Do we need regional guidelines for breast cancer management in the MENA region? MENA Breast Cancer Guidelines project

Abstract

PurposeBreast cancer is the most common cancer among females worldwide in general and in the Middle East and the North African region (MENA region) in particular. Management of breast cancer in the MENA region faces a lot of challenges, which include younger age at presentation, aggressive behaviour, lack of national breast screening programmes and lack of reliable data registries as well as socioeconomic factors. These factors make applying the international guidelines for breast cancer management very challenging. The aim of this project is to explore the need for a regional breast cancer guideline as well as to screen the clinical practice of breast cancer management in the MENA region.MethodologyThree web-based designed surveys were sent to more than 600 oncologists in the MENA region from the period of August 2013 to October 2014. Full descriptive data and information regarding the application of international breast cancer guidelines were collected. The software was using the IP address to prevent duplication of collected data. Descriptive analysis and results were shown as numbers and percentages.ResultsDuring the period of the survey, 104 oncologists responded, representing around an 11% response rate. The majority of replies came from Egypt (59 responses (59%)), followed by Saudi Arabia (ten responses (9.6%)). Fifty-one per cent of responders had more than ten years of experience, and further 31.7% had 5–10 years of experience. Seventy-four per cent were working in governmental hospitals, which is our target sector. There was a major defect in having a genetic counsel unit (78.8% declared an absence of this service), presence of a national breast screening programme (55.8% declared an absence of this service), performing sentinel lymph node biopsy (43.3% declared an absence of this service). The need for regional guidelines for the management of breast cancer was agreed upon by 90.6% of responders.ConclusionThere is a clear need to improve the management of breast cancer in the MENA region. Creating a national breast screening programme and a reliable database is essential. A regional guideline is required to establish the best possible management of breast cancer according to the patients and disease specification as well as the regional socioeconomic factors and facilities available. There is also a need to improve clinical research that meets the region’s needs.

Perception of Faculty Members of Regional Medical School Toward Faculty Development Program

“…(2015) who wrote a scientific report in KSA found that FDAP really improves MCQs writing, which supports our findings, since it is within the same context [39], together with other findings in USA items writing for USMLE [40]. Positive perceptions found include:…”

National and Subnational Incidence, Mortality, and Years of Life Lost Due to Breast Cancer in Iran: Trends and Age-Period-Cohort Analysis Since 1990

“…A study of the rural areas of Iran demonstrated that the cost-effectiveness of screening programs significantly depended on the extent of participation, highlighting the importance of focusing on improving knowledge and acceptance ( 40 ). Almost all MENA countries lack a nationally organized cancer screening program and have numerous cultural and socioeconomic barriers toward screening ( 5 , 41 , 42 ). A review article of breast cancer epidemiology in Iran reported that only about 18% of cases were detected in stage I ( 43 ).…”

The first BGICC consensus and recommendations for breast cancer awareness, early detection and risk reduction in low‐ and middle‐income countries and the MENA region

“…This was driven by data from a survey conducted on 600 oncologists in the MENA region, at which only 21% of the participating oncologists have genetic counseling services available in their health-care facilities. 9 Countries of the LMICs/MENA region lack proper national disease/ patient registries. Available data registries are merely hospital-based where its data cannot be generalized or represent the burden of disease on country level.…”

“…Available data registries are merely hospital-based where its data cannot be generalized or represent the burden of disease on country level. 9 All panel members (100%) agreed that national, population-based cancer registries, as well as other relevant surveys and data collection tools (including data collected from any available BC control programs, or developing registries that cover specific populations, or utilizing incidence and mortality rates from ongoing registries or data linkage between the available registries) should be used to collect high-quality population-based incidence and mortality data on BC, for all age groups, to properly guide policies and plans. Identifying the most important data that need to be collected or included in the registry and the most efficient and cost-effective way of collecting these data should be the first step to work on.…”

“…Add to this, most of the LMICs/MENA countries lack a well-established BC awareness and screening programs. 9 What's new As such, there is an unmet need to establish and improve BC awareness, early detection and risk reduction programs based on regional guidelines that take into consideration the regional specific disease criteria, the socioeconomics and the cultural characteristics that may be influencing BC presentation and outcome.…”