Eastern Mediterranean Health Journal [2023; Vol.29, Issue 11]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

Eastern Mediterranean Health Journal [2023; Vol.29, Issue 1]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

Ecological study of breast cancer incidence among nationals and nonnationals in the Gulf Cooperation Council countries

Background: Breast cancer incidence is increasing in the Gulf Cooperation Council (GCC) countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates. Aims: This study analysed geographical patterns, time trends, and age distribution of female breast cancer incidence among nationals and non-nationals in GCC countries. Methods: Available cancer registry data for 1979–2016 were retrieved for the GCC countries. Age-standardized rates (ASRs) per 100 000 women were calculated using the World standard population. Comparisons were made by calculating comparative incidence figures. Results: From 1998 to 2012, incidence among nationals was highest in Bahrain (ASR 61.85), Kuwait (ASR 52.66), and Qatar (ASR 56.90) and lowest in Saudi Arabia (ASR 19.76), Oman (ASR 22.33), and United Arab Emirates (ASR 31.05). In the most recent period, data were available only in Qatar (2014–2016) and Saudi Arabia (2013–2015). Non-nationals and nationals in Qatar had higher incidence rates than in Saudi Arabia. Incidence among nationals in Qatar was at least twice that in Saudi Arabia (comparative incidence figure 2.32). Incidence among non-nationals in Qatar was 3 times higher than in Saudi Arabia. Among nationals in Kuwait, 10.8% of cases of breast cancer occurred in women aged < 40 years in 2008–2012, compared with 24.2% in non-nationals in Qatar in 2014–2016. Conclusion: Breast cancer incidence has increased over time among women in most GCC countries, likely reflecting the improvements in healthcare access and screening programmes. Nationals and non-nationals developed breast cancer at a younger age than women in other high-income countries. Increased screening uptake is still required in the region. Evidence-based, locally-informed interventions should be implemented to address risk factors specific to the nationals and non-nationals in the GCC countries.

Performance of risk prediction models in breast cancer screening among women in Cyprus

Background: Tools that can predict breast cancer risk in women will have a significant impact on women and healthcare systems in low- and middle-income countries. Aims: We compared the performances of the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model, the International Breast Cancer Intervention Study (IBIS) model, and the Gail model in predicting breast cancer risk among women in Cyprus. Methods: We recruited 655 women from Dr Burhan Nalbantoglu Devlet Hastanesi Hospital in Lefkosa: 318 had breast cancer and 337 did not have breast cancer (hospital-based controls). We collected retrospective data from the hospital’s medical records and interviews with the women after informed consent. Data collected included: age, age at diagnosis, age at menarche, menopausal status, presence of benign breast disease, breast cancer in relatives, BRCA-1 and BRCA-2 mutations, history of hormone replacement therapy, and breast density. We calculated the 5-year risk of breast cancer and the risk values were used to plot receiver operating curves. Results:For the area under the curve (95% confidence interval, CI), sensitivity and specificity for the models were: BOADICEA 0.81 (95% CI: 0.77–0.84), 26.4% and 98.8%; IBIS 0.80 (95% CI: 0.77–0.84), 19.4% and 97.3%; and Gail 0.76 (95% CI: 0.73–0.80), 17.3% and 98.5%. Conclusions: The breast cancer risk prediction models performed similarly although on closer appraisal, the BOADICEA and IBIS models performed slightly better. These models are simple, appropriate, cost-effective, and non-invasive tools for identifying high-risk women in low- and middle-income countries who could benefit from mammography screening.

Eastern Mediterranean Health Journal [2022; Vol.28, Issue 12]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

Presentation and management of female breast cancer in Egypt

Background: There have been system inefficiencies in the profiling and management of female breast cancer in Alexandria, Egypt. Aims: To identify barriers to full implementation of international guidelines for the management of female breast cancer patients. Methods: Female breast cancer data were extracted from records of 3 public oncology services in Alexandria, Egypt, from 2007 to 2016 and analysed. Results: A total of 5236 of the available 7125 records were usable. Median age of the patients was 54 years, and the median duration of pre-diagnosis complaint was 3.1 months. Some 522 (31.5%) of the patients had a family history of cancer. For tumour stage, 2527 (55.2%) were early, 1717 (37.6%) were locally advanced, and 331 (7.2%) were at stage IV. Estrogen receptor, progesterone receptor, and HER2 were positive in 3869 (85%), 3545 (78%), and 461 (15.3%) patients, respectively. Chemotherapy started after a median 1.03 months. Adjuvant chemotherapy was given to 3667 (91.7 %) patients and neoadjuvant chemotherapy to 333 (8.3%); 3686 (92.1%) received anthracycline-based combination chemotherapy, and 3613 (86%) received hormonal treatment. One hundred and eighty of 317 eligible patients received Trastuzumab. Local and/or distant recurrence was seen in 1109 (21.2%) patients. In nonmetastatic cases, median overall and disease-free survival were 149.1 and 77.1 months, respectively. In metastatic cases, median progression-free survival was 19.6 months. Conclusion: We observed defects in the record system, there was delay in diagnosis and treatment, and nonadherence to targeted therapy in many patients. Strengthening of national and hospital-based registries is needed in Alexandria, Egypt, with a robust patient navigation system and targeted information, education and communication strategies. Continuous outcomes monitoring and adaptation to implementation needs should be sustained.

Eastern Mediterranean Health Journal [2022; Vol.28, Issue 10]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

Effectiveness of breast cancer screening campaigns from 2012 to 2017 by analysis of stage at diagnosis, Lebanon

Background: Breast cancer is the most common and costly disease in Lebanon, but data on cancer stage and mortality are scarce. Aims: This study aimed to assess the effect of mammography screening campaigns in reducing the breast cancer stage at diagnosis. Methods: A secondary analysis was conducted of data from the Ministry of Public Health’s Cancer Drug Scientific Committee database. The medical files of 3320 newly diagnosed breast cancer patients between 2012 and 2017 were reviewed. Demographic and pathology characteristics, cancer stage at diagnosis and presence of receptors were extracted and analysed. Results: The median age of the patients was 53 (interquartile range 36–72) years. Most patients had positive estrogen and progesterone receptors. Patients < 35 years mostly lived in South Lebanon, had advanced stages of cancer (III and IV) at diagnosis and were more likely to have triple negative breast cancer than the older groups (31.3% versus 16.7%). Advanced stage at diagnosis was common outside Beirut (60.4% in Bekaa and 54.7% in North Lebanon). In the period 2012–2017, the trend in early stages (I and II) at diagnosis decreased from 55.6% to 41.9%, while advanced stages (III and IV) increased from 44.4% to 57.9%. Conclusion: Efforts to downstage breast cancer through mammography screening in Lebanon have not succeeded. Implementation of genetic testing and tailored approaches for Lebanese women are recommended for future campaigns.

Diagnostic and treatment delays in breast cancer in association with multiple factors in Pakistan

Background: Breast cancer has the highest incidence rate among all types of cancer worldwide. There is strong evidence that delay in presentation to an oncologist may lead to a decrease in survival.Aims: This study explores factors causing diagnostic and treatment delays among the breast cancer patients enrolled in Jinnah Hospital, Lahore, from 2016 to 2018.Methods: Data from 372 patients were collected, including tumour characteristics, first symptoms, knowledge and experience of breast cancer, first visit to a doctor, etc. We calculated the patient, physician, treatment, system and total delay intervals.Results: Breast cancer cases showed longer mean patient delay in older women (> 50 years) in comparison with younger women. Women with painless lump as the initial symptom showed the longest delay with median total delay 280 days (25th and 75th percentiles 140 and 410 days respectively). Initial symptoms were correlated with total delay (P = 0.036). Educated women showed shorter delay in treatment compared with illiterate women (P = 0.068). Rural residence showed significant delay (P = 0.007). Lump size showed correlation with delay (P = 0.039). Patients with low household income (< Rs 10 000) had greater delay in diagnosis (P = 0.027) and actively employed women showed shorter delay (P < 0.0001). Unmarried women were diagnosed earlier than married (P < 0.001).Conclusions: Women showed delay in presentation due to lack of resources and lack of awareness about the disease. They presented late due to fear of surgery and chemotherapy. Using traditional treatment methods leads to diagnosis of the disease at more advanced stages.

Survival rates of patients with breast cancer in countries in the Eastern Mediterranean Region: a systematic review and meta-analysis

Background: Breast cancer is the fourth leading cause of death and disability in the Eastern Mediterranean Region (EMR); although the incidence is lower than in the developed regions, there has been an increasing trend in recent decades. Aims: Our aim was to calculate the pooled survival rate of patients with breast cancer in the EMR. Methods: We searched electronic databases from 1946 to 19 January 2018, without language restrictions. We used a random effect model to estimate pooled 1-, 3-, 5- and 10-year survival rates for patients with breast cancer. Chi-squared and I2 index were used to assess between-study heterogeneity. Subgroup analysis and meta-regression were used to investigate the potential source of heterogeneity.Results: We found 80 articles eligible for inclusion in our review. The pooled 1-, 3-, 5- and 10-year survival rates in women with breast cancer in the EMR were 0.95, 0.80, 0.71, and 0.56, respectively. The I2 index indicated considerable between-study heterogeneity (all I2 > 50%). The 5-year survival rate in the male subgroup was 0.63. The 5-year survival rate of women with breast cancer in age groups .39, 40.64, and 65+ years were 0.74, 0.76 and 0.58, respectively. There was a statistically significant association between the Human Development Index (beta = 9, P = 0.01)and decade of study (beta = 8.2, P = 0.04)and 5-year survival rate. Conclusions: The survival rate of women with breast cancer in those countries in the EMR which have better health care systems improved in the past decade; women aged 40.64 years had the best survival rate

Perceptions of Iranian women regarding breast cancer screening behaviour

Background: Breast cancer is the leading cause of death among women aged 20–59 years worldwide, with 58% of deaths occurring in less-developed countries. In the Islamic Republic of Iran, breast cancer constitutes 21% of all cancers, with an incidence rate of 22 per 100 000 women.Aims: Since research into breast cancer screening among Iranian women is scarce and results are contradictory, we aimed to explore women’s’ perceptions regarding breast cancer screening behaviour and provide insights into how breast cancer is perceived and approached. This could aid policy-makers in drafting effective interventions to stimulate women to per-form regular screening.Methods: We used the Health Belief Model as a theoretical framework. In-depth interviews with 22 women in Tehran were performed, based on a topic-list exploring the 6 constructs of the Health Belief Model: perceived barriers, perceived severity, perceived susceptibility, perceived benefits, self-efficacy and cues to action. Data-analysis was based on the Con-structive Grounded Theory Method. Results: The main barriers were fear, low priority and cultural values. Perceived severity was low for the majority of wom-en, while perceived susceptibility was high for about half of them. Perceived benefit of screening was high for all women. Women’s’ self-efficacy was low when it came to breast self-examination. Talking about breast cancer screening and having somebody in their environment adopting screening behaviour were important cues for taking up breast cancer screening.Conclusions: Interventions should focus on diminishing barriers and increasing women’s’ self-efficacy and interperson-al communication about breast cancer screening.

Contexte : Le cancer du sein est la principale cause de mortalité chez les femmes de 20 à 59 ans dans le monde. Cinquante- huit pour cent des décès se produisent dans les pays les moins développés. En République islamique d’Iran, les cancers du sein représentent 21 % de tous les cancers et le taux d’incidence est de 22 pour 100 000 femmes.Objectif : Les recherches sur le dépistage du cancer du sein chez les femmes iraniennes sont rares et leurs résultats sont souvent contradictoires. La présente étude visait donc à étudier les perceptions des femmes concernant les comportements face au dépistage du cancer du sein et à fournir des indications sur la façon dont le cancer du sein est perçu et abordé. Ses résultats pourraient aider les décideurs politiques à élaborer des interventions efficaces pour encourager les femmes à pratiquer régulièrement le dépistage.Méthodes : Nous avons utilisé comme cadre théorique le modèle de croyances relatives à la santé. Des entretiens approfondis ont été réalisés à Téhéran auprès de 22 femmes. Ils s’appuient sur une liste de sujets explorant les six composantes du modèle de croyances relatives à la santé, soit les obstacles, la gravité, la vulnérabilité et les avantages perçus, ainsi que l’auto-efficacité et les indices à l’action. L’analyse de données était fondée sur la méthodologie constructiviste de la théorie enracinée. Résultats : Les principaux obstacles étaient la peur, la faible priorité accordée au dépistage et les valeurs culturelles. La gravité perçue était faible pour la majorité des femmes et la vulnérabilité perçue était élevée pour environ la moitié d’entre elles. Les avantages perçus du dépistage étaient élevés pour toutes les femmes. Les femmes présentaient une faible auto- efficacité en ce qui concerne l’auto-examen des seins. Parler du dépistage du cancer du sein et avoir auprès de soi une personne qui adopte des comportements de dépistage ont été identifiés comme des éléments qui incitent les femmes à pratiquer le dépistage du cancer du sein.Conclusions : Les interventions devraient mettre l’accent sur la réduction des obstacles ainsi que sur l’amélioration de l’auto-efficacité des femmes et de la communication interpersonnelle au sujet du cancer du sein.

Self-reported versus proxy reported quality of life for breast cancer patients in the Islamic Republic of Iran

Since quality of life [QoL] is subjective, self-reported QoL is the main source of assessment; however, in some situations the patient cannot evaluate his/her own status. In this cross-sectional study, 148 patients with breast cancer referred to the Cancer Institute of the Islamic Republic of Iran and their caregivers were selected through the consecutive sampling method. Five oncologists from this centre also evaluated the QoL of these patients. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was completed by these 3 groups and the results compared. The patient-caregiver intra-class correlation coefficient [ICC] for all 15 QLQ.C30 domains was moderate to good [ICC = 0.41-0.76]. Agreements between QoL scores of patients and those of oncologists were moderate to good, except in the 4 domains. In the patient-caregiver comparison there was 55% exact agreement, and for the patient-physician comparison agreement was 45%. The findings can be used in the patients' decision-making process and care planning when patients with breast cancer are unable to self-report the QoL

La qualité de vie étant de nature subjective, l'auto-évaluation constitue l'instrument de choix pour la mesure de celle-ci. Pour autant, dans certaines circonstances, le patient n'est pas capable d'évaluer sa situation. Au cours de cette étude transversale, 148 patients adressés à l'Institut du Cancer de République islamique d'Iran pour un cancer du sein ont été sélectionnés avec leurs aidants à l'aide d'une méthode d'échantillonnage consécutif. Cinq oncologues travaillant dans ce centre ont également évalué la qualité de vie de ces patients. Le questionnaire Qualité de vie [QLQ] de l'Organisation européenne pour la Recherche et le Traitement du Cancer a été rempli par ces trois groupes et les résultats ont fait l'objet d'une comparaison. Le coefficient intra-classe [CIC] patient-aidant pour les 15 domaines du QLQ-C30 allait de modéré à bon [CIC= 0,41-0,76]. La concordance entre les scores des patients portant sur la qualité de vie et ceux des oncologues étaient compris entre [ modéré ] et [ bon ], excepté dans quatre domaines. La comparaison patient-aidant donnait une concordance exacte dans 55%, et la comparaison patient-médecin une concordance de 45%. Les résultats peuvent être utilisés au cours du processus de décision clinique et de planification des soins quand les patients atteints d'un cancer du sein ne sont pas en mesure d'évaluer eux-mêmes leur niveau de qualité de vie