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Forty-eight per cent of the replies have chosen the NCCN guidelines to be their institutional guidelines. This was mainly due to lack of experience in doing SLN assessment. Seventy-five per cent of the participants in our project have a centralised pathology laboratory in their centres.
An important point to declare is that we did not define the meaning of a centralised pathology laboratory in our surveys; Only Around However, this is not available for all patients. About Our surveys have shown that the essential investigation facilities for screening and diagnosis of breast cancer are acceptably available, with no major defect in the basic essential modalities. However, there is a tendency to overuse investigative techniques, against the recommendation of the guidelines when the facilities are available.
Most of the old generation of chemotherapeutic agents were recorded as available in the majority of centres.
The results of our project showed that there is an ultimate need for regional breast cancer guidelines that take into account the specific criteria of breast cancer in the MENA region. It has shown that there is a defect in the availability of national and regional breast screening programmes. The presence of a specialised breast cancer unit with a specialised onco-surgeon who is an expert in all the advanced surgical techniques in breast cancer, as well as the presence of a specialised radio-diagnosis physician in breast cancer, has become essential for the state-of-the-art care and for the sake of a multidisciplinary approach in breast cancer management [ 7 ].
According to the international guidelines, the state of the art in breast cancer management now requires a multidisciplinary team of breast cancer-specialised medical oncologists, radiation oncologists, onco-surgeons, pathologists and radiologists. There is a lot of work needed to fulfil these requirements in the MENA region to be able to cope with the international guidelines. As mentioned previously, we have a different breast cancer epidemiology in the MENA region compared with that in other parts of the world, with a higher tendency of younger age at presentation and more advanced stages with a higher breast cancer mortality rates.
This shows the important need for efficient breast screening programmes to pick up early cases and may also require modifying the age of starting screening and thus creating specific regional criteria for breast screening based on the epidemiological status as well as the available facilities.
This is one of the main points that were highlighted by our project. More efficient regional and national efforts are required, which, if achieved, can have a great effect on breast cancer management in terms of decreased treatment cost, as well as improving the breast cancer mortality rates. Our results represent the governmental public sector, which has different, and most of the time less, access to diagnostic and treatment facilities, although it covers the majority of the population in the MENA region.
Some facilities may be present in the private sector, but public patients and patients in remote areas may not have access to it. Considering the availability of advanced investigation, medication and targeted therapy, there is a lot of discrepancy between the private and government sectors. This may place more burdens on healthcare systems. For successful regional guidelines, there should be a strict indication and a way to control the abuse of the available resources and facilities.
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To the best of our knowledge, the MBCG project is the first of its kind to screen the clinical practice in the management of breast cancer in the MENA region. Although different efforts have been made to create specific guidelines for the MENA region, none have considered the differences in patient epidemiology as well the availability or nonavailability of specific facilities that are required either in the investigation or treatment of breast cancer patients.
It is clear that modification of the international guidelines is essential to optimise treatment in the MENA region. Furthermore, a different design of clinical trials is also required to address the unique clinical scenarios that arise from the limited resources, which do not occur in more developed countries. This needs the cooperation of all the centres in the MENA region as well as the formation of a breast cancer research network that covers the whole region and is the centre of designing clinical trials.
A clear need for a real and committed breast-screening programme has been shown to be mandatory. This requires the collaboration of all the centres and institutes in the MENA region to create a regional breast screening programme with the aim of decreasing the incidence of advanced breast cancer and breast cancer-related mortality within the next ten years. Our project has several limitations. The main limitation is the low response rate to our surveys. In addition, there is the inaccuracy of the collected data as well as the difficulty to get a precise response rate because of using online surveys and not face-to-face interaction.
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Expanding the MedicalSurveys Research Group to include more members from different MENA countries and using a high technology axis allowing face-to-face connection may improve these limitations. The majority of the responses being from Egypt may lead to some bias in results interpretation; however, with our knowledge of the different healthcare systems in the MENA region, we can urge that our results represent a realistic view of clinical practice in the MENA region. We did not cover in detail the distribution of facilities between different countries and also in the same country between major cities and remote cities as well as the difference between the public and private sectors.
This may have added more insight into the real practice in the region. These problems, if addressed, could improve clinical practice as well as the level of patient care in the next ten years. Our impression is that we certainly need a modification of the international guidelines based on our specific patient population and available facilities as well as our socioeconomic factors.
This by all means does not mean giving patients suboptimum care, but tailoring our facilities to maximise the care to all patients with no differentiation, and in addition detecting our own problems and trying to solve them through real clinical research that addresses our specific issues. Our idea of the regional guidelines is that they should address the following points: applying the best possible practice; applying the best alternative when there is a defect in the facilities; collaborative work to make sure that the guidelines are applicable across the whole region,.
Regional guidelines are required to establish the best possible management of breast cancer according to the patients and disease specification as well as the regional socioeconomic factors and available facilities. Collaborative working between different centres in the region is critical to improve the management of breast cancer in the MENA region.
We would also like to thank all the physicians who participated in our surveys. National Center for Biotechnology Information , U. Journal List Ecancermedicalscience v.
volunteerparks.org/wp-content/rumohyne/3046.php Published online Nov Author information Article notes Copyright and License information Disclaimer. Correspondence to: Adel T Aref. Received Jun Methodology Three web-based designed surveys were sent to more than oncologists in the MENA region from the period of August to October Aim of the MBCG project The aim of our work is to screen the clinical practice in management of breast cancer in the MENA region and to detect to what extent the international guidelines can be applied.
Methodology Using the database of the MedicalSurveys Research group Oncologists , three web-based surveys were emailed to each oncologist during the period of the project from August until October Results During the period of the project, the links of the three surveys were emailed and posted frequently. Open in a separate window. Figure 1.
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