VIENNA - Breast cancer accounts for 33% of all female cancers in Egypt, and its incidence will continue to rise, noted Prof. Dorria Salem, director of the national women's outreach program for breast cancer screening, in Saturday's European Society of Radiology (ESR) meets Egypt session.
Breast cancer is one of Egypt's three leading diseases. According to official data from 2001, its incidence was around 42.5 per 100,000 women, and the mortality rate far outstrips other cancer deaths. Although 80% to 90% of breast cancers can be cured if detected early, illiteracy, cultural barriers, and myths surrounding cancer contribute to late diagnosis and poor outcome, she said. About 10% of breast cancers are metastatic at presentation, tumors on average are 5 cm in diameter, and the average age at presentation is 10 years younger than in Europe and North America.
These statistics were the driving force behind the pilot breast screening scheme launched in 2007. Four mobile units and one fixed mammography unit covered the districts of Cairo and Giza for 12 months before the pilot went nationwide in 2008 to cover the entire country over the following five years, according to Salem, who is professor of radiology at Cairo University Hospital.
The program has had its share of challenges. Egypt has an area of 1 million km2 and many poor, isolated communities. Moreover, general practitioners have little concept of screening programs, and radiologists lacked the mammography skills necessary for screening purposes. This meant upgrading public mammography services, making screening mobile, and creating a center of excellence as a hub for remote mobile reporting using ADSL.
"Our target was not only to screen for breast cancer, but also for related risk factors of hypertension, diabetes, and obesity. We aimed to use all our resources to combat breast cancer through early detection; ongoing education and training for doctors, radiologists, and technicians; TV and radio awareness campaigns to reach the mass public; and research resulting in papers and posters," she stated.
Currently in its fourth phase, the program now has 10 mobile and 10 static units, a multidisciplinary clinic within the center of excellence, and a fully automated lab for breast cancer biomarker testing. In addition, the Egyptian initiative has won several international awards. Targeting the 5 to 6 million women older than 45 in Egypt's 85 million inhabitants, the program has screened 91,500 cases. In October 2011, the total number of suspicious cases from an accumulative total of 83,344 was 1,679, according to Salem.
"Of these suspicious cases, 1,345 were BI-RADS 4 and 334 were BI-RADS 5, and of the 414 proven malignant at follow-up, 390 were operated on. All diagnostic and therapeutic services were free of charge to the patient," Salem said.
Delegates were shown mammography and ultrasound images of some of the cases, such as infiltrating moderately differentiated mammary duct carcinoma grade II, which required conservative surgery, or invasive ductal carcinoma grade II, necessitating in that particular instance a mastectomy.
With the mobile unit (fully equipped) costing around 6.75 million Egyptian Pounds (about 848,032 euros), and with annual running costs at 1.6 million EGP, funding remains an issue. Ways to combat costs have involved a plan to recruit radiologists to take part in the program in exchange for education, rather than money, in addition to existing methods such as charitable donations, fundraising events, and proceeds from items for sale such as mugs and bags. In addition, "unreachable" women will be contacted through encouraging letters or word of mouth.
"The program will continue to promote mass community awareness about the value of early detection of breast cancer, and aims to establish a central lab to standardize pathology results, as well as create a center of excellence at every governorate to offer the same breast cancer management services," Salem said.
Yesterday's session was co-chaired by honorary president of the Egyptian Society for Radiology, Prof. Mohamed Abdel Wahab, and ECR 2012 President Prof. Lorenzo Bonomo, and delegates also learned about hepatic and urinary tract malignancy.
Other speakers, such as Prof. Sameh Hanna, head of the urogenital radiology unit, Cairo University Hospital, voiced optimism for the future.
"We are still looking for a better Egypt," he said.
Originally published in ECR Today March 4, 2012.
Copyright © 2012 European Society of Radiology
