A Focused Workshop on Breast Cancer Control

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A Focused Workshop on Breast Cancer Control

• In Partnership with EMRO and Lalla Salma
  Association Against Cancer

Ian Magrath www.inctr.org
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Cancer in the EM Region
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Cancer in the EM Region Females
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International Incidence and Mortality
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Age-Specific Incidence
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Age-Specific Mortality
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The Whole Story
Unscreened
Accurate diagnosis? Accurately staged? Refused
therapy? Received therapy after delay
(good/bad) Received prompt therapy
(good/bad) Survival for x years
Mortality (screened patients or
population) relative importance of screening
versus treatment?
Cancer
False Benign
Cancer S Reg
Even down-staging is not a guarantee of
improved survival or decreased mortality in LMIC.
Conversely, screening may result in
over-diagnosis (of both in-situ and invasive
cancers)
Frequency?
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Objectives of Workshop

• To promote actions directed to breast cancer
  control
• To identify obstacles to effective action that
  exist in the EM Region or areas where more
  research is needed
• To propose approaches to overcoming known
  obstacles
• To emphasize the value of an integrated approach
  from early detection to treatment and to discuss
  how this might be achieved at least in the
  context of pilot projects
• To emphasize the need to evaluate program
  outcomes and to consider how best this can be
  done
• Cost financial, human capital, potential
  negative impact
• Benefit increased survival/decreased mortality
• To identify tools that aid decision making re
  priorities, methodologies, data collection and
  program evaluation

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Model Data Collection Forms
INCTR has used modules 9-19 in a survey of
presentation and treatment in 4 centers 9000
collected to date
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Data Flow
Screening centers
Diagnostic centers2
Treatment centers2
Women with breast cancer
DATA CENTER Data-base containing all modules
including summary/management modules
Modules 9,13-18 10-12 if required and 22
1 It is recommended that all women invited for
screening by whatever method are registered with
the data center. 2 Diagnostic centers and
treatment centers may be identical. In some
circumstances the same center may conduct
screening, diagnosis and treatmentt.
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First Step
Link?
Initially CBE to detect prevalent cases
mammography introduced later
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Structure of Workshop

• Plenary presentations to provide background
• Structured group discussions on
• Access to care and patient tracking
• Screening
• Diagnosis and staging investigations
• Treatment
• Preliminary reports of group discussions and
  recommendations (to be finalized after the
  workshop - by January 31st 2009)

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Outcomes of Workshop

• Learning from each other
• Identification of obstacles and potential
  solutions as well as areas where more assessment
  is required
• Exploration of possibilities for regional
  cooperation in breast cancer control
• Promotion of pilot programs in breast cancer
  control that are integrated and effectively
  evaluated
• Identify tools that could help, e.g., model data
  collection templates created by INCTR (drafts)
  Model projects?
• Preparation of a report of the group discussions
  and recommendations (dissemination?)
• A basis for future actions and assessment of
  progress