Comparison of the clinical and pathological features between patients with recurrent metastatic breast carcinoma and patients with initially metastatic breast carcinoma.

OBJECTIVE: To compare initial metastatic breast carcinoma (MBC) with recurrent MBC and assess their biologic phenotypes and clinical behaviors. METHODS: A comparison of clinical and biological characteristics and median overall survival times were assessed in the 251 patients with MBC at the Division of Medical Oncology, Ege University School of Medicine, and the Division of Radiation Oncology, Tepecik Government Hospital, Izmir, Turkey between 1995 and 2004. Hormone receptors, c-erbB-2, Ki-67, and p53 expressions were performed by immunohistochemistry. RESULTS: Out of 251 MBC patients, 206 patients had recurrent MBC, and 45 had initial MBC. Regarding survival, there was no difference between the recurrent MBC group and the initial MBC group. The initial MBC group had a higher proportion of T4 tumors (46% versus 27%), a lower proportion of T1-2 tumors (31% versus 55%; p=0.01), and a higher percentage of patients with high Ki-67 expression (64% versus 49%; p=0.05). Multivariate analysis showed that T stage was an independent prognostic factor (p=0.02). CONCLUSION: Patients with initial MBC tended to present with larger tumors. This relationship can be explained by delayed diagnosis. The potential for reducing death rates from breast cancer is contingent on educational improvement and increased screening rates.

Past and present midwifery education in Turkey.

Among criteria relating to the level of development in a country are health indicators such as total fertility, maternal mortality, infant mortality, and rates of life expectancy at birth. These have a close relationship with the quality of health-care services, especially those provided by midwives. An improvement in midwifery services can be achieved to a great extent by standardised and high-quality midwifery education. Until recently, midwifery education has not been standardised in Turkey. Although improvements have been made, more needs to be accomplished. In this paper, we report the development of midwifery education in Turkey from a historical perspective, dealing with past and present applications, and make recommendations to overcome existing problems.

Cervical cancer prevention and early detection--the role of nurses and midwives.

Worldwide 31% of cancers in women are in the breast or uterine cervix. Cancer of the uterine cervix is one of the leading causes of cancer death among women. The estimated new cancer cervix cases per year is 500.000 of which 79% occur in the developing countries, where it is consistently the leading cancer and there are in excess of 233.000 deaths from the disease. The major risk factors for cervical cancer include early age at first intercourse, multiple sexual partners, low socioeconomic status, HSV, HPV infection, cigarette smoking and extended use of oral contraceptives. Well organized and applied public education and mass screening programmes can substantially reduce the mortality from cervical cancer and the incidence of invasive disease in the population. Women who are health conscious are more likely to have used screening services (mammogram, pap-smear test) and performed breast-self examination and genital hygiene. There are both opportunities and burdens for nurses and midwives working in primary health care settings. This is a prime example of a role of public education in cancer prevention with reference to population-based cancer screening programs.