Inflammatory breast cancer: Epidemiologic data and therapeutic results.

Since the early description more than a century ago, inflammatory breast cancer (IBC) remains an aggressive disease, with a different geographic repartition, with the highest ones incidence reported in the North of Africa (Tunisia, Algeria, Morocco, and Egypt), and the lowest incidence in Western countries (USA, Europe…). In this study, we reviewed the literature using the Surveillance, Epidemiology, and End Results (SEER) database compared to other published series. We observed that in the high incidence areas (North of Africa) when compared to "classical" breast cancer, IBC was associated to younger age (less than 50 years) with rapid evolution of signs and symptoms (in less than 3 up to 6 months), and more aggressive clinical and histopathological-molecular parameters, due to the predominance of triple-negative and HER2+ subtypes in around 60% of cases. An epidemiologic trend was observed in both high and low incidence areas since the eighties are towards reduction of IBC prevalence. Concerning Tunisia, in comparison with the historical series of the 1980s, the incidence decreased in part by applying more stringent diagnostic criteria but also probably due to a slight improvement of the socio-economic level (SEL). This trend was also observed in the US, due to the efforts of collaborative IBC groups from MD Anderson Cancer Center (MDACC), Duke and IBC patient advocacy groups. Therapeutic results are slightly better due to the standardization of a multidisciplinary approach and the use of combined primary chemotherapy and/or targeted therapies (especially in HER2 positive patients), followed by mastectomy plus radiotherapy. The 5-year overall and disease-free survival is at more than 60%, related to an IBC mortality decrease observed in the cohorts of patients treated in the last decade.

Prevalence of hepatitis C virus antibodies among different populations of relative and attributable risk.

OBJECTIVES: To determine the prevalence of hepatitis C virus (HCV) antibodies among 5 different population groups including; healthy individuals, blood donors, hospital health care workers, renal dialysis patients and multiple blood transfusion group. To compare the ratios, relative and attributable risk among these groups. To outline a specific policy to reduce the potential risk of HCV among the different groups studied. METHODS: A prospective study was carried out in the Department of Microbiology, Faculty of Medicine, Tripoli, Libya, over a 2 year period for 1999 to 2001, to determine the prevalence of HCV-antibodies in sera collected from 5 distinct groups using enzyme-linked immunosorbent assay test. The groups included 800 healthy adults, 1200 individuals of blood donors, 459 hospital health care workers, 200 patients on renal dialysis and multiple blood transfusion group which included 250 patients. The prevalence of HCV was correlated with relative and attributable risk that contributed to the infectivity of HCV. RESULTS: A total of 2909 individuals participated in this study with 1.6:1 male to female ratio. The prevalence of HCV varied from one group to another. It was found to be 1.6% among the general population, 1.2% among blood donors, 2% among hospital health care workers, 20.5% among renal dialysis patients and 10.8% in the multiple blood transfusion group. The relative risk and attributable risk among these groups varies from 1.25 to 12.8 and from 0.4-18.9. CONCLUSIONS: This study underlines the prevalence of HCV among different groups. The prevalence varies from one group to another, being the lowest among the blood donors and general population and the highest among the higher risk group in particular the renal dialysis patients. Specific measures should be implemented to reduce such risks. These may include specific programs for medical education, a meticulous infection control system in the hospitals, a registry program and clinical follow-up for patients positive for HCV.