A Comparative Study of Breast Cancer Screening by Age Across 10000 Tunisian Women.

INTRODUCTION: We propose in this study to analyze the results obtained in the experience of Dar El Amal by comparing the two age groups 45-49 years versus over 50 years. This experience of Dar Al Amal was started in Sfax (Tunisia) in 2004. The project had included women over a period of six and a half years. The target population was all women over the age of 45 years. RESULTS: In the period of the study, 10 000 women had at least one mammography within the first round in Dar El Amal. The average age was 51.56 years. The recall rate was more important in women aged 45-49 years compared with those over 50 years with a statistically significant relationship (p=0.013). Tests classified ACR0 and ACR3 predominated in women aged between 45 and 49 years with a statistically significant relationship. The positive predictive value (PPV) of mammography was better in those over 50 years (p=0.012). CONCLUSION: The majority of countries in the world opt for screening from the age of 50 years. Women under 50 years are not routinely concerned, but they have more right to a targeted and appropriate screening.

Breast cancer in young women in southern Tunisia: Anatomical study and clinical prognostic factors: About a series of 83 patients.

PURPOSE: To define epidemiological, clinical, therapeutic and prognostic factors influencing survival of breast cancer in young women younger than 35 in southern Tunisia. MATERIAL AND METHODS: This is a retrospective study of 83 patients younger than 35 years and treated within tumors mammary committee of Sfax. RESULTS: The mean age was 31.7 years. T2 stage, high grade with positive node tumors were frequent. Breast surgery was performed for 73 patients. Chemotherapy was neo-adjuvant, adjuvant and palliative for respectively 10, 62 and 13 patients. Radiotherapy was delivered for 65 patients with curative intent and for 8 metastatic patients. Endocrine therapy was adjuvant in 38 patients and palliative in 6 cases. The overall survival (OS) at 5 years was 66.8%. Pejorative prognostic factors in uni-variate analysis were clinical T stage (T3, T4), and the number of involved lymph nodes. CONCLUSION: Despite adequate treatment, the prognosis of breast cancer in young women remains worse. Early diagnosis is necessary to promote outcome.

[Nasopharyngeal cancers, an overview]. / Prise en charge des cancers du cavum (rhinopharynx).

Cancer of the nasopharynx is an uncommon malignancy in France (incidence = 0.5/year/100,000 men) but is endemic in areas like in South-East Asia. Exclusive radiation therapy used to be the standard and results in local control rates for T3-T4 tumors around 50-75 %. Intensity-modulated radiotherapy (IMRT) improves tumor coverage with a sparing of organs at risk and has to be privileged. Concurrent chemotherapy with IMRT achieved significant survival benefice with 5-year overall survival above 75 %. Concurrent radiochemotherapy with platinum is the most frequent scheme but induction and adjuvant chemotherapies are discussed to reduce distant failure: studies are currently ongoing. Follow-up aims to detect early local failures with a chance of cure and to manage long-term toxicities.

Stereotactic body radiation therapy in stage I inoperable lung cancer: from palliative to curative options.

Surgery has historically been the standard of care for operable stage I non-small cell lung cancer (NSCLC). However, nearly one-quarter of patients with stage I NSCLC will not undergo surgery because of medical comorbidity or other factors. Stereotactic ablative radiotherapy (SABR) is the new standard of care for these patients. SABR offers high local tumour control rates rivalling the historical results of surgery and is generally well tolerated by patients with both peripheral and centrally located tumours. This article reviews the history of SABR for stage I NSCLC, summarises the currently available data on efficacy and toxicity, and describes some of the currently controversial aspects of this treatment.

[Esthesioneuroblastoma]. / Les esthésioneuroblastomes.

Esthesioneuroblastoma is an uncommon malignancy originating from olfactive epithelium. Men are more frequently affected than women. Nasal symptoms are the most common revealing signs. Immunohistochemistry helps diagnosis. There is no randomized trial evaluating treatment due to the low incidence of this tumor. Radiotherapy and surgery are the standard of care. Radiotherapy is benefic even in early stage disease. Chemotherapy is indicated in case of locally advanced or metastatic disease.