Evaluation of Breast Cancer Screening Program in Assiut Governorate "Egyptian Women Health Initiative"

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females worldwide, Despite major efforts at early detection and new treatments, breast cancer claims the lives of over 520,000 women every year [1] with an estimated 2.3 million new cancer cases (1 in 4 new cancer cases) and 685,000 cancer deaths (1 in 6 deaths) in 2020.

Breast cancer incidence rates varied by nearly 4-fold across WHO areas. The highest incidence rates (per 100,000) were found in Australia/New Zealand (95.5), Western Europe (90.7), and Northern America (89.4), while the lowest rates were in South-Central Asia (26.2), Middle and Eastern Africa (33), and Central America (39.5). In contrast, the highest breast cancer mortality rates were recorded in Melanesia (37.5), Polynesia and Western Africa (22.3), and the Caribbean (18.9), while the lowest rates were found in Eastern Asia (9.8), Central America (10.4), and Australia/New Zealand standardized breast cancer incidence rate (per 100,000) increased from 106 (1975) to 142 (1999), decreased to 128 (2004), and then slowly increased to 137 (per 100,000) in 2019. Similar broad temporal trend patterns were observed in other western countries.[2] Incidence rates are rising in South America, Africa, and Asia where rates were historically low. Worldwide, an estimated 2,964,197 new female breast cancer cases are projected to occur in 2040, a 31% increase from the corresponding 2,260,127 cases in 2020. [3,4] Breast Cancer in Arab Countries From available data from the years 2010, 2013, and most recently 2020, breast cancer is thought to be the most common malignancy diagnosed in Arab women, estimating somewhere between 14-42% of all tumors [5 ,6]in some reports, and between 17.7-19% of all new cancers in others [7] depending on individual countries and type of reports reviewed.

In Egypt In Egypt, breast cancer is the most common malignancy in women, accounting for 38.8% of cancers in this population, with the estimated number of breast cancer cases nearly 22,700 in 2020 and forecasted to be approximately 46,000 in 2050. It is estimated that the breast cancer mortality rate is around 11%, being the second cause of cancer-related mortality after liver cancer.[9] Early diagnosis (in symptomatic populations) and screening (in asymptomatic populations) are the two main components of cancer early-detection programs, as defined by the WHO, to reduce the incidence of advanced cancer and mortality. In low- and middle-income countries, where cancer is diagnosed in advanced stages and allocated resources are limited, it is highly recommended that cancer control programs include the following elements: [1] targeted outreach/education promotion and [2] efforts to encourage clinical breast examination for at-risk groups, with or without opportunistic mammographic screening. This is to keep with the goal of downsizing symptomatic disease and/or asymptomatic disease in high-risk groups.[10] Breast self-examination (BSE), clinical breast examination (CBE) by a physician, and mammography are three instruments recommended for breast cancer screening. BSE is highly useful in breast cancer screening as it is cheap, easy, confidential, uncomplicated, and without the need for special equipment [11] Clinical Breast Examination (CBE) is defined as the examination of a woman's breasts by a healthcare professional, such as a breast surgeon, family physician or breast care nurse who is trained to recognize many different types of abnormalities and warning signs in the breast [12] Screening mammography is a low-dose X-ray examination of a woman's breasts used to detect BC when that cancer is too small to be felt as a lump. Screening mammography is very useful as it reduces mortality from BC by about 20%-35% in women aged 50-69 years and slightly less in women aged 40-49 years at a period of 14 years of follow-up [10].

In Egypt, facilities for mammographic screening are available in the major governmental and private hospitals and delivered through mobile units equipped with digital mammography units. Despite these mobile units, which increase the presence in rural areas and less affluent areas, barriers to accessing mammography still exist [13].

Delays to breast cancer treatment of greater than three months have been associated with more advanced disease stage at diagnosis and poorer survival. At the same time, education of primary care providers to recognize the early signs and symptoms of breast cancer is necessary for prompt referral through the healthcare system [14].