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MINISTRY OF HEALTH EARLY DETECTION OF BREAST CANCER IN BETHLEHEM

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.

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MINISTRY OF HEALTH EARLY DETECTION OF BREAST CANCER IN BETHLEHEM

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  1. MINISTRY OF HEALTH EARLY DETECTION OF BREAST CANCER IN BETHLEHEM A SIX-MONTHS EVALUATION STUDY Dr .Yousef Abu Ghosh M.O.H Consultant Pathologist

  2. INTRODUCTION. A MOH pilot screening program forbreast cancerwas 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.

  3. 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/orultrasound imaging.

  4. 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.

  5. 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.

  6. 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.

  7. 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(.

  8. DISCUSSION Turn up for screening was relatively high . Equipment and staff available allow reliable diagnoses . Nevertheless, specialized training coursesand 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.

  9. 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

  10. RECOMMENDATIONS : A further more detailed and more comprehensive study is advisable in the future to assess reduction in breast cancer related deathtoll as a result of the screening program. Screening is a long-term investment.

  11. The futuristic study will classify woman according to their: age group, symptoms, parity, menstrualhistory, family historyof breast cancer, reproductive history, breast feeding ( lactation ) , use ofcontraceptive 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.

  12. 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.

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