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BREAST CANCER IN LIMITED RESOURCE CENTRE
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BackgroundCancer registry statistics on cancer in Cancer registry statistics on cancer in Yemen are poor .Yemen are poor .
In southeastern of Yemen the cancer casesIn southeastern of Yemen the cancer casesduring the Period 1989-1993 and 1997-2001during the Period 1989-1993 and 1997-2001showed that breast cancer was the first showed that breast cancer was the first most common malignancy in Yemen in most common malignancy in Yemen in FemaleFemale
Aim of study
1) To determine out the pattern of breast 1) To determine out the pattern of breast cancer in Yemeni patients in limited cancer in Yemeni patients in limited resource centreresource centre2) To compare the results with those from 2) To compare the results with those from other parts of the worldother parts of the world3) To expose the obstacles and difficulties 3) To expose the obstacles and difficulties faced doctors in diagnosis and treatmentfaced doctors in diagnosis and treatment
Materials and methods
Retrospective study, conducted in Al-Retrospective study, conducted in Al-Amal Oncology Unit, Al-Gamhoria Amal Oncology Unit, Al-Gamhoria Teaching Hospital during the period Teaching Hospital during the period from January 2008 to December 2008. from January 2008 to December 2008.
The analyzed data included all patients The analyzed data included all patients admitted to ALAMAL oncology unit. admitted to ALAMAL oncology unit.
The data included in this study were The data included in this study were patients sex, age, affected site, patients sex, age, affected site, histopathological diagnosis, histopathological diagnosis, metastasis and outcome.metastasis and outcome.
ResultsPatients with breast cancer were 110 Patients with breast cancer were 110 registered during one year (2008). registered during one year (2008). The patients registered were 110 patients. The patients registered were 110 patients. 109 patients were female (99.1%) and one 109 patients were female (99.1%) and one male. male. In 87.3% of patients there is evidence of In 87.3% of patients there is evidence of metastasismetastasis The age group most affected was 40-49 The age group most affected was 40-49 years followed by age group 50-59 years and years followed by age group 50-59 years and 30-39 years. 5 patients were in the age group 30-39 years. 5 patients were in the age group of 20-29 yearsof 20-29 yearsThe age group involved is younger than in The age group involved is younger than in Europe and the USA. The most common Europe and the USA. The most common group involved was 4th decade (33.6%), group involved was 4th decade (33.6%), followed by the 5th decade (25.5%) and 3rd followed by the 5th decade (25.5%) and 3rd decade (21.8%).decade (21.8%).•)
ConclusionsThe study has several limitations and The study has several limitations and observations that must be taken into account: observations that must be taken into account: First, Absence of mammography and other First, Absence of mammography and other early diagnostic procedures played a role for early diagnostic procedures played a role for late diagnosis of breast cancer. late diagnosis of breast cancer.
The sad truth is that we have to consider all The sad truth is that we have to consider all women older than 30 at risk for this disease. women older than 30 at risk for this disease. Also we appear to have a particularly steep rise Also we appear to have a particularly steep rise of the disease in women younger than 50.of the disease in women younger than 50.
The situation in Yemen is compounded by the The situation in Yemen is compounded by the fact that the presentation is often late and high fact that the presentation is often late and high rate of metastasis is observed in our patientsrate of metastasis is observed in our patients
The national Cancer committee together with The national Cancer committee together with other groups such as hospitals of the Ministry other groups such as hospitals of the Ministry of Health, WHO, Yemen Women Centre, The of Health, WHO, Yemen Women Centre, The International Cancer Associations, are to International Cancer Associations, are to advocate for increasing funds for research, advocate for increasing funds for research, both basis , applied and for increased support both basis , applied and for increased support for early detection of breast and cervical for early detection of breast and cervical carcinoma. This collaborative advocacy brings carcinoma. This collaborative advocacy brings focus on the government to address problems focus on the government to address problems caused by cancer and will foster effective caused by cancer and will foster effective action.action.
What remains clear is that there is an urgent What remains clear is that there is an urgent need for a comprehensive national approach to need for a comprehensive national approach to tackle this issuetackle this issue
Gamal Abdul HamidGamal Abdul Hamid11 , Nadeem M Saeed , Nadeem M Saeed22 , Reem Bader AminReem Bader Amin11, Safa Shukry, Safa Shukry11
Al-Amal oncology unit, Aden, National oncology centre, Sana'a, Yemen
Recommendations1.1. Improvement quality of laboratory and Improvement quality of laboratory and
nuclear medicine.nuclear medicine.2. Urgent need for establishment nuclear 2. Urgent need for establishment nuclear
medicine and radiotherapy centersmedicine and radiotherapy centers3. Urgent need for establishment early 3. Urgent need for establishment early
detection programsdetection programs
Contact: Contact: Associate Prof. Dr Gamal Abdul HamidAssociate Prof. Dr Gamal Abdul HamidHead, Hematology-Oncology, Head, Hematology-Oncology, Al-Gamhouria teaching HospitalAl-Gamhouria teaching [email protected]@yahoo.com
The results show that most of the patients The results show that most of the patients (76.1%) had infiltrating ductal carcinoma (76.1%) had infiltrating ductal carcinoma
Out of this breast cancer were 57.3% on the Out of this breast cancer were 57.3% on the right breast and 39.1% on the left breast. And right breast and 39.1% on the left breast. And 3.6 were bilateral. 3.6 were bilateral.
The absence of carcinoma in situ reflects the The absence of carcinoma in situ reflects the late diagnosis of breast cancer in contrast to late diagnosis of breast cancer in contrast to Europe and the USA due to developed Europe and the USA due to developed programs early detection of breast cancerprograms early detection of breast cancer
Distribution of breast cancer types
Breast Cancer in limited resource centreBreast Cancer in limited resource centre
4.5
21.8
33.6
25.5
8.2
5.5
0.9
0 5 10 15 20 25 30 35 40 45 50
20-29
30-39
40-49
50-59
60-69
70-79
80&>
17.3
76.1
10.9
1.8 0.9
0
10
20
30
40
50
60
70
80
Infiltratinglobular ca
Infiltratingductal ca
Intra-ductalca
Medullaryca
Mucinous
10
75.5
7.3
0.9
12.7
0
10
20
30
40
50
60
70
80
Bone Lymphnodes
lung ovary Nometastasis
1. About 75.5% of the patients were with lymph node 1. About 75.5% of the patients were with lymph node involvement.involvement.
2. About 10.0% are bone, 7.3% lung metastasis , 0.9% 2. About 10.0% are bone, 7.3% lung metastasis , 0.9% ovary metastasis , and 12.7% are free of ovary metastasis , and 12.7% are free of metastasismetastasis
• Prognosis: Prognosis: Died; 4.5
Alive without metastasis; 60
Alive with
metastasis; 35.5
17.3
76.1
10.9
1.8 0.9
0
10
20
30
40
50
60
70
80
Infiltratinglobular ca
Infiltratingductal ca
Intra-ductalca
Medullaryca
Mucinous
