The Challenge Fund

1. The Challenge Fund The fight against cancer in the emerging world

2. The Challenge FundThe Rising Cancer Problem in the Emerging World Increasing longevity Increasing incidence Disproportionate resource distribution Lack of appropriate research

3. The Challenge FundThe Djerba Statement Research in development of simple and relevant cancer prevention recommendations Research in early detection, prevention and treatment of common cancers Defining appropriate mechanisms in developing public health research in the emerging world

4. The Challenge FundSignatories to the Djerba Statement E. Abebe, Lagos F. Ben Ayed, Tunis N. Gad El Mawla, Cairo A. Ghavamzadeh, Teheran S. Kadare, Tirana I. Mittra, India The Statement was supported by A. Costa and A. Saracco, ESO Milan N. Pavlidis, Loannina S. Plesnicar, Ljubljana

5. The Challenge Fund Challenge Fund Conferences Cairo 1996 Rome 2001 Abu Dhabi 2002 Rome 2005 Lima 2005

6. The Challenge Fund The Challenge Fund Projects The Cairo Study The Yemen Project The India Project The Sudan Project

7. The Challenge Fund The Cairo Project A Pilot Study of Early Detection of Breast Cancer by Clinical Examination plus BSE Investigators : S. Boulos ; M Gadallah ; S Naguib

8. The Challenge Fund The Cairo Project Trial Centre : The Italian Hospital, Cairo Study Population : 5,000 women, age 35 – 64 No. Participating : 4,116 Breast Cancer Detection Rate : 1st Yr : 4 / 1000 2nd and 3rd Yrs : 1 / 1000

9. In Egypt, breast cancer is the most common cancer in women. • The disease is usually diagnosed at an advanced stage, and survival is poor.

10. AIM OF STUDY (CBST) 1- To test the feasibility of conducting a Randomized Trial of Breast Physical Examination and Breast Self-Examination 2- To evaluate a Breast Cancer Screening Program in a well defined, socio-economically modest population in the city of Cairo (Abbasiah) using: (CBE)(BSE)

11. MATERIAL & METHODS • SAMPLE SIZE: 5000 women ( 35 - 65 years) • PHASES OF THE SUDY: • The study was conducted in 2 phases: • Phase I • Phase II • DURATION OF THE STUDY: Started 07/05/00 • ended 28/11/02 Group A Group B

12. METHODOLOGY: • 1. Geographical definition An area around the Italian Hospital, named Abbasiah District, was defined. The maps of this area were obtained and divided into 8 blocks.

13. METHODOLOGY (Cont.) : • 2. Door-to-Door visits • 4 Social workers were selected and trained • about the objectives and methodology of the • study.

14. 2. Door-to-Door visits (Cont.) Questionnaire

15. 3. Women invited to attend a Health Education Session in a primary health care center (PHC)

16. (a)Brief health talk by doctors.

17. ( b )Clinical Breast Examination (in a private room) ( c )Teaching of Breast Self Examination

18. 4-Referral to the Italian Hospital of any woman with suspicious finding for: a)CBE by Chief Surgeon. (Confirm)

19. b)Further investigation (+/- MX and U.S.)

20. c)Further surgical treatment (free of cost).

21. Phase II :Women who had previously been contacted • were randomly classified into two groups • (using area / block randomization) . • Group A :To be invited to attend once • more the PHC for examination • Group B :To be visited only and asked about • Breast Problems

22. Results of phase I Field Study Rates . No. of women contacted  4116 out of 5000 . Community Acceptance Rate  4116/5000

23. Field Study Rates (Cont.) . Compliance Rate at PRIMARY HEALTH CARE : 2481/ 4116

24. Field Study Rates (Cont.) Field Study Rates (Cont.) Compliance Rate at ITALIAN HOSPITAL 236/291 N.B : 55 out of 291 Symptomatic cases did not show up at the hospital for further investigation

25. Morbidity Statistics Rates ( per 1000 women )

26. Results of Phase II : GROUP A Cancer Detection Rates

27. Results of Phase II : GROUP B • CANCER DETECTION RATES : • Among women who attended PHC in phase I = 3 / 1062 • 2.8 per 1000 • Among women who did NOT attend = 3 / 865 • 3.5 per 1000

28. In the year 2003/2004, the trial has been extended in Cairo by the identification, recruitment and randomization of a second group of 5000 women.

29. From the start, women were randomly allocated into 2 groups:Group A (2500) Study arm Group B (2500) Control armBoth areas of residency are quite far from each other.

30. Results Of Phase III: • Study Group A: *No. of women contacted 2092 out of 2500 Community acceptance rate (83.7%) *Compliance rate at PHC 1548/2092 (74%) *Compliance rate at Italian Hospital 80/92 (87%) *Cancer Detection rate 10/1548 (6.5 per 1000)

31. Results Of Phase III (Cont.) • Study Group B: *No. of women contacted 2179 out of 2500 Community acceptance rate 87.2% *Cancer Detection rate 13/2179 (6 per 1000)

32. Thank You

33. The Challenge Fund The Yemen Project A National Project on Breast Cancer Screening Kuwait University Hospital, Sana’a, Yemen Coordinator : S. Shivananda

34. The Challenge Fund The Yemen Project • Replication of the Cairo Study • 1st Phase : Capacity Building • Training in Breast Examination • Training in Mammography • Training in FNAC / Pathology • Training in Breast Cancer Treatment

35. The Challenge Fund The India Project Cancer Awareness and Early Cancer Detection Project in Trichy District, Tamil Nadu, Southern India Coordinator : V. Gajalakshmi

36. The Challenge Fund The India Project • Knowledge, Attitude, Practice (KAP) Survey • Public education and assessment of its impact • Early detection of cervix, breast and oral cancer • Assessment of compliance to invitation, • referral, treatment and follow-up