacy of equipment and
proficiency of the screening team .
The high discovery rate proves that breast
cancer is a major health problem in the study
area in particular, and presumably in Palestine in
general
RECOMMENDATIONS :
A further more detailed and more
comprehensive study is advisable in
the future to assess reduction in
breast cancer related death toll as a
result of the screening program.
Screening is a long-term investment.
The futuristic study will classify woman
according to their:
age group, symptoms, parity, menstrual history,
family history of breast cancer, reproductive
history, breast feeding ( lactation ) , use of
contraceptive pills, and intake of hormone
replacement therapy.
BJGH-based unit is an example to be followed
by other units.
The MOH Breast Screening Program is
nationally coordinated; it must set its national
standards monitored through a national
assurance network .
The study showed that BJGH based screening unit
should be an example to be followed by and a reference
facility to other breast screening units in the West
Bank area and Gaza strip.
As a result of screening, more women will be diagnosed
at earlier stages of breast cancer. This implies a
consequent increasing demand for radiotherapy.
Hence, at least a radiotherapy unit will be desperately
needed in the Palestinian territory.