Tailoring neoadjuvant systemic therapy in breast cancer: "The advent of a personalized approach"-The Breast-Gynecological and Immuno-Oncology International Cancer Conference (BGICC) consensus and recommendations.

BACKGROUND: The management of early breast cancer (BC) has witnessed an uprise in the use of neoadjuvant therapy and a remarkable reshaping of the systemic therapy postneoadjuvant treatment in the last few years, with the evolution of many controversial clinical situations that require consensus. METHODS: During the 14th Breast-Gynecological and Immuno-Oncology International Cancer Conference held in Egypt in 2022, a panel of 44 BC experts from 13 countries voted on statements concerning debatable challenges in the neo/adjuvant treatment setting. The recommendations were subsequently updated based on the most recent data emerging. A modified Delphi approach was used to develop this consensus. A consensus was achieved when ≥75% of voters selected an answer. RESULTS AND CONCLUSIONS: The consensus recommendations addressed different escalation and de-escalation strategies in the setting of neoadjuvant therapy for early BC. The recommendations recapitulate the available clinical evidence and expert opinion to individualize patient management and optimize therapy outcomes. Consensus was reached in 63% of the statements (52/83), and the rationale behind each statement was clarified.

Preparation of thiourea derivative incorporated Ag3PO4 core shell for enhancement of photocatalytic degradation performance of organic dye under visible radiation light.

Photocatalysis is a promising technique to reduce hazardous organic pollutants using semiconductors under visible light. However, previous studies have been concerned with the behavior of silver phosphate (Ag3PO4) as n-type semiconductors, and the problem of their instability is still under investigation. Herein, 4,4'-(((oxalylbis(azanediyl)) bis(carbonothioyl)) bis(azanediyl)) dibenzoic acid is synthesized by green method and used to enhance the photocatalytic behavior for Ag3PO4. The incorporated Ag3PO4 core-shell is prepared and characterized via XRD, FT-IR, Raman, TEM and BET. Besides, the thermal stability of the prepared core shell was investigated via TGA and DSC measurements. The optical properties and the energy band gap are determined using photoluminescence and DRS measurements. The photodegradation of methylene blue in the presence of the synthesized Ag3PO4 core-shell under visible light is examined using UV/Vis measurements. The effect of initial dye concentration and contact time are studied. In addition, the kinetic behavior of the selected dye during the photodegradation process shows a pseudo-first order reaction with rate constant of 0.015 min-1 for ZAg. The reusability of the Ag3PO4 core shell is evaluated, and the efficiency changed from 96.76 to 94.02% after three cycles, indicating efficient photocatalytic behavior with excellent stability.

Deformable registration with intensity correction for CESM monitoring response to Neoadjuvant Chemotherapy.

This paper proposes a robust longitudinal registration method for Contrast Enhanced Spectral Mammography in monitoring neoadjuvant chemotherapy. Because breast texture intensity changes with the treatment, a non-rigid registration procedure with local intensity compensations is developed. The approach allows registering the low energy images of the exams acquired before and after the chemotherapy. The measured motion is then applied to the corresponding recombined images. The difference of registered images, called residual, makes vanishing the breast texture that did not changed between the two exams. Consequently, this registered residual allows identifying local density and iodine changes, especially in the lesion area. The method is validated with a synthetic NAC case where ground truths are available. Then the procedure is applied to 51 patients with 208 CESM image pairs acquired before and after the chemotherapy treatment. The proposed registration converged in all 208 cases. The intensity-compensated registration approach is evaluated with different mathematical metrics and through the repositioning of clinical landmarks (RMSE: 5.9 mm) and outperforms state-of-the-art registration techniques.

Waste Plastic Nanomagnetite Pour Point Depressants for Heavy and Light Egyptian Crude Oil.

One of the most widely used plastics in the world's rapidly urbanizing population is polyethylene (PE). Globally, there is a growing demand for plastics. Polyethylene plastics do pollute and harm the environment. Although polyethylene is said to be nonbiodegradable, any chemical deterioration can take hundreds of years. This study intends to improve the crude oil property, precisely its pour point, by using polyethylene derived from waste products with magnetic nanoparticles (MNPs) and applying it to heavy and light crude oils. Forty crude oil samples were prepared by changing the PE additive concentration from 0.25 to 2% with 0-2.0% MNP concentration. Dynamic light scattering (DLS), gas chromatography, and photomicrographic techniques were employed during the study. DLS results revealed that nanoparticles of heavy (B) crude oil have bigger particle sizes than light (A) crude oil samples, and the overall distribution of the added nanoparticles was much better in light crude oil than in heavy crude oil. The photomicrographic results revealed that the treated samples using additives provided a significant wax crystal reduction compatible with the provided pour point results. The prepared sample of the treated light (A) crude oil provided a more extraordinary rheology performance than the heavy (B) crude oil. Moreover, prepared crude oil samples with PE additives and MNPs are effective as pour point depressants.

Spectrum of Ovarian Incidentalomas: Diagnosis and Management.

Incidental ovarian lesions are asymptomatic lesions that are accidentally discovered during a CT or MRI examinations that involves the pelvic cavity or during a routine obstetric ultrasound study. Incidental ovarian masses are usually benign with a very low risk of malignancy yet underlying malignant pathology may be discovered during the diagnostic work-up of these lesions. Suspicion of malignancy is directly correlating with the increase in the patient's age, the increase in the size of the lesion, the presence of the solid components or thick septa and a high color scale of the ovarian mass. Following standard reporting and management protocols are essential to choose the proper work-up of these lesions to avoid unnecessary additional imaging and operative intervention. In this article, we will provide a review of the characteristic imaging features of some incidental and yet commonly encountered ovarian lesions. We will also summarize the recently published algorithms that are important for consistent reporting and standard management of these lesions.

Body mass index, breast density, and the risk of breast cancer development in relation to the menopausal status; results from a population-based screening program in a native African-Arab country.

Background: Risk factors are traits or behaviors that have an influence on the development of breast cancer (BC). Awareness of the prevalent risk factors can guide in developing prevention interventions. Purpose: To evaluate the correlation between the breast density, body mass index, and the risk of breast cancer development in relation to the menopausal status in a native African-Arab population. Material and methods: The study included 30,443 screened females who were classified into cancer and non-cancer groups and each group was further sub-classified into pre- and postmenopausal groups. The breast density (BD) was reported and subjectively classified according to the 2013 ACR BI-RADS breast density classification. The weight and height were measured, and the body mass index (BMI) was calculated and classified according to the WHO BMI classification. Results: A statistically significant difference was calculated between the mean BMI in the cancer and non-cancer groups (p: .027) as well as between the pre- and postmenopausal groups (p < .001). A positive statistically insignificant correlation was calculated between the breast density and the risk of breast cancer in the premenopausal group (OR: 1.062, p: .919) and a negative highly significant correlation was calculated in the postmenopausal group (OR: 0.234, p < .001). Conclusion: BMI and BD are inversely associated with each other. The current studied population presented unique ethnic characteristics, where a decreased BD and an increased BMI were found to be independent risk factors for developing breast cancer.

The association of age at menarche and adult height with mammographic density in the International Consortium of Mammographic Density.

BACKGROUND: Early age at menarche and tall stature are associated with increased breast cancer risk. We examined whether these associations were also positively associated with mammographic density, a strong marker of breast cancer risk. METHODS: Participants were 10,681 breast-cancer-free women from 22 countries in the International Consortium of Mammographic Density, each with centrally assessed mammographic density and a common set of epidemiologic data. Study periods for the 27 studies ranged from 1987 to 2014. Multi-level linear regression models estimated changes in square-root per cent density (√PD) and dense area (√DA) associated with age at menarche and adult height in pooled analyses and population-specific meta-analyses. Models were adjusted for age at mammogram, body mass index, menopausal status, hormone therapy use, mammography view and type, mammographic density assessor, parity and height/age at menarche. RESULTS: In pooled analyses, later age at menarche was associated with higher per cent density (ß√PD = 0.023 SE = 0.008, P = 0.003) and larger dense area (ß√DA = 0.032 SE = 0.010, P = 0.002). Taller women had larger dense area (ß√DA = 0.069 SE = 0.028, P = 0.012) and higher per cent density (ß√PD = 0.044, SE = 0.023, P = 0.054), although the observed effect on per cent density depended upon the adjustment used for body size. Similar overall effect estimates were observed in meta-analyses across population groups. CONCLUSIONS: In one of the largest international studies to date, later age at menarche was positively associated with mammographic density. This is in contrast to its association with breast cancer risk, providing little evidence of mediation. Increased height was also positively associated with mammographic density, particularly dense area. These results suggest a complex relationship between growth and development, mammographic density and breast cancer risk. Future studies should evaluate the potential mediation of the breast cancer effects of taller stature through absolute breast density.

High-Density Polyethylene Waste (HDPE)-Waste-Modified Lube Oil Nanocomposites as Pour Point Depressants.

Sustainability metrics have been established that cover the economic, social, and environmental aspects of human activities. Reduce, reuse, and recycle (3R) strategy targets solid waste management in the waste generation sectors. The purpose of this work is to study the possibility of using various plastic wastes containing high-density polyethylene (HDPE) and high-density polyethylene nanoclay (PMON) as polymer additives to modify lubricating oil. The structure of these additives was elucidated by Fourier transform infrared (FTIR) spectra, and the particle size of PMON was determined by dynamic light scattering (DLS). The thermal stability of HDPE and nanoclay HDPE (PMON) was studied, which showed higher thermal stability, and these additives completed degradation above 500 °C. The performance of HDPE and nanoclay HDPE (PMON) in lubricating oil was evaluated as pour point depressants by standard ASTM methods. The results showed that the efficiency of these additives increases with the decrease in the dose of these additives and lubricating oil treated with HDPE at 0.25% dosage lowers PPT to -30 °C, while lubricating oil treated with nanoclay HDPE (PMON7) at 0.25% dosage reduces PPT to -36 °C. Photomicrographic analysis was conducted to study accumulations and modifications in the wax crystal morphology in lube oil without and with HDPE and nanoclay HDPE (PMON7). Photomicrographs revealed that wax morphology changes due to effective pour point depressants on crystal growth.

Can artificial intelligence replace ultrasound as a complementary tool to mammogram for the diagnosis of the breast cancer?

OBJECTIVE: To study the impact of artificial intelligence (AI) on the performance of mammogram with regard to the classification of the detected breast lesions in correlation to ultrasound-aided mammograms. METHODS: Ethics committee approval was obtained in this prospective analysis. The study included 2000 mammograms. The mammograms were interpreted by the radiologists and breast ultrasound was performed for all cases. The Breast Imaging Reporting and Data System (BI-RADS) score was applied regarding the combined evaluation of the mammogram and the ultrasound modalities. Each breast side was individually assessed with the aid of AI scanning in the form of targeted heat-map and then, a probability of malignancy (abnormality scoring percentage) was obtained. Operative and the histopathology data were the standard of reference. RESULTS: Normal assigned cases (BI-RADS 1) with no lesions were excluded from the statistical evaluation. The study included 538 benign and 642 malignant breast lesions (n = 1180, 59%). BI-RADS categories for the breast lesions with regard to the combined evaluation of the digital mammogram and ultrasound were assigned BI-RADS 2 (Benign) in 385 lesions with AI median value of the abnormality scoring percentage of 10 (n = 385/1180, 32.6%), and BI-RADS 5 (malignant) in 471, that had showed median percentage AI value of 88 (n = 471/1180, 39.9%). AI abnormality scoring of 59% yielded a sensitivity of 96.8% and specificity of 90.1% in the discrimination of the breast lesions detected on the included mammograms. CONCLUSION: AI could be considered as an optional primary reliable complementary tool to the digital mammogram for the evaluation of the breast lesions. The color hue and the abnormality scoring percentage presented a credible method for the detection and discrimination of breast cancer of near accuracy to the breast ultrasound. So consequently, AI- mammogram combination could be used as a one setting method to discriminate between cases that require further imaging or biopsy from those that need only time interval follows up. ADVANCES IN KNOWLEDGE: Recently, the indulgence of AI in the work-up of breast cancer was concerned. AI noted as a screening strategy for the detection of breast cancer. In the current work, the performance of AI was studied with regard to the diagnosis not just the detection of breast cancer in the mammographic-detected breast lesions. The evaluation was concerned with AI as a possible complementary reading tool to mammogram and included the qualitative assessment of the color hue and the quantitative integration of the abnormality scoring percentage.

The first BGICC consensus and recommendations for breast cancer awareness, early detection and risk reduction in low- and middle-income countries and the MENA region.

In low-middle income countries (LMICs) and the Middle East and North Africa (MENA) region, there is an unmet need to establish and improve breast cancer (BC) awareness, early diagnosis and risk reduction programs. During the 12th Breast, Gynecological & Immuno-oncology International Cancer Conference - Egypt 2020, 26 experts from 7 countries worldwide voted to establish the first consensus for BC awareness, early detection and risk reduction in LMICs/MENA region. The panel advised that there is an extreme necessity for a well-developed BC data registries and prospective clinical studies that address alternative modalities/modified BC screening programs in areas of limited resources. The most important recommendations of the panel were: (a) BC awareness campaigns should be promoted to public and all adult age groups; (b) early detection programs should combine geographically distributed mammographic facilities with clinical breast examination (CBE); (c) breast awareness should be encouraged; and (d) intensive surveillance and chemoprevention strategies should be fostered for high-risk women. The panel defined some areas for future clinical research, which included the role of CBE and breast self-examination as an alternative to radiological screening in areas of limited resources, the interval and methodology of BC surveillance in women with increased risk of BC and the use of low dose tamoxifen in BC risk reduction. In LMICs/MENA region, BC awareness and early detection campaigns should take into consideration the specific disease criteria and the socioeconomic status of the target population. The statements with no consensus reached should serve as potential catalyst for future clinical research.

Ovarian cancer screening-ultrasound; impact on ovarian cancer mortality.

Although ovarian cancer (OC) is the most lethal of all female malignancies, debate still exists concerning the benefits and harms of the screening programs and their impact on long-term survival and mortality from the disease. The most widely tested screening strategies have focused on transvaginal ultrasound (TVU) and on algorithms that measure serum levels or interval changes of cancer antigen-125 (CA-125) either individually or in combination. Transvaginal ultrasound can identify size and morphology changes of the ovary that may signal a developing malignancy; yet, it is still accused of having a low specificity. There is preliminary evidence that screening can improve survival, but the impact of screening on mortality from OC is still unclear and warrants further validation. In spite of having many published prospective studies, up to-date, none have been able to demonstrate conclusively a reduction in mortality from OC both in the screened general or high-risk population. Data from the US Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial has not shown survival or mortality benefits in the general population. Most prospective trials have reported a decrease in stage at detection (with the exception of the PLCO trial), thereby allowing treatment to be initiated when the disease is most curable. Research is in progress to develop new diagnostic tests and novel biomarkers, which when used in combination can increase the accuracy and outcomes of screening. In this review article, we will discuss the debate provoked on OC screening programs and the impact of using ultrasound on the reduction of OC-related mortality.

Diffusion-weighted MR imaging and assessment of ovarian carcinomas with vaginal deposit accidentally detected during pregnancy.

Ovarian cancer during pregnancy is a complex situation that endangers the lives of both the pregnant female and the fetus. We present a 40-year-old pregnant female in the third trimester with bilateral undifferentiated ovarian adenocarcinoma and vaginal metastasis. The case was evaluated by ultrasound and MRI supported with diffusion-weighted sequence.

Mammographic density assessed on paired raw and processed digital images and on paired screen-film and digital images across three mammography systems.

BACKGROUND: Inter-women and intra-women comparisons of mammographic density (MD) are needed in research, clinical and screening applications; however, MD measurements are influenced by mammography modality (screen film/digital) and digital image format (raw/processed). We aimed to examine differences in MD assessed on these image types. METHODS: We obtained 1294 pairs of images saved in both raw and processed formats from Hologic and General Electric (GE) direct digital systems and a Fuji computed radiography (CR) system, and 128 screen-film and processed CR-digital pairs from consecutive screening rounds. Four readers performed Cumulus-based MD measurements (n = 3441), with each image pair read by the same reader. Multi-level models of square-root percent MD were fitted, with a random intercept for woman, to estimate processed-raw MD differences. RESULTS: Breast area did not differ in processed images compared with that in raw images, but the percent MD was higher, due to a larger dense area (median 28.5 and 25.4 cm2 respectively, mean √dense area difference 0.44 cm (95% CI: 0.36, 0.52)). This difference in √dense area was significant for direct digital systems (Hologic 0.50 cm (95% CI: 0.39, 0.61), GE 0.56 cm (95% CI: 0.42, 0.69)) but not for Fuji CR (0.06 cm (95% CI: -0.10, 0.23)). Additionally, within each system, reader-specific differences varied in magnitude and direction (p < 0.001). Conversion equations revealed differences converged to zero with increasing dense area. MD differences between screen-film and processed digital on the subsequent screening round were consistent with expected time-related MD declines. CONCLUSIONS: MD was slightly higher when measured on processed than on raw direct digital mammograms. Comparisons of MD on these image formats should ideally control for this non-constant and reader-specific difference.

Can we apply the MRI BI-RADS lexicon morphology descriptors on contrast-enhanced spectral mammography?

OBJECTIVE:: To assess the feasibility of using the MRI breast imaging reporting and data system (BI-RADS) lexicon morphology descriptors to characterize enhancing breast lesions identified on contrast-enhanced spectral mammography (CESM). METHODS:: The study is a retrospective analysis of the morphology descriptors of 261 enhancing breast lesions identified on CESM in 239 patients. We presented the morphological categorization of the included lesions into focus, mass and non-mass. Further classifications included (1) the multiplicity for "focus" category, (2) the shape, margin and internal enhancement for "mass" category and (3) the distribution and internal enhancement for "non-mass" category. Each morphology descriptor was evaluated individually (irrespective of all other descriptors) by calculating its sensitivity, specificity, positive-predictive value (PPV) and negative-predictive value (NPV) and likelihood ratios (LRs). RESULTS:: The study included 68/261 (26.1%) benign lesions and 193/261 (73.9%) malignant lesions. Intensely enhancing foci, whether single (7/12, 58.3%) or multiple (2/12, 16.7%), were malignant. Descriptors of "irregular"-shape (PPV: 92.4%) and "non-circumscribed" margin (odds ratio: 55.2, LR positive: 4.77; p-value: <0.001) were more compatible with malignancy. Internal mass enhancement patterns showed a very low specificity (58.0%) and NPV (40.0%). Non-mass enhancement (NME) was detected in 81/261 lesions. Asymmetrical NME in 81% (n = 52/81) lesions was malignant lesions and internal enhancement patterns indicative of malignancy were the heterogeneous and clumped ones. CONCLUSION:: We can apply the MRI morphology descriptors to characterize lesions on CESM, but with few expectations. In many situations, irregular-shaped, non-circumscribed masses and NME with focal, ductal or segmental distribution and heterogeneous or clumped enhancement are the most suggestive descriptors of malignant pathologies. ADVANCES IN KNOWLEDGE:: (1) The MRI BI-RADS lexicon morphology descriptors can be applied in the characterization of enhancing lesions on CESM with a few exceptions. (2) Multiple bilateral intensely enhancing foci should not be included under the normal background parenchymal enhancement unless they are proved to be benign by biopsy. (3) Mass lesion features that indicated malignancy were irregular-shaped, spiculated and irregular margins and heterogeneous internal enhancement patterns. The rim enhancement pattern should not be considered as a descriptor of malignant lesions unless CESM is coupled with an ultrasound examination.

International Consortium on Mammographic Density: Methodology and population diversity captured across 22 countries.

Mammographic density (MD) is a quantitative trait, measurable in all women, and is among the strongest markers of breast cancer risk. The population-based epidemiology of MD has revealed genetic, lifestyle and societal/environmental determinants, but studies have largely been conducted in women with similar westernized lifestyles living in countries with high breast cancer incidence rates. To benefit from the heterogeneity in risk factors and their combinations worldwide, we created an International Consortium on Mammographic Density (ICMD) to pool individual-level epidemiological and MD data from general population studies worldwide. ICMD aims to characterize determinants of MD more precisely, and to evaluate whether they are consistent across populations worldwide. We included 11755 women, from 27 studies in 22 countries, on whom individual-level risk factor data were pooled and original mammographic images were re-read for ICMD to obtain standardized comparable MD data. In the present article, we present (i) the rationale for this consortium; (ii) characteristics of the studies and women included; and (iii) study methodology to obtain comparable MD data from original re-read films. We also highlight the risk factor heterogeneity captured by such an effort and, thus, the unique insight the pooled study promises to offer through wider exposure ranges, different confounding structures and enhanced power for sub-group analyses.

Contrast-enhanced spectral mammography: Impact of the qualitative morphology descriptors on the diagnosis of breast lesions.

OBJECTIVE: To analyze the morphology and enhancement characteristics of breast lesions on contrast-enhanced spectral mammography (CESM) and to assess their impact on the differentiation between benign and malignant lesions. MATERIALS AND METHOD: This ethics committee approved study included 168 consecutive patients with 211 breast lesions over 18 months. Lesions classified as non-enhancing and enhancing and then the latter group was subdivided into mass and non-mass. Mass lesions descriptors included: shape, margins, pattern and degree of internal enhancement. Non-mass lesions descriptors included: distribution, pattern and degree of internal enhancement. The impact of each descriptor on diagnosis individually assessed using Chi test and the validity compared in both benign and malignant lesions. The overall performance of CESM were also calculated. RESULTS: The study included 102 benign (48.3%) and 109 malignant (51.7%) lesions. Enhancement was encountered in 145/211 (68.7%) lesions. They further classified into enhancing mass (99/145, 68.3%) and non-mass lesions (46/145, 31.7%). Contrast uptake was significantly more frequent in malignant breast lesions (p value ≤ 0.001). Irregular mass lesions with intense and heterogeneous enhancement patterns correlated with a malignant pathology (p value ≤ 0.001). CESM showed an overall sensitivity of 88.99% and specificity of 83.33%. The positive and negative likelihood ratios were 5.34 and 0.13 respectively. CONCLUSION: The assessment of the morphology and enhancement characteristics of breast lesions on CESM enhances the performance of digital mammography in the differentiation between benign and malignant breast lesions.

Breast imaging in the young: the role of magnetic resonance imaging in breast cancer screening, diagnosis and follow-up.

Diagnosis of breast cancer in young individuals (younger than 40 years old) poses a real challenge to breast radiologists because their breast tissue is often denser than the breast tissue of older women. Magnetic Resonance Imaging (MRI) may be particularly helpful in such situations. The American Cancer Society (ACS) recommended breast MRI screening as an adjunct to mammography for: BRCA mutation carriers and their first-degree relatives; women with a lifetime breast cancer risk ≥20% to 25%; women with a history of chest radiation between ages of 10 and 30 years; and women with predisposing genetic syndromes. Currently, breast MRI demonstrates a high sensitivity in the range of 93-100%. As many benign lesions also show enhancement or other atypical features on MRI, the primary weakness of contrast enhanced MRI remains in its low specificity, reported to be in the range of 37-97%. Breast MRI is helpful in demonstrating the true tumor size initially, as well as identifying residual tumor following the completion of neo-adjuvant therapy. In general, sensitivities ranging from 61% to 86% for detecting residual disease have been reported. The absence of enhancement virtually excludes a recurrence and the presence of enhancement is very specific for tumor even in the radiated breast. MRI is also the preferred modality for assessment of the breast after re- constructive surgery. The role of Magnetic Resonance Imaging (MRI) in breast diagnosis will continue to evolve as technology improves and clinical experience with new techniques expands.

Classification of inflammatory breast disorders and step by step diagnosis.

In this study, the authors proposed a classification of inflammatory breast disorders based on which a practical systematic scheme in diagnosis was applied aiming to differentiate simple forms of mastitis from more complicated and malignant forms. The study population included 197 female patients who were clinically or pathologically diagnosed as having mastitis. All patients underwent Ultrasound examination. Mammography was performed for 133/197 cases. Cases of simple mastitis and periductal mastitis were followed up to ensure complete resolution. Abscess cavities and postoperative collections were drained. Other cases were biopsied to confirm diagnosis and were managed accordingly by their treating physicians. Statistical analysis was performed by the Statistical Package for Social Science. Nominal Data were expressed as frequency and relative frequencies (percentage). Ultrasound and Mammography categorical results were compared using the Pearson Chi Square and Fisher's exact test. Patients were classified into three groups; infectious, noninfectious and malignant mastitis. Simple and malignant forms of mastitis showed many signs in common. The presence of ill defined collections and abscess cavities on ultrasound favored simple over malignant forms of mastitis while extensive skin thickening and infiltrated malignant nodes favored malignant forms. Interstitial edema, edematous fat lobules, abscess cavities, skin thickening seen on ultrasound examination were significantly lower in noninfectious than simple and malignant mastitis. Mammography signs were less discriminating. Diffuse skin thickening and increased density favored malignant mastitis while dilated retro areolar ducts and characteristic calcification patterns favored noninfectious forms. Simple mastitis showed nonspecific signs. Ultrasound examination in mastitis cases shows more specific signs in differentiating between the three forms of mastitis and is useful in monitoring treatment, excluding complications and guide for interventional procedures. Mammography should be performed whenever complicated, malignant and uncommon forms of mastitis are suspected.

Women Health Outreach Program; a New Experience for all Egyptian Women.

UNLABELLED: The global health community faces a challenge with breast cancer being the most common cause of cancer related death among women around the globe. Since breast cancer's pathogenesis is poorly understood, primary prevention is still a distant goal. Thus secondary prevention through early detection is the only feasible approach at present. With this strong conviction, the launching of the first Egyptian national screening program "Women Health Outreach Program" (WHOP), was announced on October 30th 2007. This project is a government- funded program that offers free breast screening for all Egyptian women above the age of 45 years. In addition to free mammograms, the program gives the participants a chance to be screened for diabetes, hypertension and obesity as well. Positively detected cases are also offered the option of free management. During the period from October 30th, 2007, up to February 9th, 2009, 20, 098 women in Cairo, Alexandria and Suez governorates were screened for breast cancer, diabetes, hypertension and obesity through the program. In this article we will represent the achievements, challenges and services delivered by WHOP. KEY WORDS: Breast cancer - Breast screening - Early detection - Breast biopsy.