Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project

Objective: We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (20092019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey. Materials and Methods: Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP. Results: A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $677.171, which implies an incremental cost-effectiveness ratio (ICER) of$ 2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($ 10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis. Conclusion: Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.Roche Turkey; Breast Health Society of Turkey (MEMEDER); Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Advancing Translational Sciences (NCATS) [UL1TR000427]; NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCESUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Advancing Translational Sciences (NCATS) [UL1TR000427] Funding Source: NIH RePORTERThe study was funded by Roche Turkey and in part by the Breast Health Society of Turkey (MEMEDER). Also, it was partially supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH

Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism

This study had been presented at the 6th ESES Biennial Scientific Meeting held in Cardiff (15-17 May 2014).Address for Correspondence: Dr. Özer Makay, Department of General Surgery, Division of Endocrine Surgery, Ege University School of Medicine, İzmir, TurkeyPhone: +90 232 390 50 50 Received: 13 July 2015 e-mail: [email protected]: 27 January 2016 o DOI: Background: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. Aims: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. Study Design: Retrospective, clinical-based multicentric study of 694 patients with pHPT.Methods: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease.Results: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria.Conclusion: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT

Radiologic findings of screen-detected cancers in an organized population-based screening mammography program in Turkey

PURPOSE:Bahçeşehir Breast Cancer Screening Program is a population based organized screening program in Turkey, where asymptomatic women aged 40–69 years are screened biannually. In this prospective study, we aimed to determine the mammographic findings of screen-detected cancers and discuss the efficacy of breast cancer screening in a developing country.METHODS:A total of 6912 women were screened in three rounds. The radiologic findings were grouped as mass, focal asymmetry, calcification, and architectural distortion. Masses were classified according to shape, border, and density. Calcifications were grouped according to morphology and distribution. Cancers were grouped according to the clinical stage.RESULTS:Seventy cancers were detected with an incidence of 4.8/1000. Two cancers were detected in other centers and three were not visualized mammographically. Mammographic presentations of the remaining 65 cancers were mass (47.7%, n=31), calcification (30.8%, n=20), focal asymmetry (16.9%, n=11), architectural distortion (3.1%, n=2), and skin thickening (1.5%, n=1). The numbers of stage 0, 1, 2, 3, and 4 cancers were 13 (20.0%), 34 (52.3%), 14 (21.5%), 3 (4.6%), and 1 (1.5%), respectively. The numbers of interval and missed cancers were 5 (7.4%) and 7 (10.3%), respectively.CONCLUSION:A high incidence of early breast cancer has been detected. The incidence of missed and interval cancers did not show major differences from western screening trials. We believe that this study will pioneer implementation of efficient population-based mammographic screenings in developing countries

Lithium-associated primary hyperparathyroidism complicated by nephrogenic diabetes insipidus

Lithium-associated hyperparathyroidism is the leading cause of hypercalcemia in lithium-treated patients. Lithium may lead to exacerbation of pre-existing primary hyperparathyroidism or cause an increased set-point of calcium for parathyroid hormone suppression, leading to parathyroid hyperplasia. Lithium may cause renal tubular concentration defects directly by the development of nephrogenic diabetes insipidus or indirectly by the effects of hypercalcemia. In this study, we present a female patient on long-term lithium treatment who was evaluated for hypercalcemia. Preoperative imaging studies indicated parathyroid adenoma and multinodular goiter. Parathyroidectomy and thyroidectomy were planned. During the postoperative course, prolonged intubation was necessary because of agitation and delirium. During this period, polyuria, severe dehydration, and hypernatremia developed, which responded to controlled hypotonic fluid infusions and was unresponsive to parenteral desmopressin. A diagnosis of nephrogenic diabetes insipidus was apparent. A parathyroid adenoma and multifocal papillary thyroid cancer were detected on histopathological examination. It was thought that nephrogenic diabetes insipidus was masked by hypercalcemia preoperatively. A patient on lithium treatment should be carefully followed up during or after surgery to prevent life-threatening complications of previously unrecognized nephrogenic diabetes insipidus, and the possibility of renal concentrating defects on long-term lithium use should be sought, particularly in patients with impaired consciousness

Predictive factors for local recurrence after breast conservative surgery following neoadjuvant chemotherapy: Our long-term results

AMAÇ Meme kanserinde neoadjuvan kemoterapi sonrası meme koruyucu cerrahi (MKC) için uygun seçim kriterleri konusunda henüz konsensüs sağlanmamıştır. Bu çalışmada, neoadjuvan kemoterapi sonrası MKC yapılan hastalardaki uzun dönem sonuçları sunuldu. GEREÇ VE YÖNTEM Ocak 1991-Temmuz 2005 tarihleri arasında neoadjuvan kemoterapi verilen klinik evre 2 ve evre 3 toplam 244 hastadan MKC uygulanan 29 hasta çalışmaya alınarak lokal nükse etkili faktörler araştırıldı. BULGULAR TNM sınıflamasına göre kemoterapi öncesi hastaların biri T0, biri T1, 14'ü T2, 7'si T3, 6'sı T4 ve 2 hasta N0, 9 hasta N1, 17 hasta N2 ve 1 hasta N3 olarak değerlendirildi. İlk beş yılda 2 hastada (%7) ve 10 yılda toplam 4 hastada (%14) ipsilateral memede tümör nüksü saptandı. Beş yıllık ve 10 yıllık lokal nükssüz sağkalım oranları sırasıyla %91,5 ve %75 ve genel sağkalım oranları da sırasıyla %92 ve %78 bulundu. Lokal nükse etkili faktörler araştırıldığında kemoterapi öncesi T0-2 hastalarda T3-4 hastalara göre 10 yıllık lokal nükssüz sağkalım oranı daha yüksek bulundu (%86 ile %60; p=0,078). SONUÇ Lokal ileri meme kanserinde neoadjuvan kemoterapi sonrası meme koruyucu cerrahi başlangıç klinik evresi T0-2 hastalarda onkolojik olarak daha güvenle yapılabilmektedir.OBJECTIVES There is still no consensus on the eligibility criteria for breast conservation after neoadjuvant chemotherapy in patients with breast cancer. The present study investigated the long term outcome in patients with breast conservation following chemotherapy to determine its feasibility. METHODS Between January 1991 to July 2005, 29 patients with clinical stage 2 or 3 who underwent breast conservative surgery following chemotherapy, were included into the study. RESULTS The clinical stages before neoadjuvant chemotherapy were as follows: T0 (n=1), T1 (n=1), T2 (n=14), T3 (n=7), and T4 ( n= 6); and N0 (n=2), N1 (n=9), and N2 (n=17), and N3 (n=1). Out of 4 ipsilateral breast tumor recurrences, 2 local recurrences (7%) were detected in the first 5 years, whereas 4 local recurrences (14%) were detected in the first 10 years. The 5-year and 10- year local recurrence free rates were 91.5% and 75%, and the 5-year and 10-year overall survival rates were 92% and 78%, respectively. The 10-year local recurrence-free survival rate was only found to be higher in patients with T0-2 tumors compared to patients with T3-4 tumors (86%, vs 60%, p=0.078). CONCLUSION Breast conservation after neoadjuvant chemotherapy seems to be safe in selected patients with locally advanced disease including those with clinical T0-2 tumors before neoadjuvant chemotherapy

Feasibility of Mammary Ductoscopy in Management of Pathologic Nipple Discharge

16th Annual Meeting of the American-Society-of-Breast-Surgeons -- APR 29-MAY 03, 2015 -- Orlando, FL[No Abstract Available]Amer Soc Breast Sur