[Breast cancer in Tunisia: epidemiologic characteristics and trends in incidence]

The goal of this study is to analyze certain epidemiologic characteristics of breast cancer in Tunisia and to foresee the consequences that will arise from the trends in incidence of this cancer. Data obtained from the North-Tunisia Cancer Registry [NTCR] and from the Salah AZAIZ Institute [SAI] Registry is used to estimate the different incidence rates and to compare these rates with those of other countries. In 15 years the crude incidence rate for breast cancer in the North Tunisia almost doubled to reach 21.5 cases / 100, 000 women per year during 1994-1998. The high rate of this cancer among women younger than 35 years [11%] could be related to a relatively low incidence among post-menopausal women. The clinical profile of breast cancer remains quite alarming: 40.2% of cases have a tumor with a clinical diameter equal or greater than 5 cm. Birth cohort effect, also know as the generation effect, is expected to lead to an increase of cancer incidence in the future. The rather high number of young cases is a source of additional cost on social and financial level. The priority is now to solve the problem of late diagnosis it has aggravated the prognosis of this cancer in Tunisia

[Practice of large scale mammography Ariana in state in Tunisia: precluding for an organized screening?]

To study and analyse the results of breast cancer mammography screening program in the Ariana state and to try to determinate its feasibility and reproducibility on a broader scale. A pilot study on the mammography feasibility of screening with large scales was initiated, by Family and Population National Office, in September 2003. The duration of the study was fixed at 5 years. The adopted protocol takes account of epidemiologic and socialcultural specificities of Tunisian environment that is in the selection and in the mode of recruitment of the target population as well as in the choice of the adopted radiological protocol. 8244 women were screened in the first round. The majority of sensitized women was recruited in residence and in the reproductive and health centers. Nevertheless, recruitment in residence was proved to be heavy, not very effective and no reproducible in a broader scale. The participation rate was weak [9.6%]. The channels of sensitizing used made it possible to touch in manner more important the "young" women [Middle Age 48.6 years]. The absence of radiologist on the spot involved the recall of 18.1% of the women for which a complementary assessment was necessary, has to contribute to increase the stress among certain women and to increase the average time of reading which was, in this case, 61.7 days. The majority of the women profited from the double reading of the tests [99.4%]. On the whole 50 women presented a cancer including 40 detected by the program and 10 interval cancers. This study has permitted to study the feasibility of mammography study. Except the topic of the cost, the two hand conditions of his feasibility binds in the systematic invitation of the women as well as in the wider uses of sensitization and information ways of the population

[Results and evaluation of 3 years of large scale mammography program in the Ariana state in Tunisia]

To asses and analyse the results of 3 years large scale mammography screening of breast cancer in Ariana state in Tunisia This program, managed by the Family and Population National Office, was addressing to women aged from 49 to 69 years old residing in a area with adds up a population of 459 700 inhabitants including 52 729 women in the target age population. The screening was including a breast clinical examination and a mammography with two incidences face and external profile. The women was invited at their residence or were sensitized in the reproductive health centers, care and base health centers or by a close relation which heard of the program. An enlightened assent was submitted to the women who wished to profit from the screening. In three years, 9093 mammography were carried out of which 8244 were retained in the analyses, that is to say a rate participation of 9, 6%. The rate of women recalled for suspect test was of 18, 1% and it was of 13, 1% among women of more than 50 years. The rate of practiced surgical biopsies was of 0, 5% and the positive predictive value was of 45, 5%. The average time between the date of screening and the result of the screening was 9, 7 days, more important in the event of tests requiring a complementary assessment [61, 7 days]. On the whole 40 cancers were detected by the program, that is to say a rough rate of detected cancers, of 4, 9%, in conformity with the recommendations. The percentage of invasive cancers

[Preliminary results and analysis of feasability of mammographic breast cancer screening in women younger than 50 years of the L'Ariana state of Tunisia]

To report the preliminary results of the feasibility of breast cancer mammographic screening among women younger than 50 years from the l'Ariana state of Tunisia. The National office of the Family and Population [ONFP] launched a protocol on feasibility of breast cancer mammographic screening targeting asymptomatic women aged 40-69 years, from the l'Ariana state in Tunisia. We practiced two oblique and face incidences at the mammography screening unit of the ONFP, whose equipment and control system of quality answered to the European Communitiy for breast cancer screening. We did 5325 mammograms between April 2004 and March 2006. Our targeted population had a 48, 9 years mean age [CI 95% = [48.7 - 49.1]], 60, 3% of them younger than 50 years. There were more young women with high breast denisty [8.2%] compared to the group from 50 to 69 years [2,1%]. The women arising from the 40-49 years cohort had a socio-economic and educational level higher. The complementary rate of examination/explorations was higher in this cohort [19.5%] vs 11.5% for the 50-69 years. The youngest women presented a more often positive test [7.0 vs 5.2%] than the oldest women [p<0.01]. The option to screen breast cancer by mammography in women younger than 40 years in Tunisia is partially justified by the relatively high frequency of this cancer in this age group. Our feasibility poorly useful in screening will be used to sensibilise females to the problematic of breast cancer to obtain a better compliance compared to the older age group of 50-59 years

[Estimation of years of life gained within the pilot screening program of L'Ariana stale in Tunisia]

Breast cancer is the principle cancer among female cancer in Tunisia. It represents 30% of the woman's cancers with about 1000 new cases per year. The main intervention control is mass screening living mammography in to reduce breast cancer mortality. Breast cancer screening efficacy in term of breast cancer mortality reduction is closely related to incidence and survival of this cancer. National Office of Family and Population [ONFP] conducted a pilot experience of breast cancer mass screening using the mammography in place. The main objective of this study is to calculate the potential number of life years saved through this pilot experience of the ONFP. For the methodology, we used the software Dismod [Disease Model] or the evaluation of the prevalence and the duration of the cancer of the breast in the governorate, as well as to estimate the number of life years saved. The potential breast cancer mortality reduction is 30% for women aged of 50 at 69 years. and 10% for those aged of 40 at 49 years. Breast cancer incidence in Ariana according to age for the period 1995-1998, has been calculated from the data have of cancer registry of the North of Tunisia. According to Dismod. mean duration in the absence of screening, is 11.12 years for the age group 40 to 49 years and 9.57 or the age group 50 at 69 years. Screening would increase these duration means of 2.22 years and 1.71 years. respectively for age groups 40 to 49 years and 50 at 69 years. The number of life years saved for 1000 women is of 2.97 years. In conclusion breast cancer screening using mammography would be actually little benefit in Tunisia. Mammography should he reserved for the diagnosis of the suspected cases and screening for high risk women

[Prognostic value of the parapharyngeal space involvement in nasopharyngeal carcinoma]

This study evaluated the prognostic value of the Para pharyngeal space involvement in nasopharyngeal carcinoma T 2 disease [UICC 1997 classification]. From January 1997 and December 20G1 32 patients with nasopharyngeal carcinoma were examined by CT scan and according to the 1997 International Union Against Cancer [UICC] staging system 15 had stage T2a MO [G1] and 17 T2hMO[G2]. The median age was 47 years .The male to female ratio was 1.81 [G1]; 4.3[G2] All patients were pathologically confirmed by biopsy from the nasopharynx as having UCNT in 100%[G1] and 94%[G2].The node involvement was 52%for the GI[N2: 26%, N3: 26%] and 80%for the G2[N2: 47%, N3: 41%]. Both neoadjuvant chemotherapy and radiotherapy were performed for advanced N disease and only radiotherapy for NO. Examination and CT scan were performed for the evaluation of the treatment. The completely clinical remission after chemotherapy was 12.5%[G1] and 53%[G2], partial remission was 25%[G1] and 35%[G2]. The CT scan control wasn't performed for all patients. The complete response was 69%[G1] and 53%[G2]: partial response was 6%for both two groups. The median follow op was 79 months. Disease free survival rates were 70%for G1 [T2a] and 48%for G2 T2b]. Distant metastasis rates were 26%[G1] vs 6%[G2] and more likely in the presence of advanced N disease. Five years overall survival was 78%[G1] T2a vs 55%[G2] T2b.The N disease was correlated to metastasis as overall survival was 66.7%for N3 disease vs 85.7%for NO. Parapharyngeal tumor involvement affects local and regional tumor failure. Subclassification of T2 disease into T2a112b should have an impact on treatment strategies

[Breast cancer prognosis in Salah Azaiez Institute of Cancer, Tunis]

We estimated survival rate at 9 years of all [470] women with breast cancer diagnosed at Salah Aza‹ez Institute of Cancer in Tunis to identify the main prognosis factors. Data were collected on residence, socioeconomic level, circumstances of discovery of the tumour, histological type, tumour size, presence of metastases, extension of the tumour, treatment and survival. Comparison of survival curves was done with Log Rank test. Cox model was used for multivariate adjustments and calculation of the hazard ratio [HR] [relative risk of death]. There was a survival rate of 61% at 5 years and of 51% at 9 years. Tumour size > 5 cm was significantly associated with lower survival as was capsular rupture. After stratification for tumour size and age, only surgery and radiotherapy were significantly associated with improved survival