Disease Watch
theHealth, 2011 (2)1:8-10
Breast cancer in Egypt: A fact sheet
N. Zawilla,
PhD,
is a researcher at
National Organization
for Drug Control &
Research, Cairo, Egypt
Breast cancer is the most common malignant tumor among
women. In Egypt, it is the most common cancer among
women, representing 18.9% of total cancer cases (35.1% in
women; 2.2% in men) among the Egypt National Cancer
Institute’s (NCI) series of 10,556 patients during the year
2001, with an age-adjusted rate of 49.6 per 100,000 people.
Breast cancer is unfortunately yet undoubtedly highly prevalent. However, a positive
diagnosis is not necessarily a death sentence.
Sadly, the lack of public awareness and the
financial shortages that impede screening
and diagnostic services render chances of
survival low and mortality rates correspondingly high.
Every October, breast cancer charities all
over the world participate in the international health campaign. Breast Cancer
Awareness Month (BCAM), dedicating their
efforts to raise both awareness and funding
for research on the prevention and cure. As
a Non-Governmental Organization (NGO)
registered under the Ministry of Social Solidarity, the Breast Cancer Foundation of
Egypt raises awareness of diagnosis, treatment and rehabilitation of breast cancer
through the provision of free education and
patient services.
On 23 October 2010, thousands of Egyptians fought for breath while fighting breast
cancer, as they embarked on the second
Egyptian Race for the cure around the Pyramids of Giza.
or reading, Egyptians had an ample opportunity to gain a wealth of knowledge of
breast cancer during the BCM, facilitated by
local NGOs.
Efforts to decrease mortality from breast
cancer in Egypt
At this time, the only way to decrease mortality and morbidity from breast cancer is to
detect the disease before the patient presents the symptoms. In Egypt, a national
breast-screening program to improve early
detection was launched by the Ministry of
Communications and Information Technology
in partnership with the Ministry of Health.
The program operates under the patronage
of Mrs. Mubarak, who was also a laureate
of the 2008 International Telecommunication
Union (ITU) World Telecommunication and
Information Society Award.
As a government-funded service, the program offers free-breast screening to Egyptian women over the age of 45 years nearly 5.5 million females conforming about
17.5% of Egyptian women.
Basic information about breast cancer
1. Types of breast cancer
BCAM is the perfect opportunity for women
to be reminded of the importance of early
detection, which is key in the treatment and
development of the disease. Whether racing
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There are many different types of breast
cancer including Ductal Carcinoma In Situ
(DCIS), Invasive Ductal Carcinoma (IDC),
Invasive Lobular Carcinoma (ILC), inflammatory breast cancer, male breast cancer, recurrent breast cancer, and metastatic breast
cancer. Breast cancer symptoms vary widely
- from lumps to swelling to skin changes - but
many breast cancers have no obvious symptoms at all. Symptoms that are similar to
those of breast cancer may be the result of
non-cancerous conditions like an infection or
a cyst.
Breast cancer in Egypt: A fact sheet
2. Human epidermal growth factor receptor
(HER2) & breast cancer
Knowing the biological makeup of the tumor
helps the doctor understand how quickly the
cancer might grow and what breast cancer
treatments may be best. It was found that
one in every five women with breast cancer
showed over expression of this growth factor
by the cancer cell owing to gene mutation
and hence therapy was focused on this finding. Doctors use a special regimen based on
drugs targeting the cancer cells over expressing this protein for the treatment of
HER2 positive breast cancer.
3. Stages of breast cancer
Stage 0 - carcinoma in situ
In stage zero, atypical cells have not spread
outside of the ducts or lobules into the surrounding breast tissue.
Stage I - early stage invasive breast cancer
In stage one breast cancer, the cancer is no
larger than two centimeters (approximately
an inch) and has not spread to surrounding
lymph nodes or outside the breast.
Stage II breast cancer
It is divided in two categories according to
the size of the tumor and whether or not it
has spread to the lymph nodes.
Stage III breast cancer
This stage is divided in two categories:
Stage III A breast cancer - the tumor is between 2 and 5 centimeters and has spread
to upto nine auxillary underarm lymph
nodes.
Stage III B breast cancer - the cancer has
spread to tissues near the breast including
the skin, chest wall, ribs, muscles, or lymph
nodes in the chest wall or above the collarbone.
Stage IV breast cancer
In this stage, the cancer has spread to other
organs or tissues such as the liver, lungs,
brain, skeletal system, or lymph nodes near
the collarbone.
Breast cancer treatment options
Depending on the risk factors and the stage
of the tumor, the doctor will select the appropriate breast cancer treatment plan for
the patient. Most patients with early breast
cancer will have surgery to get rid of as
much of the cancer as possible.
Types of surgery
1. Mastectomy
This surgery is recommended for those with
large tumors, widespread cancer, more than
one tumor in the same breast, recurrent tumors, advanced local disease, previously
radiated breasts, tumor(s) located in part of
breast that would give a strange appearance if lumpectomy is performed, Paget’s
disease (if extensive) and for males with
breast cancer.
2. Surgery of the lymph nodes
There are about 20-35 lymph nodes under
the arm. Removal and analysis of some of
these nodes give information about whether
the cancer has spread outside the breast.
The number of nodes involved is an important indicator of the stage of the cancer and
hence the recommendations for treatment.
Those who have invasive breast cancer much
have surgical intervention to the lymph
nodes to detect whether the cancer has
spread to them. If the spread has occurred,
the nodes must be removed.
3. Lumpectomy
Surgery
or
Breast
Conserving
This type of surgery is performed to remove
only the tumor plus some normal tissue
around it. This can only be performed in the
early stages of the cancer.
Radiation therapy
This therapy is a treatment performed with
high-energy rays aimed at the area around
the tumor.
Chemotherapy and Biologic Therapy
Chemotherapy is based on giving medications that have toxic effect towards rapidly
multiplying cancer cells as they interfere
with their uncontrolled growth and multiplication. Biologic therapy is based on monoclonal antibodies which are produced in a
laboratory by making multiple copies of a
single cell. Monoclonal antibodies are designed to recognize a specific protein on
theHealth | Volume 2 | Issue 1 | 9
Breast cancer in Egypt: A fact sheet
certain cells and signal the body’s immune
system to destroy the cell. Monoclonal antibodies are generally a more targeted therapy than chemotherapy.
What is secondary breast cancer?
Secondary breast cancer, also known as
metastasis, results when cancerous cells
break away from the primary breast cancer
tumor site, travel through the bloodstream or
lymphatic system, and implant themselves in
other areas of the body. This occurs when
breast cancer cells have extended past the
breast and underarm lymph nodes. This
situation is condisered the most advance
form of breast cancer, or stage IV. In the
case of metastatic cancer, the local cells in
that secondary region of the body have not
turned cancerous, but because the cells deriving from the primary site are cancerous, it
is still possible to have a tumor growth.
Breast cancer cells can travel to the lymph
nodes (including near the breast, neck, and
collarbone area), liver, bones, lungs, and
even parts of the brain, although such cases
are rarely seen. It is more common for metastasis to appear in one part of the body;
however, it is possible to have more than one
metastatic site. These metastatic cancer cells
can remain inactive for many years and then
suddenly begin to grow and cause symptoms.
What are the symptoms of secondary
breast cancer?
The symptoms of metastatic breast cancer
vary depending on where in the body the
cancerous cells have implanted themselves.
Most women, regardless of metastatic site,
experience general symptoms including:

Being more tired than usual

Experiencing low energy levels

Having a poor apetite
These symptoms resemble those for the cold
and flu and can even be the side effects of
chemo and radiotherapies. It is best for a
patient to address these symptoms with a
doctor.
A breast self-exam should be part of a
monthly health care routine. Females over 40
are at a high risk for the disease should also
have an annual mammogram and physical
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exam by a doctor. The earlier breast cancer
is found and diagnosed, the better the
chances of recovery.
The actual process of diagnosis can take
weeks and involves many different kinds of
tests. Waiting for results can feel like a lifetime. But once a patient understands his/her
own unique “big picture”, he/she can make
better decisions and formulate a unique
treatment plan with a doctor.
Is any irregular finding in the selfexamination always indicative of a cancer?
If unnatural lumps, infections, or any irregularities are detected in breast self examination, one should immediately consult a specialist doctor. It is possible that detected
irregularities are not cancerous; however
only a specialist doctor can identify and
determine its nature. Often, many may
avoid seeking immediate help from healthcare facilities as they are afraid of what
they might discover. People should be responsible for their own health through breast
self-examinations, routine visits to specialist
doctors, and routine X-ray mammography.
By taking a proactive approach to health,
one can control and increase the chances of
early detection and curability.
Conferences
Middle East and North Africa (MENA) Oncology Conference, organized by Fleming
Gulf, is due to take place on the 11-12
March, 2011, Cairo, Egypt. It will focus
mainly on breast cancer as it is the most
common type of cancer in the region. This
conference will include among other things,
new information, consolidated knowledge,
and conversations on controversial issues
regarding the prevention and risk of breast
cancer, imaging and screening, and new
approached in targeted therapies.
References:
1. Salem AAS, Salem MAE, Abbas H. Breast Cancer:
Surgery at the South Egypt Cancer Institute. Cancers.
2010;2:1771-8.
2. Race for the cure: Breast cancer awareness month
(http://www.almasryalyoum.com/en/news/race-curebreast-cancer-awareness-month).
3. http://www.herceptin.com/her2-breast-cancer/
treatment-options.jsp
4. http://www.nci.edu.eg/