Surgical Management of Breast Cancer in Saudi Arabia: A Call For Improvement

Abstract

In carefully studied populations of the world, the incidence of breast cancer among women has shown an increase of 50% from 1960 to 1995. However, through screening programs and highly specialized, experienced multi-disciplinary teams using all modern diagnostic and therapeutic modalities available, the mortality has decreased and the relative survival (at 2, 5 and 10 years) has increased in this period.If age-specific incidence rates for Japan and USA were applied to the estimated female Saudi population in 1994, the yearly number of new breast cancer cases would be around either 500 or 3200. In 1994, 437 cases were reported in the country. 1 We currently receive 250-300 new cases every year. Every new patient is assessed by a team composed of a medical oncologist, a radiation oncologist and a surgeon. The assessment is based on referral notes from the outside hospitals, history, physical examination, review of outside pathology slides and x-ray films. The patient is then discussed in a conference (with a radiologist, pathologist, radiation oncologist, medical oncologist and breast surgeon). The plan for the patient's further work-up treatment and follow-up is decided upon and implemented. All follow-up visits are done in a combined clinic (medical oncologist, radiation oncologist, breast surgeon and, if needed, pathologist and radiologist). 2,3This study was part of a review of our current standards for work-up, treatment and follow-up of breast cancer patients. The aim of the study was: 1) to assess the standard management of breast cancer patients before referral to KFSH&RC; 2) to compare this management with accepted international standards of diagnosis, i.e., triple assessment (TA) (clinical examination, mammography and fine-needle aspiration); and 3) to discuss actions for improvement of the management of breast cancer patients, if found necessary. Patients and MethodsThe medical records of 100 consecutive patients referred to KFSH&RC during 1996 for breast cancer were pulled. Data was extracted from the charts during a two-week period. Ninety-two charts were available for review during that time. All data from the charts were transferred to a database for this study. The 92 patients were all women between 25 and 71 years of age (mean=45.3; SD=12.06) from all parts of the Kingdom. Results Clinical InformationThe referral notes mentioned palpable tumor size in 69.6%, tumor relation to the skin in 57.6%, and its relation to the underlying structures in 46.7% of the patients. The status of the ipsilateral axilla was mentioned in 69.6% of the notes, and information about the size of the tumor, together with its relation to underlying structures and to the skin, was available in 41.3%. The status of the tumor and axilla was accurately described to allow a clinical TNM classification in only 35.9% of the patients. Information About Pre-Referral Diagnostic ProceduresMammography was reported performed in 29.4% of the patients and the majority of those investigations were Surgical Management of Breast Cancer in Sa...

Surgical Management of Breast Cancer in Saudi Arabia before and after Outreach Activities

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