Modification and Implementation of NCCN Guidelines™ on Breast Cancer in the Middle East and North Africa Region

Abulkhair, Omalkhair; Saghir, Nagi S. El; Sedky, Lobna; Saadedin, Ahmed; Elzahwary, Heba; Siddiqui, Neelam; Saleh, Mervat; Geara, Fady; Birido, N.; Al-Eissa, Nadia; Al-Sukhun, Sana; AbdulKareem, Huda; Ayoub, Menar Mohamed; Deirawan, Fawaz; Fayaz, Salah; Kandil, Alaa; Khatib, Sami; Elmistiri, Mufid; Salem, Dorria; Sayd, El Siah Hassan; Jaloudi, Mohammed; Jahanzeb, Mohammad; Gradishar, William

doi:10.6004/jnccn.2010.0126

Cited by 36 publications

(30 citation statements)

References 45 publications

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“…It is also important to realize that patients in Libya have a mean age of 46 years, showing that premenopausal cancers are more common than in Europe. The age pattern is identical with the ages of breast cancer patients in Africa or Middle East and North Africa (MENA) region 3-5.…”

Section: Introductionmentioning

confidence: 58%

Prognostic Value of Proliferation Markers: Immunohistochemical Ki-67 Expression and Cytometric S-Phase Fraction of Women with Breast Cancer in Libya

Ermiah¹,

Buhmeida²,

Abdalla³

et al. 2012

J. Cancer

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Background: We evaluated the association of the immunohistochemical Ki-67 expression, and S-phase fraction with clinicopathological variables and patient outcome.Patients and methods: Histological samples from 100 primary Libyan breast carcinoma patients were retrospectively studied with monoclonal antibody to Ki-67. S-phase fraction was determined by DNA image cytometry.Results: The median Ki-67 percentage for all tumors was 27.5%, ranging from 1 to 80% and the median S-phase fraction (SPF) was 11%, ranging from 0 to 62 %. Tumors with high Ki-67 expression were found in 76% of patients and with high SPF values in 56%. Ki-67 expression was more frequent in tumors with high SPF than low SPF. High Ki-67 and high SPF were associated with advanced stages, poor differentiation of tumors, positive lymph nodes, and distant metastasis. The Ki-67 was associated with hormone receptor negative tumors. The SPF was higher in young patients (<50 years) than in older patients. In the overall population (median follow-up 49 months), patients with high Ki-67 and high SPF had shorter survival time and predicted recurrence than patients with low Ki-67 and low SPF. In a Cox multivariate analysis, high SPF (p= 0.007), hormonal status (p= 0.001) and clinical stage (p=0.005) were independent predictors of disease-specific survival. The Ki-67 (p=0.065) in borderline significance proved to be independent predictor of disease-free survival. The SPF showed more statistically significance with a high grade of malignancy and survival time than Ki-67.Conclusions: The SPF value is useful cell proliferation marker to assess tumor prognosis. These markers may reflect the aggressive behavior of Libyan breast cancer and predict of the recurrence. It is therefore important to take these markers into consideration to select a high risk subgroup of the patients for intensive treatment.

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Section: Introductionmentioning

confidence: 58%

Prognostic Value of Proliferation Markers: Immunohistochemical Ki-67 Expression and Cytometric S-Phase Fraction of Women with Breast Cancer in Libya

Ermiah¹,

Buhmeida²,

Abdalla³

et al. 2012

J. Cancer

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“…On other hand, the World Health Organization predicts an increase in cancer cases in developing countries. Significant advances in breast cancer management can probably improve the quality and efficacy of oncology practice in the MENA region [19,20]. …”

Section: Discussionmentioning

confidence: 99%

Diagnosis delay in Libyan female breast cancer

et al. 2012

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AimsTo study the diagnosis delay and its impact on stage of disease among women with breast cancer on Libya.Methods200 women, aged 22 to 75 years with breast cancer diagnosed during 2008–2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. This period (diagnosis time) was categorized into 3 periods: <3 months, 3–6 months, and >6 months. If diagnosis time was longer than 3 months, the diagnosis was considered delayed (diagnosis delay). Consultation time was the time taken to visit the general practitioner after the first symptoms. Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from medical records.ResultsThe median of diagnosis time was 7.5 months. Only 30.0% of patients were diagnosed within 3 months after symptoms. 14% of patients were diagnosed within 3–6 months and 56% within a period longer than 6 months. A number of factors predicted diagnosis delay: Symptoms were not considered serious in 27% of patients. Alternative therapy (therapy not associated with cancer) was applied in 13.0% of the patients. Fear and shame prevented the visit to the doctor in 10% and 4.5% of patients, respectively. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was associated with initial breast symptom(s) that did not include a lump (p < 0.0001), with women who did not report monthly self examination (p < 0.0001), with old age (p = 0.004), with illiteracy (p = 0.009), with history of benign fibrocystic disease (p = 0.029) and with women who had used oral contraceptive pills longer than 5 years (p = 0.043). At the time of diagnosis, the clinical stage distribution was as follows: 9.0% stage I, 25.5% stage II, 54.0% stage III and 11.5% stage IV.Diagnosis delay was associated with bigger tumour size (p <0.0001), with positive lymph nodes (N2, N3; p < 0.0001), with high incidence of late clinical stages (p < 0.0001), and with metastatic disease (p < 0.0001).ConclusionsDiagnosis delay is very serious problem in Libya. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast cancer. Especially, guidelines for good practices in managing detectable of tumors are necessary.

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“…All the patients subsequently underwent modified radical mastectomy after the last cycle of neoadjuvant chemotherapy. Treatment related side effects such as myelosuppression, nausea and vomiting were managed according to the National Comprehensive Cancer Network (NCCN) protocols (5) . None of the patients had any treatment modifications (e.g., delay, dose reduction or both).…”

Section: Methodsmentioning

confidence: 99%

Study to Compare TAC versus FAC Regimen as Neoadjuvant Chemotherapy in Locally Advanced Breast Cancers

S¹

2018

jmscr

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Modification and Implementation of NCCN Guidelines™ on Breast Cancer in the Middle East and North Africa Region

Cited by 36 publications

References 45 publications

Prognostic Value of Proliferation Markers: Immunohistochemical Ki-67 Expression and Cytometric S-Phase Fraction of Women with Breast Cancer in Libya

Prognostic Value of Proliferation Markers: Immunohistochemical Ki-67 Expression and Cytometric S-Phase Fraction of Women with Breast Cancer in Libya

Diagnosis delay in Libyan female breast cancer

Study to Compare TAC versus FAC Regimen as Neoadjuvant Chemotherapy in Locally Advanced Breast Cancers

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