title: Management of breast lesions by breast physicians in a heavily populated South asian developing country.
abstract: BACKGROUND
  In Asia, from 1998 to 2002, the highest annual-age standardized incidence rates of breast cancer per 100,000 women were recorded as follows: in the Karachi South district of Pakistan 69.0 and in the Israeli Jews 96.8. At Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore, Pakistan, in 15-years from Dec. 1995-Dec. 2009, among adult females, approximately 46% (8,915) of malignancies were recorded as breast tumors. Further, according to Pakistan's population estimates (2009), the total population of the country is 177 million; females 85 million (40-69 years: 13.6 million).
  
  
  CONCLUSIONS
  Screening of asymptomatic women: Basing the recommendations on biennial mammograhic screening for average-risk women in the 40-69 year age-band, about 6.8 million women will have to be screened every year. In a resource-constrained country like Pakistan, early detection by this method is not possible. As most symptomatic women present with advanced disease, clinicians skilled in breast diseases are required. The Australasian Society of Breast Physicians has developed a formal three year training model for General Practitioners to qualify as breast physicians by: i) developing their skills in the areas of clinical breast-examination, interpretation of mammography and breast ultrasound; performance of image-guided interventional procedures; counseling of and planning/coordinating treatment of females with breast cancer and assessment/monitoring of women at potentially 'high-risk' of cancer; and ii) working in consultation with surgeons, radiologists, pathologists, oncologists, and other members of the multidisciplinary team.
  
  
  CONCLUSIONS
  Easily accessible one-stop breast clinics staffed by trained breast physicians can help reduce morbidity/mortality from breast cancer in developing countries, and improve the quality of life and survival.
authors.affiliation: Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan. farhana@skm.org.pk
authors.forename: F
authors.initials: F
authors.lastname: Badar
authors.forename: Z S
authors.initials: ZS
authors.lastname: Faruqui
authors.forename: N
authors.initials: N
authors.lastname: Uddin
authors.forename: E A
authors.initials: EA
authors.lastname: Trevan
mesh_terms: D000328:Adult; D001941:Breast Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D003906:Developing Countries; D005260:Female; D058005:General Practitioners; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D010154:Pakistan / Q000453:epidemiology