[Guidelines for breast cancer screening in Lebanon public health communication]

The accumulation of national epidemiological data since the late 1990s has led to the adoption of evidence-based guidelines for breast cancer screening in Lebanon [2006]. Almost 50% of breast cancer patients in Lebanon are below the age of 50 years and the age-adjusted incidence rate is estimated at 69 new cases per 100,000 per year [2004]. This official notification calls for breast self-examination [BSE] every month starting age 20, and a clinical breast examination [CBE] performed by a physician every three years between the ages of 20 and 40 years. Starting age 40, and for as long as a woman is in good health, an annual CBE and mammography are recommended. Women with known genetic family history of breast cancer should start screening 10 years earlier than the first young patient in the family, or earlier depending on medical advice. The Breast Cancer National Task Force [BCNTF] recommends certification of mammography centers and continued training of personnel to assure high quality mammograms, and to minimize unnecessary investigations and surgeries. It recommends that a national program should record call-backs of women for annual screening and follow-up data on abnormal mammograms. BCNTF encourages the adoption of these guidelines and monitoring of their results, as well as follow-up of breast cancer epidemiology and registry in Lebanon, and scientific progress in early breast cancer detection to determine needs for modifications in the future

Age Distribution of breast cancer in Lebanon: increased percentages and age adjusted incidence rates of younger-aged groups at presentation

Background: Breast cancer is the most common cancer in Lebanese women. Lebanon has no national cancer registry and the American University of Beirut Medical Center [AUBMC] is one of the largest hospitals in Lebanon and has a fully operational cancer registry. Earlier studies showed that it sees about one third of all cancer cases in Lebanon. Methods: All female breast cancer patients recorded at AUBMC between 1983 and 2000 were evaluated. We used the sex-specific age distribution of 1995 Lebanese Population and Housing Survey to estimate the age-specific incidence of breast cancer in Lebanon. The results were calculated as number and proportion of cases, 10-year age-specific incidence rates, crude rates and age standardized rates [ASR] per 100,000 population. The ASR per 100,000 population was estimated by the direct method with the use of the World Standard Population. Results Between 1983 and 2000, there were a total of 16421 cancers of which 8007 were in women. There were 2673 female breast cancers, averaging 148 cases per year [Range 94-202]. Almost half of cases [9.1%] were in women below the age of fifty. The mean age was 49.8 years +/- 13.9 years. Ten-year age groups distribution showed that 4.7% were below 30 years of age, 16.1% were 30-39 years, 28.3% were 40-49 years, 26.3% were 50-59 years, 16.9% were 60-69 years, 6.1% were 70-79 years and 1.6% were 80 years of age or older. Twenty-two patients [0.9%] had their age missing in the records. Overall ASR was 30.6, for a crude rate of 27.7. Age adjusted incidence rate-had its peak in women aged 50-59, followed by women 40-49 then 60-69 with values of 96.3, 79.9 and 77.4 per 100,000 respectively. We also noted 19 male breast cancer cases corresponding to 0.7% of the 2692 combined total. Conclusions: The percentage of women with breast cancer in Lebanon seen at AUBMC in pre-menopausal and younger-aged groups is higher than those reported from western countries. Our results emphasize the need to search for possible environmental, lifestyle and/or genetic risk factors in Lebanon.Our study also shows the importance of implementing early detection and screening programs which, along with high quality mammography and medical care, can have a positive impact on survival, especially in younger-aged women

Adult acute nonlymphocytic leukemia in Saudi Arabia: experience at King Khalid University Hospital in Riyadh

Twenty-two adult patients with acute nonlymphocytic leukemia [ANLL]] were analyzed. There were 15 males [68%] and 7 females [32%]. Their median age was 42 years. Thirty-six percent had acute myelomonocytic leukemia [M4], and 46% had acute monocytic leykemia [M5], according to the French-American-British classification. Of 17 patients who received intensive combination chemptherapy, 47% achieved complete remission. Of the subgroup of 14 new and the patients previously mutreated patients, the complete remissian rate was 57%. The rest of died of septic complications. We report an increased ratio of M4 and M5 in ANLL in Saudi Arabia and an increased rate of severe septic and fungal complications