[Practice of large scale mammography Ariana in state in Tunisia: precluding for an organized screening?]

To study and analyse the results of breast cancer mammography screening program in the Ariana state and to try to determinate its feasibility and reproducibility on a broader scale. A pilot study on the mammography feasibility of screening with large scales was initiated, by Family and Population National Office, in September 2003. The duration of the study was fixed at 5 years. The adopted protocol takes account of epidemiologic and socialcultural specificities of Tunisian environment that is in the selection and in the mode of recruitment of the target population as well as in the choice of the adopted radiological protocol. 8244 women were screened in the first round. The majority of sensitized women was recruited in residence and in the reproductive and health centers. Nevertheless, recruitment in residence was proved to be heavy, not very effective and no reproducible in a broader scale. The participation rate was weak [9.6%]. The channels of sensitizing used made it possible to touch in manner more important the "young" women [Middle Age 48.6 years]. The absence of radiologist on the spot involved the recall of 18.1% of the women for which a complementary assessment was necessary, has to contribute to increase the stress among certain women and to increase the average time of reading which was, in this case, 61.7 days. The majority of the women profited from the double reading of the tests [99.4%]. On the whole 50 women presented a cancer including 40 detected by the program and 10 interval cancers. This study has permitted to study the feasibility of mammography study. Except the topic of the cost, the two hand conditions of his feasibility binds in the systematic invitation of the women as well as in the wider uses of sensitization and information ways of the population

[Results and evaluation of 3 years of large scale mammography program in the Ariana state in Tunisia]

To asses and analyse the results of 3 years large scale mammography screening of breast cancer in Ariana state in Tunisia This program, managed by the Family and Population National Office, was addressing to women aged from 49 to 69 years old residing in a area with adds up a population of 459 700 inhabitants including 52 729 women in the target age population. The screening was including a breast clinical examination and a mammography with two incidences face and external profile. The women was invited at their residence or were sensitized in the reproductive health centers, care and base health centers or by a close relation which heard of the program. An enlightened assent was submitted to the women who wished to profit from the screening. In three years, 9093 mammography were carried out of which 8244 were retained in the analyses, that is to say a rate participation of 9, 6%. The rate of women recalled for suspect test was of 18, 1% and it was of 13, 1% among women of more than 50 years. The rate of practiced surgical biopsies was of 0, 5% and the positive predictive value was of 45, 5%. The average time between the date of screening and the result of the screening was 9, 7 days, more important in the event of tests requiring a complementary assessment [61, 7 days]. On the whole 40 cancers were detected by the program, that is to say a rough rate of detected cancers, of 4, 9%, in conformity with the recommendations. The percentage of invasive cancers

[Preliminary results and analysis of feasability of mammographic breast cancer screening in women younger than 50 years of the L'Ariana state of Tunisia]

To report the preliminary results of the feasibility of breast cancer mammographic screening among women younger than 50 years from the l'Ariana state of Tunisia. The National office of the Family and Population [ONFP] launched a protocol on feasibility of breast cancer mammographic screening targeting asymptomatic women aged 40-69 years, from the l'Ariana state in Tunisia. We practiced two oblique and face incidences at the mammography screening unit of the ONFP, whose equipment and control system of quality answered to the European Communitiy for breast cancer screening. We did 5325 mammograms between April 2004 and March 2006. Our targeted population had a 48, 9 years mean age [CI 95% = [48.7 - 49.1]], 60, 3% of them younger than 50 years. There were more young women with high breast denisty [8.2%] compared to the group from 50 to 69 years [2,1%]. The women arising from the 40-49 years cohort had a socio-economic and educational level higher. The complementary rate of examination/explorations was higher in this cohort [19.5%] vs 11.5% for the 50-69 years. The youngest women presented a more often positive test [7.0 vs 5.2%] than the oldest women [p<0.01]. The option to screen breast cancer by mammography in women younger than 40 years in Tunisia is partially justified by the relatively high frequency of this cancer in this age group. Our feasibility poorly useful in screening will be used to sensibilise females to the problematic of breast cancer to obtain a better compliance compared to the older age group of 50-59 years

[Lesions classified ACR3 with the breast cancer screening mammography program of Ariana state: features and problems encountered]

This retrospective work is related to ACR3 mammograms of the program "Feasibility of breast cancer screening by mammography in Ariana Governorate" in order to evaluate the efficiency and short-term quality control of these probably benign lesions. Mammograms classified ACR3 raised the indication of further examination, futher mammogram [profile. expanded or compression]. The monitoring and control period are explained to the patient by the radiologist. 6.6% mammograms were classified as ACR 3 with 71.3% under the age of 50 years. Breast is very dense in 20.5% of cases, and transparent in 6% of cases. Further exams has been performed in 94.5% of cases with a profile in 52% of cases, enlarged in 22.1%, compression in 24.9% and ultrasound in 82.5%.The surveillance protocol was insufficient for 126 women lost to the 1st control, 32 women lost for the 2nd control and 19 women were lost to the 3rd control. After two years monitoring. 219 women were reclassified as ACR2 with a negative test. In 2 patients, we found an invasive ductal carcinoma at 4 months control. ACR 3 mammograms are the most important operator dependent category. The diagnosis of probably benign lesion dependant of the analysis of images and requires a great experience of the radiologist and a comprehensive complementary examination. In this study, this assessment was often heavy in relation to the frequency of dense breasts itself in connection with the young age of patients. In addition, for this particular category, the need of training is important and in terms of public health cost, the management of ACR3 mammograms increases difficulties and cost of screening

[Retrospective results of breast ultrasonographically-guided cytoponctions and microbiopsies within the breast cancer screening program of L'Ariana state in Tunisia]

To report the results of breast ultrasonographically-guided fine needle aspirations and needle biopsies within the breast cancer screening program of L'Ariana state in Tunisia. Our retrospective study include 143 patients, with mammographically detected lesions, which underwent a diagnostic percutanous ultrasonographically guided procedures. 57 patients underwent a fine needle aspiration, 25 underwent a needle biopsy and 61 patients underwent both procedures. Sensitivity and specificity of fine needle aspiration are of 84, 2% and 98, 5%. We report 13, 5% of non contributive results. The needle biopsy have a sensitivity of 97, 3% and a specificity of 100% with one false negative corresponding to an atypical ductal hyperplasia at the excisional biopsy. Fine needle aspiration is a reliable method of accurately establishing a diagnosis. Needle biopsy is recommended for a preoperative lesion characterisation before adequate treatment

[Management of breast cancers detected by screening mammography program of L'Ariana state in Tunisia]

To report the epidemiological and anatomoclinical features of breast cancers referred to a department of gynecology from the screening program of l'Ariana state in Tunisia. A longitudinal retrospective Study was done over a period of 4 years [2004 - 2006] at the Unit "A' gynecology department of the maternity of Tunis. We collected all the cases with histologically confirmed breast cancer diagnosed within the mammography screening program of l'Ariana state, referred to our unit for treatment. 10 patients with histologically confirmed breast cancer were collected during the study period, treated at our unit. Mean age of patients was of 48.8 years. Clinical examination was initially negative in 50% of cases. Mean clinical tumor size was 18 mm, while invasive ductual carcinoma represents the most frequent histological type. One patient [10%] had histological axillary involvement. Conservative surgery was performed for 8 [80%] of the 10 patients. This pilot study of mammography screening confined to a Tunisian state, precludes to the future profile of BC In Tunisia, showing that an early diagnosis can lead to a dramatic reduction of mean clinical tumor size, less histological poor prognostic features, more conservative surgery and a slight improvement of survival. A structured extended screening program must be installed to achieve these goals but requires an important financial and human investment

[Satisfaction inquiry within women involved in the pilot program of large scale mammography in the Ariana state in Tunisia]

Evaluate the degree of satisfaction of women included in the large scale mammography program of breast cancer screening in the state of Ariana in Tunisia. Within the women explored by mammography, we have contaced 112 patients who had a positive screening requiring histological checking. We have established a questionnaire concerning: the invitation, the clinical examination, the result announcement and the therapeutic management. The average age of patients was 49 years. 64% had a primary education level. 80 women or 71.4% were satisfied with the process of screening and the method of announcement. The main cause of dissatisfaction for patients with cancer diagnosis was delay and difficult access to adjuvant treatments. Among patients who had histological diagnosis: 47.3% had a malignant disease [53 cases] against 37.5% of benign [42 cases]. 100% of patients who had a pathological result reassuring are satisfied at the end of the screening program. The psychosocial impact of screening must be considered for the development of new programs. The waiting and announcement of results are essential factors that allow us to judge the success of the project, because of patient satisfaction will depend the quality of monitoring and adherence to screening

Implementing a quality improvement programme in a family planning centre in Monastir, Tunisia

We aimed to improve the quality of family planning and reproductive health services in a family planning centre though implementation of a quality improvement programme. Clients were surveyed to identify quality-related problems. Health care teams then analysed the causes of the problems, developed solutions for 3 selected ones and established a quality assurance framework. The selected issues were: long waiting time at the centre; insufficient integration of family planning and reproductive health services; and lack of a holistic approach. The final phase was aimed at testing and implementing corrective measures

[Reproductive tract infections prevalence among women consulting in the reproductive health center of Ariana]

A transversal study has been performed from June the 7[th] 2001 to January the 4[th] 2002 among 504 women consulting at the Reproductive Health Center of Ariana in the framework of a project in collaboration with Marocco for the prevention of STI. The objec-tif of this projects is to assess STI prevalence and the proportion of asymptomatic carriers. Vaginal, cervical and blood samples have been performed for the screening of most common STI organisms. Urinary samples has been sent to the [Unite de Biologie Moleculaire de L'lnstitut National d'hygiene-Rabat] for PCR test [Chlamydia trachomatis et Neisseria gonorrhoea]. RTI prevalence is 22.6%. IST prevalence [Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae] including PCR is 5,0% Most common IST organism is Trichomonas vaginalis. The high prevalence of asymptomatic carriers make the management of STI difficult and argue for the syndromic approach for STI management