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Advanced Breast Cancer


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Advanced Breast Cancer

  1. 1. Advanced breast Cancer: Response and Responsibility! J.K. ALMASAD. M.D FRCS. Associated Professor of Surgical Oncology Jordan University Hospital .
  2. 2. <ul><li>Breast cancer is the commonest among females world wide and only preceded by lung cancer in developed countries as a leading cause of death. </li></ul><ul><li>In Jordan (1) breast cancer is heading the list of all cancer affecting Jordanian women (33.9%) </li></ul>
  3. 3. <ul><li>In United States up to 20% of cases had initially advanced presentation (2). </li></ul><ul><li>In the developing countries the picture is more gloomy. Between 40-60% in developing countries were advanced at presentation (3, 4,5). </li></ul>
  4. 4. Case Report: <ul><li>48year old single woman presented to Jordan university hospital on13-5-2001 with huge fungating ulcerating mass in right breast </li></ul>
  5. 5. <ul><li>Her history dated back two years prior to presentation date, when she noticed a painless mass in her right breast. She did not seek any medical advice since then until the mass became painful, smelly, ulcerating and bleeding associated with breath shortening </li></ul>
  6. 6. <ul><li>T4N2M1 (pulm) </li></ul><ul><li>Stage IV </li></ul>
  7. 7. causes of delay presentation <ul><li>The fear of declaration of cancer” as believed by the community” will cause several social impacts on patient and her family. </li></ul>
  8. 8. causes of delay presentation <ul><li>The patients may afraid of loosing attraction as wives or may fear of isolation if the family members still falsely belief that cancer is contagious disease. </li></ul>
  9. 9. causes of delay presentation <ul><li>Significant reasons to hide the disease by an affected mother or old sister &quot;as our patient&quot; are their worries of negative attitude of others against younger female members of the family which ultimately prevent them of future marriage </li></ul>
  10. 10. causes of delay presentation <ul><li>Lack of awareness (6) about the seriousness of problem. </li></ul><ul><li>Difficult access to proper medical care service and poverty are other causes of delay in seeking medical advice. </li></ul>
  11. 11. causes of delay presentation <ul><li>The fear of extensive surgery (ref 7), the bad reputation of chemo and radiotherapy, make patients search for and try alternative treatments (8) which usually not effective and causing significant delay in presentation . </li></ul>
  12. 12. <ul><li>Goals of Treatment </li></ul><ul><li>Palliation no cure?? </li></ul><ul><li>Cost of treatment 30,000 JD??? </li></ul><ul><li>10 times of early case (3000)JD </li></ul><ul><li>but without cure!!! </li></ul>
  13. 13. 350 JD for each day of life Life worth but could be better and cheaper
  14. 14. conclusion <ul><li>It is the public responsibility including governmental and non governmental organization to work sincerely to over come this problem </li></ul>
  15. 15. <ul><li>In short term, carefully planned campaigns against the social misconceptions about breast cancer, stressing the value of screening, early detection and the modern developments in the fields of breast cancer management, such as the conserving breast and axillary management, options of breast reconstruction, the use of protective agents during chemotherapy . </li></ul>
  16. 16. <ul><li>In long term, fighting poverty, illiteracy and development of comprehensive, well equipped, professionally run, easy accessed and women friendly breast units well definitely change the women attitude and improve the outcome of this disease . </li></ul>
  17. 17. References <ul><li>1) Ministry of Health. Cancer Incidence in Jordan: 2001 national cancer registry report. Amman- </li></ul><ul><li>Jordan: Ministry of Health; 2001 </li></ul><ul><li>2) ValeroV V, Buzdar AU, Hortobagyi GN.Locally Advanced Breast Cancer. Oncologist.1996; 1(1, 2):8-17. </li></ul><ul><li>3) Perera N, Amarasinghe I and Wijesundara N. Establishing a breast clinic in a developing country: effect of a collaborative project. Eur J Surg Oncol. 2004; 30(3):229-32. </li></ul><ul><li>4) Al-Moundhri M, Al-Bahrani B , Pervez I, Ganguly S, Nirmala V, Al-Madhani A, Al-Mawaly K and Grant C. The outcome of treatment of breast cancer in a developing country—Oman. Breast. 2004; 13(2):139-45. </li></ul><ul><li>5) Gabriel N, Hortobagyi, Aman U, Buzdar Eric A, Strom Frederick C, Ames, and S. Eva Singletary. Primary chemotherapy for early and advanced breast cancer. Cancer Letters. 1995; 90(1):103-109. </li></ul><ul><li>6)Madanat H, Merrill R.Breast Cancer Risk-factors and Screening Awareness Among Nurses and Teachers in Amman, Jordan. Cancer Nursing. 2002; 25: (4)276-282. </li></ul><ul><li>7)Malik IA, Gopalan S. Use of CAM results in delay in seeking medical advice for breast cancer. Eur J Epidemiol. 2003; 18(8):817-22. </li></ul><ul><li>8) Abdullah N. Hisham and Cheng-Har Yip Asian Journal of Surgery. 2004; 27(2): </li></ul>
  18. 18. Thank you