Cost-effectiveness of clinical breast assessment-based screening in rural Egypt.
BACKGROUND
Breast cancer is the most common cancer in Egyptian women. However, the mean tumor size at diagnosis is 4.5 cm, and the median age is approximately 46 years. Both of these factors decrease the utility and cost-effectiveness of a mammography-based screening program typically designed for developed countries. We report the first clinical breast assessment-based screening project in an entirely rural Egyptian community.


METHODS
Targeted population: Women aged 25-65 years in three municipal regions of Dakahlia province, Egypt. The estimated targeted population was 57,500 and participation was voluntary. First stage was performed at primary health care points. Surgeons performed systematic clinical breast examination. All data were collected at Mansoura University. Abnormal findings in the primary examination led to an invitation to the Oncology Center--Mansoura University--where the second stage of the study took place. It comprised repeat examination, ultrasonography, and/or mammography. Therapeutic interventions were performed at the governmentally funded Mansoura Oncology Center.


RESULTS
Voluntary participation reached 10.2% of the target group and abnormal clinical examination represented 3.2% (191/5,900). The screen-detected cancers were (18/5,900) of examined population, and thus the cancer detection rate of clinical breast assessment-based screening was 30.5 per 100,000 of participating women during 2 years. The tumor size was 1.5 cm (median) and 1.3 cm (mean). The cost of screening per cancer case detected was approximately 415 US$, and the overall cost of treating a screen-detected cancer was 1,015-1,215 US$.


CONCLUSIONS
Clinical breast assessment-based screening with selective mammography is an effective modality, which improves the results of breast cancer management in Egypt.
Surgical Oncology Department, Oncology Center, Mansoura University, Mansoura 35516, Egypt. adeldenewer@yahoo.com
Adel
A
Denewer
Osama
O
Hussein
Omar
O
Farouk
Waleed
W
Elnahas
Ashraf
A
Khater
Aiman
A
El-Saed
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D003362:Cost-Benefit Analysis; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000458:organization & administration; D008408:Mastectomy; D008875:Middle Aged; D010808:Physical Examination / Q000191:economics; D012424:Rural Population / Q000706:statistics & numerical data