The Challenge Fund

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The Challenge Fund

• The fight against cancer in the emerging world

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The Challenge FundThe Rising Cancer Problem in
the Emerging World

• Increasing longevity
• Increasing incidence
• Disproportionate resource distribution
• Lack of appropriate research

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The Challenge FundThe Djerba Statement

• Research in development of simple and relevant
• cancer prevention recommendations
• Research in early detection, prevention and
• treatment of common cancers
• Defining appropriate mechanisms in developing
• public health research in the emerging world

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The Challenge FundSignatories to the Djerba
Statement

• E. Abebe, Lagos
• F. Ben Ayed, Tunis
• N. Gad El Mawla, Cairo
• A. Ghavamzadeh, Teheran
• S. Kadare, Tirana
• I. Mittra, India
• The Statement was supported by
• A. Costa and A. Saracco, ESO Milan
• N. Pavlidis, Loannina
• S. Plesnicar, Ljubljana

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The Challenge Fund Challenge Fund Conferences

• Cairo 1996
• Rome 2001
• Abu Dhabi 2002
• Rome 2005
• Lima 2005

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The Challenge Fund The Challenge Fund Projects

• The Cairo Study
• The Yemen Project
• The India Project
• The Sudan Project

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The Challenge Fund The Cairo Project

• A Pilot Study of Early Detection of Breast Cancer
  by Clinical Examination plus BSE
• Investigators
• S. Boulos M Gadallah S Naguib

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The Challenge Fund The Cairo Project

• Trial Centre The Italian Hospital, Cairo
• Study Population 5,000 women, age 35 64
• No. Participating 4,116
• Breast Cancer Detection Rate
• 1st Yr 4 / 1000
• 2nd and 3rd Yrs 1 / 1000

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• In Egypt, breast cancer is the most common
  cancer in women.
• The disease is usually diagnosed at an
  advanced stage, and survival is poor.

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AIM OF STUDY (CBST) 1- To test the feasibility
of conducting a Randomized Trial of Breast
Physical Examination and Breast
Self-Examination 2- To evaluate a
Breast Cancer Screening Program in a well
defined, socio-economically modest
population in the city of Cairo (Abbasiah) using
(CBE) (BSE)

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• MATERIAL METHODS
• SAMPLE SIZE 5000 women ( 35 - 65 years)
• PHASES OF THE SUDY
• The study was conducted in 2 phases
• Phase I
• Phase II

• DURATION OF THE STUDY Started 07/05/00
• 
  ended 28/11/02
  

Group A
Group B
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• METHODOLOGY
• 1. Geographical definition

An area around the Italian Hospital, named
Abbasiah District, was defined. The maps of this
area were obtained and divided into 8 blocks.
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• METHODOLOGY (Cont.)
• 2. Door-to-Door visits
• 4 Social workers were selected and trained
• about the objectives and methodology of the
• study.

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2. Door-to-Door visits (Cont.)
Questionnaire
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3. Women invited to attend a Health Education
Session in a primary health care center
(PHC)

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(a) Brief health talk by doctors.
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• ( b ) Clinical Breast Examination (in a private
  room)

( c ) Teaching of Breast Self Examination
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4- Referral to the Italian Hospital of any woman
with suspicious finding for a)
CBE by Chief Surgeon. (Confirm)

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b) Further investigation (/- MX and U.S.)

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c) Further surgical treatment (free of cost).

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• Phase II Women who had previously been
  contacted
• were randomly classified
  into two groups
• (using area / block
  randomization) .
• Group A To be invited to attend once
• more the PHC for
  examination
• Group B To be visited only and asked
  about
• Breast Problems

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Results of phase I Field Study Rates . No. of
women contacted ? 4116 out of 5000
. Community Acceptance Rate ?

4116/5000
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Field Study Rates (Cont.) . Compliance Rate at
PRIMARY HEALTH CARE
2481/ 4116
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Field Study Rates (Cont.)

Field Study Rates (Cont.)
Compliance Rate at ITALIAN HOSPITAL
236/291

N.B 55 out of 291 Symptomatic cases did not
show up at the hospital for further investigation
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Morbidity Statistics Rates ( per 1000 women )
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Results of Phase II GROUP A Cancer Detection
Rates
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• Results of Phase II GROUP B
• CANCER DETECTION RATES
• Among women who attended PHC in phase I 3 /
  1062
• 2.8 per 1000
• Among women who did NOT attend
  3 / 865
• 3.5 per 1000

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In the year 2003/2004, the trial has been
extended in Cairo by the identification,
recruitment and randomization of a second group
of 5000 women.
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From the start, women were randomly allocated
into 2 groups Group A (2500)
Study arm Group B (2500) Control
armBoth areas of residency are quite far from
each other.
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Results Of Phase III

• Study Group A
• No. of women contacted 2092 out of
  2500
• Community acceptance rate (83.7)
• Compliance rate at PHC
• 
  1548/2092 (74)
• Compliance rate at Italian Hospital
• 
  80/92 (87)
• Cancer Detection rate 10/1548 (6.5 per
  1000)

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Results Of Phase III (Cont.)

• Study Group B
• No. of women contacted 2179 out of
  2500
• Community acceptance rate 87.2
• Cancer Detection rate 13/2179 (6 per
  1000)

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Thank You
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The Challenge Fund The Yemen Project

A National Project on Breast Cancer Screening
Kuwait University Hospital, Sanaa,
Yemen Coordinator S. Shivananda
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The Challenge Fund The Yemen Project

• Replication of the Cairo Study
• 1st Phase Capacity Building
• Training in Breast
  Examination
• Training in Mammography
• Training in FNAC / Pathology
• Training in Breast Cancer
  Treatment

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The Challenge Fund The India Project
Cancer Awareness and Early Cancer Detection
Project in Trichy District, Tamil Nadu, Southern
India Coordinator V. Gajalakshmi

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The Challenge Fund The India Project

• Knowledge, Attitude, Practice (KAP) Survey
• Public education and assessment of its impact
• Early detection of cervix, breast and oral
  cancer
• Assessment of compliance to invitation,
• referral, treatment and follow-up