National Egyptian Model of Breast Cancer Care Project As a Model for Low Resource–Setting Countries to Improve Outcomes From Early Screening Early Treatment

Background: 40% of Egyptians has access to public health system, 60% served by NGOs and private centers. The problem is the late presentation and inadequate access to services due to lack of a structured screening program and awareness. Aim: To present a model of breast cancer (BC) care in low resource setting (LRS) and to assess risk factors for BC in Egypt the high BC incidence country based on registry estimates stating that about 22000 new BC cases will be diagnosed by 2020. Strategy: In Giza region there used to be no mammographic (MMG) reference service. Women with breast symptoms were referred to the NCI, where they were offered the services (diagnosis, treatment). With very long waiting times. Women aged 20 years or older visiting one of the 5 participating centers were evaluated in a cross-sectional study, which included: (1) Data entry form questionnaire of risk factors for breast cancer - including family history of cancer - and presence of breast symptoms, and (2) Breast examination by a trained professional (nurse or medical doctor). All patients with breast complaints or an abnormal physical exam were referred to NCI, MISR Cancer Center, Kasr El Aini, Agouza and Bahia Hospital for further evaluation. Women 40-69 years of age were invited to participate in the screening both actively (digital invitations, Facebook groups, brochures distributed in governmental buildings and WhatsApp groups) and passively (women that attended for any reason to other hospitals in the region are called and delivered brochures and vouchers to join the project). The screening program is based on annual MMG in women between the ages of 40 and 69 years, which are always preceded by physical examination performed by a breast surgeon or a trained nurse. Program: Close control of the frequency of visits using a simple computer program with patient listing and reminder. The close contact and continuous feedback that helped adherence to the screening program. The proposal of the project includes the performance of all clinical, imaging and pathology exams, as well as clinical visits and surgical treatment, in the same center in the shortest time and the highest standards of care. The health care approach is multidisciplinary, including nurses, breast surgeons and a nutritionist. Outcomes: High rate of compliance is the main strength of project, achieved by patient education about the importance of the screening, intense contact with the primary trained staff, with provision of lists of patients who should come next visits. Free transportation for women with very low income is arranged. Every 3-4 months, we established jointly a charity workshops and projects of handmade cloths and bags for BCPs and encouraged social clubs and societies to adopt parties and to host educational BC advocacy campaigns. What was learned: A simple project is successful and its cost-effectiveness is balanced in Egypt as a developing country where the mortality associated with this disease is very high.