National Egyptian Model of Breast Cancer Care
Authors: Sallam Ibrahim M. , Amira Gamal , Yousri Ahmed 
Published: October 2018

Purpose Forty percent of Egyptians have access to the public health system, and 60% are served by nongovernmental organizations and private centers. A problem exists, however, with the late presentation and inadequate access to services because of a lack of a structured screening program and awareness. The aim of this work was to present a model of breast cancer (BC) care in a low-resource setting and to assess risk factors for BC in Egypt, which has a high incidence of BC on the basis of registry estimates that indicate that approximately 22,000 new BC cases will be diagnosed by 2020. Methods In the Giza region, there was no mammographic reference service. Women with breast symptoms were referred to the National Cancer Institute, where they were offered services—diagnosis and treatment—with long wait times. Women age 20 years or older visiting one of the five participating centers were evaluated in a cross-sectional study, which included a data entry form questionnaire of risk factors for BC, including a family history of cancer, and the presence of breast symptoms, and breast examination by a trained professional—nurse or medical doctor. All patients with breast complaints or an abnormal physical exam were referred to the National Cancer Institute, MISR Cancer Center, Kasr El Aini, Agouza, and Bahia Hospital for additional evaluation. Women age 40 to 69 years were invited to participate in the screening both actively (digital invitations, Facebook groups, brochures distributed in governmental buildings, and WhatsApp groups) and passively (women who visited other hospitals in the region for any reason were called and delivered brochures and vouchers to join the project). The screening program was based on annual mammographies in women age 40 to 69 years, which are always preceded by physical examination by a breast surgeon or trained nurse. Close control of the frequency of visits was kept using a simple computer program with patient listing and reminder. Close contact and continuous feedback that helped adherence to the screening program. The proposal of the project includes the performance of all clinical, imaging, and pathology exams, as well as clinical visits and surgical treatment, in the same center, in the shortest time, and with the highest standards of care. The health care approach is multidisciplinary and includes nurses, breast surgeons, and a nutritionist. Results A high rate of compliance is the main strength of project. We achieved this with patient education on the importance of screening, intense contact with the primary trained staff with the provision of patient lists of those who should be screened next, and free transportation for women with low income. Every 3 to 4 months, we established jointly a charity workshop and projects of handmade cloths and bags for patients with BC and encouraged social clubs and societies to host parties and educational BC advocacy campaigns. Conclusion A simple project was successful and its cost effectiveness is balanced in Egypt as a developing country where mortality associated with BC is high. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.