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Cost-Effectiveness of Clinical Breast Assessment-Based Screening in Rural Egypt

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Abstract

Introduction

Breast cancer is the most common cancer in Egyptian women. However, the mean tumor size at diagnosis is 4.5 cm, and the median age is approximately 46 years. Both of these factors decrease the utility and cost-effectiveness of a mammography-based screening program typically designed for developed countries. We report the first clinical breast assessment-based screening project in an entirely rural Egyptian community.

Methods

Targeted population: Women aged 25–65 years in three municipal regions of Dakahlia province, Egypt. The estimated targeted population was 57,500 and participation was voluntary. First stage was performed at primary health care points. Surgeons performed systematic clinical breast examination. All data were collected at Mansoura University. Abnormal findings in the primary examination led to an invitation to the Oncology Center—Mansoura University—where the second stage of the study took place. It comprised repeat examination, ultrasonography, and/or mammography. Therapeutic interventions were performed at the governmentally funded Mansoura Oncology Center.

Results

Voluntary participation reached 10.2% of the target group and abnormal clinical examination represented 3.2% (191/5,900). The screen-detected cancers were (18/5,900) of examined population, and thus the cancer detection rate of clinical breast assessment-based screening was 30.5 per 100,000 of participating women during 2 years. The tumor size was 1.5 cm (median) and 1.3 cm (mean). The cost of screening per cancer case detected was approximately 415 US$, and the overall cost of treating a screen-detected cancer was 1,015–1,215 US$.

Conclusions

Clinical breast assessment-based screening with selective mammography is an effective modality, which improves the results of breast cancer management in Egypt.

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References

  1. Lacey JV Jr, Devesa SS, Brinton LA (2002) Recent trends in breast cancer incidence and mortality. Environ Mol Mutagen 39(2–3):82–88

    Article  CAS  PubMed  Google Scholar 

  2. Rennert G (2006) Breast cancer. In: Freedman L, Edwards B, Ries L, Young J (eds) Cancer incidence in four member countries (Cyprus, Egypt, Israel, and Jordan) of the Middle East cancer consortium (MECC) compared with US SEER. Pub. No. 06–5873. National Cancer Institute (NIH), Bethesda

    Google Scholar 

  3. Althuis MD, Dozier JM, Anderson WF, Devesa SS, Brinton LA (2005) Global trends in breast cancer incidence and mortality 1973–1997. Int J Epidemiol 34(2):405–412

    Article  PubMed  Google Scholar 

  4. Omar S, Khaled H, Gaafar R, Zekry AR, Eissa S, el-Khatib O (2003) Breast cancer in Egypt: a review of disease presentation and detection strategies. East Mediterr Health J 9(3):448–463

    CAS  PubMed  Google Scholar 

  5. Hosny G, Elkaffas SM (2002) A prediction model for the incidence patterns of female breast cancers in Alexandria, Egypt. J Egypt Public Health Assoc 77(3–4):329–345

    PubMed  Google Scholar 

  6. Green BB, Taplin SH (2003) Breast cancer screening controversies. J Am Board Fam Pract 16(3):233–241

    Article  PubMed  Google Scholar 

  7. Miller AB, To T, Baines CJ, Wall C (2002) The Canadian National Breast Screening Study-1: breast cancer mortality after 11 to 16 years of follow-up. A randomized screening trial of mammography in women age 40 to 49 years. Ann Intern Med 137(5 Part 1):305–312

    Google Scholar 

  8. Tu SP, Reisch LM, Taplin SH, Kreuter W, Elmore JG (2006) Breast self-examination: self-reported frequency, quality, and associated outcomes. J Cancer Educ 21(3):175–181

    Article  PubMed  Google Scholar 

  9. Baxter N (2001) Preventive health care, 2001 update: should women be routinely taught breast self-examination to screen for breast cancer? CMAJ 164(13):1837–1846

    CAS  PubMed  Google Scholar 

  10. Jatoi I (2003) Screening clinical breast examination. Surg Clin North Am 83(4):789–801

    Article  PubMed  Google Scholar 

  11. Barton MB, Harris R, Fletcher SW (1999) The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA 282(13):1270–1280

  12. Dinshaw K, Mishra G, Shastri S, Badwe R, Kerkar R, Ramani S, Thakur M, Uplap P, Kakade A, Gupta S, Ganesh B (2007) Determinants of Compliance in a Cluster Randomised Controlled Trial on screening of breast and cervix cancer in Mumbai, India. Oncology 73:145–161

    Article  PubMed  Google Scholar 

  13. Anderson BO, Shyyan R, Eniu A, Smith RA, Yip CH, Bese NS, Chow L, Masood S, Ramsey SD, Carlson RW (2006) Breast cancer in limited-resource countries: an overview of the Breast Health Global Initiative 2005 Guidelines. Breast J 12(1):S3–S15

    Article  PubMed  Google Scholar 

  14. Kishk NA (1999) Breast cancer in relation to some reproductive factors. J Egypt Public Health Assoc 74(5–6):547–566

    CAS  PubMed  Google Scholar 

  15. Denewer A, Setit A, Farouk O (2007) Outcome of pectoralis major myomammary flap for post-mastectomy breast reconstruction: extended experience. World J Surg 31:1382–1386

    Article  PubMed  Google Scholar 

  16. Pisani P, Parkin DM, Ngelangel C, Esteban D, Gibson L, Munson M et al (2006) Outcome of screening by clinical examination of the breast in a trial in the Philippines. Int J Cancer 118(1):149–154

    Article  CAS  PubMed  Google Scholar 

  17. Kuroishi T, Hirose K, Suzuki T, Tominaga S (2000) Effectiveness of mass screening for breast cancer in Japan. Breast Cancer 7(1):1–8

    Article  CAS  PubMed  Google Scholar 

  18. Miller AB, Baines CJ, To T, Wall C (1992) Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. CMAJ 147(10):1477–1488

    CAS  PubMed  Google Scholar 

  19. Miller AB, Baines CJ, To T, Wall C (1992) Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years. CMAJ 147(10):1459–1476

    CAS  PubMed  Google Scholar 

  20. Shapiro S, Venet W, Strax P, Venet L (1988) The Health Insurance Project Plan and its sequelae, 1963–1966. The John Hopkins University Press, Baltimore

    Google Scholar 

  21. Alexander FE, Anderson TJ, Brown HK, Forrest AP, Hepburn W, Kirkpatrick AE et al (1994) The Edinburgh randomised trial of breast cancer screening: results after 10 years of follow-up. Br J Cancer 70(3):542–548

    CAS  PubMed  Google Scholar 

  22. Shen Y, Parmigiani G (2005) A model-based comparison of breast cancer screening strategies: mammograms and clinical breast examinations. Cancer Epidemiol Biomarkers Prev 14(2):529–532

    Article  PubMed  Google Scholar 

  23. Park BW, Kim SI, Kim MH, Kim EK, Park SH, Lee KS (2000) Clinical breast examination for screening of asymptomatic women: the importance of clinical breast examination for breast cancer detection. Yonsei Med J 41(3):312–318

    CAS  PubMed  Google Scholar 

  24. Boulos S, Gadallah M, Neguib S, Essam E, Youssef A, Costa A et al (2005) Breast screening in the emerging world: high prevalence of breast cancer in Cairo. Breast (Edinburgh, Scotland) 14(5):340–346

    Google Scholar 

  25. Bonfill X, Marzo M, Pladevall M, Martí J, Emparanza JI (2001) Strategies for increasing the participation of women in community breast cancer screening. Cochrane Database of Systematic Reviews: reviews 2001, Issue 1. Wiley, Chichester. doi:101002/14651858CD002943

  26. Vahabi M (2003) Breast cancer screening methods: a review of the evidence. Health Care Women Int 24(9):773–793

    Article  PubMed  Google Scholar 

  27. De Koning HJ (2000) Breast cancer screening; cost-effective in practice? Eur J Radiol 33(1):32–37

    Article  PubMed  Google Scholar 

  28. Ohnuki K, Kuriyama S, Shoji N, Nishino Y, Tsuji I, Ohuchi N (2006) Cost-effectiveness analysis of screening modalities for breast cancer in Japan with special reference to women aged 40–49 years. Cancer Sci 97(11):1242–1247

    Article  CAS  PubMed  Google Scholar 

  29. Feigin KN, Keating DM, Telford PM, Cohen MA (2006) Clinical breast examination in a comprehensive breast cancer screening program: contribution and cost. Radiology 240(3):650–655

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank all members of Mansoura University Breast Cancer Screening Group, who assisted in the present study. We gratefully acknowledge the contributions of Dr. Fayez Shahatto, Dr. Sameh Roshdy, and Dr. Osama El-Damshety. This trial was supported by internal fund from Mansoura Faculty of Medicine.

Author information

Authors and Affiliations

  1. Surgical Oncology Department, Oncology Center, Mansoura University, Mansoura, 35516, Egypt

    Adel Denewer, Osama Hussein, Omar Farouk, Waleed Elnahas & Ashraf Khater

  2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Bellefield Avenue, Room 405, Pittsburgh, PA, 15213, USA

    Aiman El-Saed

Authors
  1. Adel Denewer
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  2. Osama Hussein
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  3. Omar Farouk
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  4. Waleed Elnahas
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  5. Ashraf Khater
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  6. Aiman El-Saed
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Corresponding author

Correspondence to Adel Denewer.

Appendix: Mansoura University Breast Cancer Screening Group

Appendix: Mansoura University Breast Cancer Screening Group

Executive committee

Gamal Dahab (Vice Dean)

Adel Denewer

Mohamed Taher El-Shobaky

Atef Abdel-Latif

Amro Sarhan (Vice Dean)

Mohamed El-Gendy

Mohamed Farag

Ashraf Shoma

Members

Khalil El-Etriby

Nabeeh Anwar

Mohamed Farid

Ramadan El-Lithy

Samir Zidan

Sherif Kotb

Ahmed Mo’atemed

Ibrahim Daoud

Ihab Saad

Hamed Horia

Mosad Morshed

Nazem Shams

Mokhtar Farid

Wael Khafagy

Hesham Abdel Monem

Hesham Sharaf

Waled Omar

Yaser Mosbah

Tarek El-Mahdy

Saleh El-Awady

Samir Ateia

Abdel-Salam Megahid

Abdel-Azim Youssef

Mahoud Amin

Mohamed Hegazy

Sabry Ahmed Badr

Khalid Moafy

Ahmed Abdel-Monaem

Amir Fikry

Osama Hussein

Tamer Fady

Tamer Youssef

Hosam El-Wakil

Mosaad Soliman

Waleed Borham

Wageh Momtaz

Ibrahim Awad

Ashraf Khater

Aiman El-Nakib

Hosam Ghazy

Khalid El-Alfy

Waleed El-Nahas

Omar Farouk

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Denewer, A., Hussein, O., Farouk, O. et al. Cost-Effectiveness of Clinical Breast Assessment-Based Screening in Rural Egypt. World J Surg 34, 2204–2210 (2010). https://doi.org/10.1007/s00268-010-0620-3

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  • DOI: https://doi.org/10.1007/s00268-010-0620-3

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