MBCG Project Primary Results MEDICALSURVEYS-17 RESEARCH GROUP IN COLLABORATION WITH THE EASO

Introduction  Breast cancer represents a major health care problem in the MENA region.  In a population of about 500 million, the political and socioeconomic factors had created a variety of health care systems with different standards and different abilities. But non of them had worked together to create a regional guidelines for this part of the world.  Most of the breast cancer international guidelines came from USA (NCCN, ASCO) and from Europe (ESMO, NICE). These parts of the world have a different health care system and different facilities than those in the MENA region.

MBCG Project  Through a collaborative work between MedicalSurveys-17 Research Group and the EASO, we have created the MBCG project.  Through 3 online web based surveys, we tried to collect as much data as we can regarding the real clinical practice and the availability of different facilities as well as the obstacles that face the oncologist in the MENA region to apply the best clinical practice.  To our knowledge, The MBCG is the first regional project that screen and asses the real practice in management of Breast cancer in the MENA region.

MBCG project  Management of Breast cancer was covered in three on line surveys which cover diagnosis, screening, management of early breast cancer as well as advanced Breast cancer.  The surveys were sent to all the oncologist in our data base as well as in the EASO data base.

MBCG Primary Results.  The surveys were sent to about 600 Oncologists who are practicing oncology in the MENA region  We got replies from 90 oncologists ( 15 % reply) till now from the MENA region.  There was participation from the majorities of countries in the MENA region but with different proportion

 More than 50% of the replies came from oncologists with more than 10 years of practice.  The majority of replies were from University and Governmental institutes  The majority were places where treatment is covered by government

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Specialized Breast cancer center  In around 35%, there was no specialized breast cancer unit available.  In around 40% there was no Radiodiagnosis specialist specialized in breast cancer

 In spite of the absence of specialized breast cancer unit, there was also defect in the presence of a multidisciplinary tumor board

Facilities  There was no centralized specialized pathology lab in 25% of replies.  Radiotherapy facility was not available to 25% of our participant.

Radiodiagnosis  Most of the essential Radiodiagnosis facilities required for screening and diagnosis as well as staging of breast cancer were available  The main concern was with the duration of reporting ( average of 1 week)

Pathology reporting  An important issue that has been raised is the long time required for pathology reporting.

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Breast screening and familial breast cancer  There is a clear defect in the presence of national or institutional breast screening program, as well as the unavailability of genetic counsel unit.

Surgery  Regarding surgery, and surgical facilities, there was clear concern regarding the presence of specialized breast onco-surgeon.  There is also clear defect in the performance of putting marker before preoperative chemotherapy

 In more than 40%, there is no facility to perform SLNB  Also, in more than 40%, there was defect in performing skin sparing mastectomy

 The absence of facilities as well as the long waiting list for radiotherapy were representing the reason in around 35% to perform Mastectomy in early breast cancer

Chemotherapeutic agents  The availability of chemotherapeutic agents was acceptable regarding the classical agents as well as trastuzumab.  But, for new agents and new anti her2 agents, there was a clear availability defect.

Trastuzumab  Trastuzumab is available in the majority (>80%) for adjuvant treatment for one year.  But in around 25%, anti her2 treatment is either not available or not offered in the metastatic setting.

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Hormonal treatment  First line hormonal treatment is available in the majority  However, there is some defect in the options of second line ( fulvestrant, everolimus )

 The Oncotype-Dx was not available to more than 70% of the oncologist participated with us.

Feedback from the oncologist in the region  Around 50% are applying the NCCN guidelines.  More than 40% of the institutes participating in our survey were not involved in clinical trials

 The long time taken to have reports of pathology as well as the radiology investigation was the main concern that delay treatment.

Improving care  Having more facilities that allow following the guidelines as well as participating more in the clinical trials were the main suggestions to improve the quality of care to the patients

 90% of the participant see that we need regional guidelines for our region.

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Conclusion and take home message  There is a need to have a specialized Breast cancer units with dedicated onco-surgeon, Radiodiagnosis facilities as well as centralized pathology labs. Able to perform IHC.  National and \or institutional breast screening programs are highly required for screening and early detection ( specially with the fact that around 30% of our patients are below age of 45)  Surgical facilities and ability to perform the new techniques of diagnosis and treatment is also required to avoid suboptimal or overtreatment of the patients  New chemotherapeutic agents and targeted therapies are required to be available ( at least to be able to follow the guidelines ) specially in second line setting  There is a clear need to increase the research work and the participation in the international and regional clinical trials, with more concentration on collaborative work between different institutes

Conclusion cont…  There is a need to have a regional guidelines and recommendations to be able to : 1. Put the essential requirement for treatment of breast cancer 2. Put a plan to involve governmental, non governmental, charities and research institutes to participate in creating a regional supporting program to breast cancer patients 3. Detect the best alternative if the recommended treatment will not be available ( new clinical trial designs)

 We will continue to collect more reply to have a more representing data for our real situation  We hope that by the end of 2014, we will be able to come with a detailed recommendation regarding the management of breast cancer in the MENA region

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