bluuebunny/crossref_metadata_2025 huggingface dataset:
Saving Lives One Bite at a Time: The King Hussein Cancer Foundation´s Restaurant Care Program
Authors: Nababteh M. , Al Mahdi N. Al Abed
Published: September 2018

Amount raised: Since 2007, the program has raised USD 5.25 million. Background and context: In 2007, the King Hussein Cancer Foundation (KHCF) established the Restaurant Care Program (RCP); an innovative sustainable fundraising program targeting the general public. The RCP invites restaurants to incorporate a fixed contribution to KHCF as a line item on their diner bills, enabling restaurant guests to join the fight against cancer. At the time when cancer was still considered a taboo, the idea of bringing cancer onto restaurant tables and associating it with food was a huge undertaking which was frowned upon by most. It took one champion to join the program to for the rest to follow suit; gradually overcoming the taboo and changing public behavior. Within 10 years, the program was able to partner with over 70 restaurants with an annual growth of 8.4%. Aim: Establishing an innovative, sustainable fundraising program that creates behavior change and serves as an accessible, effortless donation channel while they dine Strategy/Tactics: Generating funds in a systematic and sustainable method by including the contribution as a line item on diners' bills within partner restaurants' financial/billing systems. Customizing the contributions according to restaurant's tier; JD 1 (USD 1.4), JD 0.50 (USD 0.70) and JD 0.25 (USD 0.35). Implementation of a donation opt-out method rather than making it opt-in. This means that the contribution is automatically added by the restaurant to the bill, yet allows the diner to optionally remove the donation if they request to do so. Shifting from the opt-in to opt-out method significantly more than doubled the donations received allowing the program to raise USD 512,711 in 2017 alone. Training and educating restaurant employees and raising their awareness about cancer, the program and the impact of raising funds to support patients- deeming them on-the ground KHCF advocates. Program process: Official agreements are signed with partner restaurants indicating the fixed donation amount and the financial process. Restaurants add the contribution as a fixed line item within their financial/billing system-KHCF provides restaurant partners with jointly branded marketing materials which are placed on dining tables and which explain the program and its process. Training of restaurant financial staff and waiters on program process in addition to educating them on cancer, KHCF mission and impact of the donations. Monthly financial reconciliation with each partner restaurant based on provided and audited receipts/bills. Costs and returns: The expenditure of the program is 2-4% of the programs' returns making the program cost-effective and sustainable. What was learned: Despite KHCF being in a resource-poor developing country, the program´s success is proof that it´s possible to conquer taboos and create an innovative funding model that is both cost-effective and sustainable and can be replicated across sectors and countries.
Public Health Mode Personalized Medicine: Risk Stratification for Breast Cancer Screening
Authors: Wolfson M.
Published: September 2018

Background: Breast cancer (BC) screening, primarily age-based, is a major public health program in many wealthy countries. At the same time, there is a dramatic increase in using genetics to support personalized medicine. These two approaches would seem antithetical. However, they can join powerfully with the possibility of using genetic information as the basis for a major shift from age-based to a risk-based BC screening programs. Aim: To assess the prospective cost-effectiveness of such a shift to risk-based BC screening requires representative population data on the relationships among a woman's age when a risk assessment is done, her family history of cancer in the context of pedigree data, and specific features of her genotype - comprising both the presence of rare genetic mutations like BRCA1/2 and recently derived polygenic risk scores. We use our newly developed Genetic Mixing Model (GMM) to estimate this joint distribution as the initial step in assessing the prospective cost-effectiveness of risk stratified BC screening in Canada. Methods: BOADICEA is a BC risk stratification algorithm already in wide use around the world, and in particular in Ontario, for high risk screening. A new version of BOADICEA incorporating a polygenic risk score has recently (will have) been published. We embedded the new core BOADICEA algorithm into the GMM. GMM thus provides the empirical foundation for assessing risk stratification for a representative population by constructing an estimate of the multivariate joint distribution of family history, presence of rare genetic mutations including BRCA1/2, and a polygenic risk score, derived from genome-wide association studies. Results: Using a polygenic risk score (PRS) would be far more useful for stratifying women according to their risk of breast cancer than the two most commonly used indicators at present: family history and rare genetic mutations. We have assessed a variety of combinations of these genetic indicators, in combination with offering universal risk assessment to women in Canada at various ages, and using different thresholds for categorizing women as being at high risk. The optimal age for risk assessment is in the 35 to 40 range. And the PRS is substantially more useful than family history or rare mutations for stratifying women for screening intensity by their risk of BC. Conclusion: Shifting from the current public health approach of primarily age-based screening for breast cancer, to one based on risk stratification, especially making use of recent advances in assessing polygenic risk, offers major potential benefits.
The Role of Childhood Cancer Civil Society on Cancer Control on Low-Income Countries
Authors: Manirakiza A.
Published: September 2018

Background and context: Over 250,000 new pediatric cancer cases are diagnosed yearly worldwide. In the developing countries, the childhood cancer burden is estimated to increase even more. Rwanda Children's Cancer Relief (RCCR) is a nonprofit organization with a mission to ensure that children with cancers access high standards of treatment and support. After realizing that majority in our community lack information on childhood cancers, our efforts since 2014 has been concentrated on raising awareness of childhood cancers. Aim: Raise awareness on childhood cancer among community members. Strategy/Tactics: During a massive walk, trained volunteers with informative brochures, posters in both local and international languages comprising information on early symptoms of childhood cancers, ways to navigate referral system among others are used during community outreaches. These activities are aired on national radios and TVs, newspapers and social media are also used to spread information. Program/Policy process: Many activities are carried out in September during the RCCR Annual Childhood Cancers Awareness Month. We involve community health workers, private sectors and academic institutions. We focus on talks, community outreaches and childhood cancers awareness activities. Outcomes: 2017 campaign included the aforementioned activities and was concluded by a walk dubbed (#KidsCancerWalk2016) which attracted more than 600 participants. Two local TVs, 6 radios and 7 online diaries covered the campaign in its different phases. More than 1000 posters, 1100 brochures and 500 flyers were distributed followed by intensive online campaign with more than 100 Facebook posts, 350 Tweets, and 700 Retweets. Strong partnerships with private, public sectors were created and Ministry of Health approved September as the national childhood cancer awareness month following RCCR campaigns. What was learned: Childhood cancers are fatal when left untreated but treatable when they are detected at an early stage. Activities that RCCR carry out on annual basis increase the general population knowledge about childhood cancers. Civil societies like RCCR play a crucial role in addressing the growing burden of childhood cancers and the disparities in access to and quality of care. They can also influence policy changes and address the specific patients' and community needs.
Symptom Burden in Oral Cancer Patients During and Postcancer Treatment
Authors: Sundaramoorthy C. , Pooja V. , Surendran V.
Published: September 2018

Background: Oral cancer is one of the most common cancers seen in India which accounts for about 30% of all type cancers, with ranking as the top most among male. Due to advancements in diagnostic and treatment modalities, the survivorship of oral cancer patients has increased significantly during the last decade. Yet, the treatment of cancer accompanies symptom burden and psychosocial problems that impacts the quality of life of the patients. Aim: To assess the symptom burden among oral cancer patients during and post cancer treatment. Methods: A cross-sectional investigation was conducted to assess the symptom burden of 100 oral cancer patients (age range= 18-65 years, mean age=49.76) from a regional cancer institute (WIA), Chennai, India. Among them, 59 patients were under treatment and 41 had completed the treatment. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and QLQ-H & N 35 module were used. The dependent t-test was used to compare two groups and Spearman correlation coefficients were used to assess the relationship between symptoms and demographic variables. Results: Significant difference was observed in the levels of pain and insomnia on symptoms scale of QLQ-C 30 between patients receiving and completed treatment ( P < 0.05). Similarly, pain score on QLQ-HN 35 differed significantly between the patients on and after treatment ( P < 0.05). In the QLQ-HN 35 module, dry mouth, opening mouth, sticky saliva, pain and tooth problems ranked as most worsening symptoms among oral cancer patients. However, in the QLQ-C 30, financial difficulties, fatigue and pain were ranked as the most worsening symptoms among oral cancer patients. Scores were significantly associated with a number of demographic variables such as age, gender, education, disease stage, time since diagnosis and treatment ( P < 0.05). Conclusion: Oral cancer patients experience numerous worsening symptoms during as well as, posttreatment. This study emphasis the importance of assessing the symptom burden of the patients throughout the course of and completion of treatment as effective management could be implemented.
In the World of Politics and Stigma Around Cancer, Can Cancer Survivors With Political Career Become Cancer Advocates?
Authors: Abdullah M.
Published: September 2018

Background and context: According to WHO estimates in 2012, around 20,000 Afghans suffered from various types of cancers while around 15,000 die of this disease. Until late 2015, there was not a single dedicated bed for cancer patients nor there was a doctor, nurse or other cancer care professionals within the structure of Afghan government, especially within the Ministry of Public Health. In November 2014 when Dr. Shinkai Karokhail, member of parliament, returned Afghanistan after spending almost a year overseas for breast cancer treatment misdiagnosed in Afghanistan, she and H.E. the First Lady, Rolla Ghani, began advocating for cancer prevention and control in Afghanistan. They managed to bring the few cancer care professionals and advocates under one umbrella called Afghanistan Cancer Foundation (ACF). Aim: To provide cancer care services to cancer patients. Strategy/Tactics: The main strategy was the involvement of known social and political figures in cancer advocacy. Considering the disparity in cancer incidence among men and women and breast cancer being the leading cancer, one of the most influential people was H.E. the First Lady who is a strong advocate of women rights. The other tactic was the involvement of members of parliament who were cancer survivors. Program/Policy process: Once the political commitment regarding cancer prevention and control was gained, H.E. the First Lady and members of parliament asked the Ministry of Finance to allocate fund for cancer prevention and control. Thus, first fund of only $50,000 was provided by the Ministry of Finance provided to Ministry of Health in the fiscal year 2015. Outcomes: As a result of the advocacy efforts by cancer control advocates, especially by Ms. Shinkai Karokhail, the breast cancer survivor, and H.E. the First Lady of Afghanistan, the first 10-bed day-care and 29-bed IPD cancer center was established in Afghanistan in March 2016. Subsequently, the National Cancer Control Program (NCCP) was created in January 2017 within the Ministry of Public Health. In addition, the first hospital-based cancer registry was formed which will be followed by establishment of Kabul Cancer Registry. The only cancer center provided health care services to around 12,000 patients in 2017 who were either not receiving cancer care services or were traveling to neighboring countries for diagnosis and treatment. What was learned: Cancer patients/survivors who have political career can be the best cancer prevention and control advocates.
Fostering a Multisectoral Approach in the Fight Against Cancer in Uganda: The Launch of the National Cancer Symposium
Authors: Olodi D. , Asiimwe P. , Ebusu P.
Published: September 2018

Background and context: The 70th World Health Assembly Cancer Resolution was passed in May 2017. In Uganda, there is a clear need for social mobilization and to involve all stakeholders in the process of implementing the Cancer Resolution. The National Cancer Symposium (NCS) was launched on the 28th February 2018 to create an inclusive process where all sectors and stakeholders are engaged in the dialogue and processes leading to effective cancer control in Uganda. Aim: To build a systematic and impactful response to cancer epidemic in Uganda through a multisectoral approach. Strategy/Tactics: These included but not limited to; partnership through the TWG, media campaigns, lobbying, team meetings and panel/plenary discussions. Program/Policy process: NCS is an annual joint stakeholder event that will foster stakeholders' discussion and stock taking of progress made toward implementation of cancer control efforts. A Technical Working Group (TWG) comprised of representation from government, WHO, civil society, academia, professional bodies and international partners, has been constituted to lead the planning, coordination and execution. Outcomes: Increased collaboration and partnerships built among partners as demonstrated in commitment for joint cancer control efforts. A total of over 300 participants attended the event representing different agencies including religious groups, private sector, media, policy makers, government ministries and departments, civil society, development partners, cancer survivors and patients, and the general public. Wider publicity gained as over 3 national level newspapers ( New Vision, The Observer, and The Monitor publications) run the story about NCS. A total of 1028 people reacted to our posts on Facebook with 41 likes, 40 post clicks and 2 shares. The Prime Minister re-echoed the restoration of radiotherapy services and made commitment on the procurement of more radiotherapy equipment as the construction of the new bunker progresses. The panel discussion led to the recognition that cancer control requires a multisectoral approach if interventions are to become more effective. Deliberations at the panel discussions re-echoed the need for the population to be sensitive to the risk factors including tobacco usage, body activity, proper diet with emphasis on vegetables and fiber, among others. What was learned: We learned that through coalescing with stakeholders, we are able to come up with a much stronger voice. The working of the TWG of this symposium is a clear testimony to this. We also learned that the media is an important partner for greater visibility to be realized. There is great need for continuous engagement among stakeholders to influence policy decisions and general intervention in the fight against cancer.
Breast Cancer Pathology Reporting in a LMIC: Filling in the Gaps
Authors: Joseph A. , Salako O. , Agaga L.
Published: September 2018

Background: Breast cancer biology has been studied extensively over the past 5 decades, with a deeper understanding of the epidemiologic, clinical, and prognostic value of specific pathologic features. Tumor characterization beyond histologic type has been shown to guide treatment choices and ultimately improve outcomes. Pathologic features such as tumor grade, margin involvement, hormone and growth factor receptor overexpression, are all pieces of the puzzle that a clinician must put together to adequately map out the best treatment options available to the present-day breast cancer patient. Guidelines for breast cancer pathology reporting have been published, with universal consensus regarding the basic elements required to make a breast cancer pathology report complete. Aim: The aim of this study was to assess the completeness of pathology reports of breast cancer patients at all stages of diagnosis or treatment, presenting in an oncology department of a Nigerian teaching hospital over the period of one year. Methods: Pathology reports of 981 breast cancer patients attending the oncology clinic in 2016 were analyzed. Reports originated both from within the teaching hospital and from external pathology centers all over the country. Eight parameters were selected to analyze completeness of the reports: Specimen type, histologic type, immunohistochemistry, margin involvement, lymphovascular space invasion, pathologic stage, and tumor grade. Results: Of 981 pathology reports analyzed, 20.9% originated from the hospitals' pathology department. Specimen type was documented in 86% of reports. 24% of did not specify the histologic type, and almost half (44%) of reports did not specify the grade. 72% of the pathology reports did not have immunohistochemistry results ( Fig 1 ). Presence or absence of lymphovascular space invasion was reported in 10%; margin status in 32.3% ( Fig 2 ). Tumor stage was documented in 45%. Ki-67 was not reported in 99% of the pathology reports (Fig 3). Conclusion: Breast cancer survival has improved significantly globally; however LMICs such as Nigeria continue to lag behind. The reasons for this are undoubtedly multifactorial, however inadequate pathology reporting is worth exploring in the context of assessing the consequences of clinicians making decisions, armed with limited information regarding the biology of the tumor they are treating. In general, reports originating from within the hospital's pathology department were more complete than those from referring centers, with up to 7 out of 8 parameters present in at least 50%. Pathology reporting of breast cancer must be standardized in LMICs. Hundreds of years after Cheatle and Cutler first published their pathologic findings from breast cancer specimens; clinicians should no longer be subjected to the practice of making treatment decisions using inadequate data. Perhaps this will bring us one small step closer to achieving survival rates comparable to the rest of the world.[Figure: see text]
Trends of Colorectal Cancer Incidence in Thailand by Age, Gender, and Region
Authors: Jeon J. , Meza R. , Rozek L. , Sriplung H.
Published: September 2018

Background: Colorectal cancer (CRC) is the third most common cancer in the world. While CRC incidence has decreased in many western countries over the last decades, largely thanks to screening, it is increasing in low and middle-income countries, including Thailand. However, it is unclear if these increases are consistent across different regions, gender and age groups. Aim: To understand the age-, gender- and region-specific temporal variation in CRC incidence in Thailand since the 1990s. Methods: We analyzed CRC incidence data from the Thailand National Cancer Network (TCIN) cancer registries, which include Chiang Mai (1990-2012), Lampang (1993-2014), Lopburi (2000-2014), Khon Kaen (1990-2014) and Songkhla (1990-2014) cancer registries. Trends in age-adjusted incidence (measured by annual percentage change (APC)) were assessed using Joinpoint regression. Trends by birth-year and calendar-year were assessed using age-period-cohort models. All analyses were done by region, gender, and age group (30-49, 50-84, 30-84). Results: CRC incidence has been increasing significantly in all regions, gender, and age groups; Overall, the APC was 3.82 for men and 3.84 for women (Chiang Mai, 4.34 for men & 3.26 for women; Khon Kaen, 2.69 for men & 3.68 for women; Lampang, 2.13 for men & 3.37 for women; Lopburi, 5.31 for men & 4.67 for women; Songkhla, 4.67 for men & 4.32 for women). The increase in incidence was higher for ages 50-84 (APC = 3.99 for men & 4.04 for women) compared with ages 30-49 (APC=2.97 for men & 3.09 for women). Test of parallelism suggests that increases are consistent between gender (P-value=0.97). The age-period-cohort analysis suggests that both calendar-year and birth-year are strongly correlated with CRC incidence trends, with a stronger relationship with birth-year than calendar-year for both genders. Conclusion: In contrast to western countries such as the US, CRC incidence is increasing across all age groups in Thailand, with faster increase in older ages. This highlights the needs for establishing population-wide screening programs to reduce the burden and stop the rise of CRC in Thailand and low-middle income countries.
Comprehensive Analysis of Cancer Burden in Andaman and Nicobar Islands: A Descriptive Study
Authors: Shahid P.P. Abdul
Published: September 2018

Introduction: Cancer is one of the leading causes of mortality and morbidity worldwide. The common sites of cancer have varied distribution in different geographical locations. This study was conducted to determine the demographic profile in cancer patients at a tertiary care teaching hospital in Andaman and Nicobar Islands. Methods: A retrospective study was carried out in Oncology OPD of G.B Pant Hospital, ANIIMS, Port Blair. Data were collected from hospital based registry for demographic profile of cancer patients, who attended oncology OPD, between January 2015 to January 2016, with a pretested and validated structured format. Data were analyzed in the form of percentage and proportions. Results: A total of 275 patients attended Oncology OPD in one year, out of which 138 of the total cases were males. Seventy percent of patients belonged to South Andaman province. 15 patients were of indigenous tribal origin of Andaman and Nicobar Islands. Cancer was most common in the age group of 50 to 69 years, which comprised 48.7% of the total cases. Oral cancer was overall, the most common cancer. It comprised 19.27% of all the cases, followed by breast cancer comprising 16.36% of the total cases. The most common site of malignancy noted in males was oral cavity, comprising of 31.15% cases, followed by lung, with 9.4% cases. In females, the most common site of malignancy was breast, comprising 32.8% of the total cases, followed by cervical, with 7.2% of the total cases. Majority of the patients, 64.36% were in advanced stage of cancers at the time of diagnosis. Conclusion: Head and neck cancers are more prevalent in population of Andaman & Nicobar Islands and the reasons for this should be explored for better control of malignancies in the island. Thus, cancer registration helps the public health professionals to understand the dynamics of cancer incidence for the formulation of future strategies.
Patient-Reported Outcome Measures Among Breast Cancer Survivors in Malaysia: A Comparative Study With Patients From High-Income Countries
Authors: Lim Z.Y. , Rajaram N. , Song C.V. , Kaur R. , Taib N.A. Mohd , Muhamad M. , Ong W.L. , Schouwenburg M. , See M.H. , Teo S.-H. , Saunders C. , Yip C.H.
Published: September 2018

Background: Patient-reported outcome measures (PROMs) are essential for identifying how patients perceive the outcomes of their cancer treatment, and is the ultimate success of cancer care. Although a growing number of studies have focused on PROMs in high income countries (HICs), outcomes relevant to patients in developing countries are less understood. Furthermore, the lack of standardization in PROMs makes it difficult to interpret these data for research or quality monitoring. Aim: In this study, we compared the results of PROM measures between patients in Malaysia, a middle income country, and those in HICs, using standard PROMs questionnaires. We also explored the differences in perceived importance of patient reported outcomes within the multiracial Malaysian cohort. Methods: Breast cancer patients (n=1063) were recruited in hospitals serving suburban areas of Malaysia. Of these, 969 patients were eligible for analysis. The surveys were conducted through face-to-face interviews (68%) or were self-administered (30%). An outcome was considered important if it was scored between 7-9 on a 9-point Likert scale. We compared PROMs scores between Malaysian patients and data previously collected from patients in HICs using logistic regression models, adjusting for demographic and clinical characteristics. A two-step cluster analysis was conducted to explore differences in the perceived importance of PROMs between clusters of Malaysian patients. Results: Compared with 1777 patients from HICs, Malaysian patients were less likely to rate overall and recurrence free survival, as well as emotional, cognitive, social and sexual functioning as very important outcomes. Interestingly, more Malaysian women reported that pain (50% vs. 39%), breast symptoms (51% vs. 35%), and major complications (60% vs. 44%) were very important outcomes ( P < 0.001). Compared with young, married Malaysian women, the cluster of older married women (mean age of 57 vs. 52), who were less likely to have received breast reconstructive surgery (8.6% vs. 16.8%), was more likely to rate sexual functioning (32.8% vs. 25.0%, P = 0.036), body image (63.9% vs. 42.4%, P < 0.001), and satisfaction with the breast (50.7% vs. 37.0%, P = 0.011) as very important outcomes. Conclusion: The differences in breast cancer patient needs between and within populations should be considered carefully to better clinician-patient relationship, patient care and satisfaction and assess the outcomes of our cancer care. Future research is needed to find suitable targeted interventions to identify and address the diverse needs of breast cancer patients in low and middle income countries.
Prevalence of Tobacco Consumption Among Coal Mine Workers in Neyveli Lignite Corporation, Cuddalore District, Tamil Nadu, India
Authors: Dhamodhar D.
Published: September 2018

Background: There is a dearth of literature on prevalence of tobacco consumption among coal mine workers. Aim: To assess the prevalence of tobacco consumption among coal mine workers in Cuddalore District, Tamil Nadu, India. Methods: A cross-sectional descriptive survey was conducted among 603 coal mine workers in Cuddalore District. Simple random sampling method was used to recruit the subjects. Informed consent was obtained from the participants. A pretested questionnaire was used to collect data on tobacco consumption. The data were entered in Microsoft Excel sheet. SPSS software version 20 was used and descriptive statistics was used. Results: All 603 subjects were males. The mean age of the participants was 35.01 (±8.77). Totally, n=197 (32.67%) subjects reported smoking habit. Of those who reported of smoking habit, cigarette smoking was reported by n=172 (87.2%) subjects. Bidi smoking was reported by n=25 (12.8%) subjects. None of the smokers reported of using smokeless form of tobacco. Conclusion: High prevalence of tobacco smoking was observed among the workers. Combined and organized initiatives by the health care professionals, management and the people should be taken to reduce the tobacco consumption. Common risk factor approach and behavior counseling can be advocated to change their attitude toward tobacco consumption. To start tobacco cessation clinics to aid the workers in cessation of tobacco consumption. To advertise about the ill effects of tobacco by displaying pictures and information in public area and work places.
Radiotherapy Facilities, Equipment, and Staffing in Brazil: A Survey by the Brazilian Society of Radiation Oncology
Authors: Moraes F.Y. , Mendez L.C. , Marta G.N. , Rosa A.A. , Weltman E.
Published: September 2018

Background: The rising incidences in cancer, together with the population aging have increased the demand for radiotherapy (RT) services in Brazil. Currently, Brazil faces a dearth of RT and solutions to provide a more universal care to cancer is a hot topic in this country. Aim: To evaluate the current status of RT department, staffing, and techniques in Brazil for 2017 following the launch of the National Cancer Program and the EXPANDE program. Methods: The Brazilian Society for Radiation Oncology (SBRT), sent detailed, online-based survey to heads of departments of all Brazilian RT centers (public and private), located in the 27 states in 2017. The survey included questions related to personnel, equipment, type of the center, and % of patients treated (private exclusive (≥ 90% of the treatments focused the private system) or public exclusive (≥ 90% of the treatments focused the public system) or mixed). Respondents were asked to provide average data from the last 5 year. For final analysis we grouped the states per region north, northeast (NE), central-west (C), southeast (SE) and south. A descriptive analysis was performed. Results: A total of 142 responses from 212 sent surveys (67% response rate) were received from 23 states. The total number of the departments and median functioning years per federative region was: 7 departments and 8 years in the north; 27 and 13 years in the NE; 7 and 11.5 years in the central; 27 and 17 years in the south; and 72 and 20 years in the SE region, respectively. The rate of radiation oncologist, physicist, nurse and dosimetrist per department was 3.0, 2.0, 1.7, 0.2 (north), 3.2, 2.4, 1.6, 0.7 (NE), 2.5, 1.7, 1.0, 0.3 (central), 3.4, 2.6, 1.6, 0.7 (south) and 3.9, 2.8, 1.6, 0.9 (SE), respectively. High dose rate brachytherapy was offered by 70% of the departments in the north, 55% in the NE, 30% in the central, 40% in the SE and 37% in the south region, respectively. Ninety-five percent of the department had at least one linear accelerator and only 5% had exclusively cobalt machines. The minority of the centers offered intensity modulated RT (36%) and image-guided RT (42%). 3D-conformal was the technique offered by 87% of the departments and 18% of them still treat patients with 2D technique. Overall, 30% of the departments provide services to the public health system exclusively, 1% to the private sector only and 69% of the department to both private and public. Conclusion: Important heterogeneity in the number of departments and professionals involved within RT services among Brazilian regions was found. Most departments were found to be in operation > 10+ years, indicating the need for recent hardware and software update and/or maintenance. 3D-conformal is the most common offered technique and mixed approach (public and private partnership) is the most common model of business in the country.
Dietary Pattern in Relation With CRC Risk Among Moroccan Population; A Multicenter Case-Control Study
Authors: Boudouaya H.A. , Elkinany K. , Deoula M. Sidi , Hatime Z. , Elasri A. , Abda N. , Hliwa W. , Khouchani M. , El Abkari M. , Nejjari C. , El Rhazi K.
Published: September 2018

Background: Colorectal cancer (CRC) is a global public health problem, an estimated of 1.4 million cases were diagnosed worldwide in 2012. Studies in health and nutrition confirmed that dietary factors were strongly associated with CRC risk. Aim: The objective of this empirically study was to reveal unobserved dietary profiles that were associated favorably or unfavorably with CRC risk in Moroccan study population. Methods: This case-control study included a total of 2906 participants in five centers, 1453 cases and 1453 controls, and was gender, age and center matched. Statistical exploratory data reduction methods were performed in this study population based on a specific scientific hypothesis linking dietary behavior and colorectal cancer risk. Principal component analysis (PCA) was applied separately in cases and in controls as individuals and with FFQ nutritional group's heads items as variables. The correlation matrix of food variables was examined to explain most of the variation in the data, reducing a large number of food variables to a smaller set that captures the major dietary factors differences in Moroccan population. Results: Three alimentary profiles were identified for controls based on three principal component analysis, which the first one was highly positive with high cereals, fruits and nuts, legumes, fish, olive oil, dairy products and legumes consumption, and was highly negative with an increasing consumption of poultry and red meat. This component explained 26.5% of the variance in initial data and described a healthy pattern characterized with high fiber intake. In opposite, five principal components were identified for cases that indicated five nutritional profiles with a predominance of dairy products, nuts, fish consumption and low legumes, olive oil and fruits intake: its explained 15.37% of total variance. Conclusion: PCA analysis is a multidimensional factor analysis method that was used in this epidemiologic study to describe the variance in our big database in relation with CRC risk among Moroccan people. This method needs a supervised analysis such as linear discriminant analysis (LDA) to give interpretation and prediction models of CRC risk related to nutritional behavior among this study population.
Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations and Colorectal Cancer Risk in Morocco: A Case-Control Study
Authors: El Kinany K. , Huybrechts I. , Kampman E. , Boudouaya H.A. , Hatime Z. , Deoula M. Mint Sidi , Benslimane A. , Khalis M. , Nejjari C. , Ibrahimi S.A. , El Feydi A.E. , Mrabti H. , El Rhazi K.
Published: September 2018

Background: Currently, colorectal cancer (CRC) incidence and mortality were rising in African countries; these rates are alarming and should be considered to make prevention policies. The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) released 8 recommendations on body fatness, physical activity and diet to prevent against cancer development. Aim: The current study was designed to evaluate the association between the WCRF/AICR recommendations and the risk of CRC in a case-control study among Moroccan adults. Methods: A case-control study was conducted in 5 Moroccan hospital centers, including 1516 cases and 1516 controls. The study was matched on sex, age (± 5 years) and center. The habitual diet was assessed with a validated food frequency questionnaire. Adherence to WCRF/AICR recommendations was evaluated through a score that incorporates 6 components (body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, alcoholic drinks). Each related component recommendation was rated using a score of 2 levels: (1) when the recommendation was met; (0.5) when the recommendation was partially met; (0) when the recommendation was not met. The overall WCRF/AICR score ranged from 0 (no adherence to WCRF/AICR guidelines) to 6 (high adherence). To categorize this score, we calculated the tertile cut-offs of controls (reference population) for both sexes (men and women separately) that we applied on the whole population. Conditional logistic regression was used to calculate ORadjusted and its 95% confidence intervals adjusted for age, residence, education level, monthly income, family history of CRC, smoking status, BMI, physical activity, total energy intake, and alcohol intake unless the variable was part of recommendation under evaluation. Results: CRC risk was significantly reduced with increasing adherence to each WCRF/AICR recommendation: for body fatness (ORa = 0.47; 95% CI, 0.36-0.63), physical activity (ORa = 0.33; 95% CI, 0.24-0.45), sugary drinks (ORa = 0.58, 95% CI, 0.42-0.80), plant foods (ORa = 0.18; 95% CI, 0.12-0.29) and animal foods (ORa = 0.47; 95% CI, 0.36-0.62). Also a significant inverse association was observed for the highest category of adherence to WCRF/AICR guidelines for CRC risk (ORa = 0.29; 95% CI, 0.23-0.37) compared with the lowest category. Conclusion: The WCRF/AICR index including a combination of 6 components showed strong protective associations for CRC risk in Morocco. These results confirm the importance of promoting the WCRF guidelines among the Moroccan population to prevent CRC incidence.
The Unbelievable Story of the HPV Vaccination Program in Colombia...From a Beautiful Dream to a Nightmare!
Authors: Castro C.J.
Published: September 2018

Background and context: When the Ministry of Health of Colombia decided to provide the HPV vaccination free of charge to all Colombians girls age 9-13 in the year 2012 we were very happy. Aim: This certainly was a wise decision in the right direction in a country where cervical cancer is a major public health issue. Strategy/Tactics: The campaign was launched with great enthusiasm and in the first two years we were able to vaccinate 95% of the targeted population. Program/policy process: But in Colombia, happiness seems to be of short duration. In a small village of the Caribbean region (Carmen de Bolivar), 15 girls were admitted to the emergency of the local hospital with bizarre symptoms such as abdominal pain, headaches, dizziness, some did faint on admission. All the girls were adolescents from the same school and grade. Initially the situation was attributed to a kind of food poisoning. Who and why “someone” decided to blame this clinical syndromes to the HPV vaccination is something that still remains in mystery. Specially when the vaccination was administered many months before. Unfortunately, the media, some lawyers and some irresponsible local politicians took advantage of this situation to promote social unrest, blaming the government and the pharmaceutical company that produces the vaccine as the culprits of the medical event and looking for economic compensations. Outcomes: To make things worse, the Colombian Academy of Medicine wrote an unfortunately statement that gave support to discredit the safety of the vaccine. Fortunately, but late, two months later a new statement was published by the Academy saying that the vaccine was safe and encouraging the Ministry of Health to continue the program. But the damage was done! The vaccination dropped from 95% to 14%. And three years after the episode we haven't been able to recover our initial figures...we are still below 20% nationwide. What was learned: There are many things that need to be learned from the Colombian nightmare. First...Communication is of major importance in dealing with a health crisis. The health authorities need to give quick answers and reassure the community about the safety of the vaccine. The academia and the scientific societies are obliged to pronounced themselves in an issue of such importance and invite their associates to encourage the vaccination among adolescents. Second...empower women making them realize that this program is for their daughters that deserve a better future free of cervical cancer. Third, educate the community, the medical doctors and nurses regarding the safety and importance of the vaccine. We must speak up! And don't tremble and look weak in front of the virulent antivaccine groups. What happened in Colombia can happen in any country. And the consequences will be paid by the next generation. There are no excuses! Not a single women should die of cervical cancer in the future. Not a single one.
Application of Database and Data Science Techniques in the Malaysian Breast Cancer Survivorship Cohort STUDY
Authors: Ganggayah M.D. , Taib N.A. , Islam T. , Dhillon S.K.
Published: September 2018

Background: Breast cancer is one of the leading cause of mortality among women worldwide. The Breast Cancer Resource Centre (BCRC) of University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, started the Malaysian Breast Cancer Survivorship Cohort (MyBCC) study in 2012. Aim: As a further enhancement of the research, the MyBCC database has been developed to conduct the survey in a convenient way, which aims to predict the factors influencing different survival rate among patients from multiethnic origin using data science techniques. Methods: The database comprised of life style related data of the patients including demographic factors, information on other illness, clinical factors, quality of life, psychosocial support, physical activity, work related questions, depression score, family background, type of medication consumed and financial status of the patients. This paper presents an approach to build an automated workflow using the MySQL database management system and PHP, integrated with R and HTML for web display. Results: A relational database comprising 816 breast cancer patients' data were developed for the MyBCC cohort study. This database serves as the backend for the MyBCC application where researchers can register new patients' records, update and view the information of recruited patients by using the system in a more commodious environment than before. Besides, the MyBCC database has been integrated with R programming tool by deploying the RMySQL package to perform audits. A few important analysis using plotly package, leveraging the integration of R with database are presented. Conclusion: In this paper, the development of the MyBCC database is presented, with the aim to automate the manual process of data entry, storage and analysis for performing audits for the breast cancer cohort study. The integration of database with R for automated analysis of data are also shown using examples of predictions that can be generated using functions in R. This fully automated workflow reduces the workload and time taken in performing manual predictions using data sources stored in flat files.
Cancer Awareness Among Adults in the Kilimanjaro Region
Authors: Henke A. , Henke O. , Serventi F.
Published: September 2018

Background: Approximately 14 million new cases were diagnosed with cancer internationally and 8 million of these new cases were diagnosed in low-resource regions according to the International Agency for Research on Cancer (IARC). For Tanzania, it is estimated that the cancer incidence will double in the year 2030, from 37,000 new cases in 2015 to more than 61,000 cases. In Tanzania is a high prevalence of Burkitt´s lymphoma in children, cervical and breast cancer in women, and prostate and esophagus/stomach cancer in men. Many types of cancer could be prevented by modifying lifestyle choices (e.g., reduce of alcohol consumption and HPV-vaccinations etc). In Tanzania very few studies were published about cancer awareness. A Kilimanjaro Christian Medical Center (KCMC) based-registry shows that the majority of patients come in the late stages of cancer to the hospital. In 2017 came in total 760 patient and 85% of them showed up in stage III and IV. Reasons why patients come so late is a lack of knowledge about the cancer symptoms and risk factors and the people in the Kilimanjaro Region are not aware of the new Cancer Care Centre at KCMC which opened in December 2016. Aim: A cross-section study want to gain a deep understanding of the cancer knowledge in the community for future focus programs. This survey want to identify the knowledge of cancer, awareness of cancer risk factors and treatment options among adults in the Kilimanjaro Region. Methods: In collaboration with Berlin Charité in 2017 started a cross-section study about prevention and awareness among adults in the Kilimanjaro Region. In total over 5000 people will be interviewed in all 7 districts in the Kilimanjaro Region from October 2017 until April 2019. The study use will a valid questionnaire with 46 items about cancer awareness, cancer knowledge, risk factors and treatment options. First preliminary results: Since October 2017 over 2000 people were interviewed in Siha, Moshi Urban and Moshi Rural district. First preliminary results give already a overview about the demographic characteristics in the Kilimanjaro Region and the knowledge about cancer and the awareness about cancer risk factors in the community. 52% of the community members consider cancer as a problem in the community. 12% of this people have currently somebody with cancer in the household. Most known cancer types are cervical cancer and breast cancer. 14% of the people have never heard about cancer. Only (35.0%) knew ≥1 risk of cancer. Majority were not even able to justify their specific aspects in related to cancer. Results: About 2 cancer risk factors: 28% of the community members drink 2 times per week and more alcohol, only 3% smoke cigarettes currently and 31% eat more than 3 times a week red meat. Conclusion: Overall about cancer in the community is very poor. Especially in the rural areas is a strong need for more education and awareness.
Scaling Up of Cervical Cancer Screening at Primary Health Care Level in Rwanda
Authors: Francois U. , Balinda J.P. , Hagenimana M. , Samuel R. , Arielle E. , Muhimpundu M.A.
Published: September 2018

Background: Rwanda is a high cervical cancer-burden country, with an age standardized rate (ASR) of cervical cancer incidence of 41.8 cases per 100,000 people in 2012. In the same year, cervical cancer mortality lay at 26.2 deaths per 100,000 people. Aim: To address this burden, Rwanda initiated the vision inspection with acetic acid (VIA) screening-based strategy in 2013 in line with WHO recommendations for low- and middle-income countries. The target audience of the program was set for women between the ages of 30 and 49 and remains today. Here, we describe the implementation status of the program at the primary health care level; health centers and district hospitals in Rwanda. Methods: Integrating into Rwanda's existing health system, the program was purposefully rooted in health centers, with a pathway designed for women who screen positive to be referred to the district hospital for cryotherapy or LEEP, according to the lesions' size. Nurses, midwives and medical officers from health centers and district hospitals are trained through a 10-day curriculum (5 days for theory and 5 days for practice) before initiating the provision of services to clients in routine care. Monitoring of the program is conducted through both quarterly, on-site mentorship and screening indicators that are integrated into Rwanda's Health Management Information System (HMIS), through which facilities report on monthly basis. Results: Since its initiation in August 2013, Rwanda's cervical cancer screening program has been established in 21 of 38 (55%) district hospitals and 256 health centers in their catchment area. Training has been an integral component as well, with at least two nurses/midwives trained at implementing health centers and a medical officer with two nurses/midwives trained on cervical cancer screening and the treatment of precancerous lesions at district hospital. In addition, district hospitals have been equipped with cryotherapy, LEEP, and colposcopy machines. Over this program's implementation three-and-a-half-year course, 38,000 women have been screened for cervical cancer. Conclusion: Using a simple VIA-based strategy, Rwanda has been able to swiftly and effectively increase the number of health facilities implementing cervical cancer screening program. Though additional innovative implementation strategies are still needed to proportionally increase women's screening coverage, these initial steps hold great promise in Rwanda's ability to effectively implement a sustainable cervical cancer screening program.