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The aim of this study is to determine the clinicopathological features of Looking for big breast today in Trinidad cancer in two dedicated cancer treatment centers in north Trinidad. The histological types and stage at presentation were also investigated. A retrospective cohort Looking for big breast today in Trinidad was used; data were collected from a review of medical records of patients meeting the entry criteria. Clinical and demographic data were extracted.
A total of patients were selected for the study and were available for the analysis. The annual cumulative incidence rate of breast cancer for the calendar years and in north Trinidad was The age group between 51—60 years had the highest proportion of cases of breast cancer. There was a significant ethnic disparity in the occurrence of breast cancer, as it was more common in people of African origin than among South East Asians. Surgery and chemotherapy were the major interventions employed.
Breast cancer prevalence continues to be high in Trinidad; we provide evidence of the extent of and the degree of sophistication required to care for patients with breast cancer in a health care system in a small developing country. In the developing world, the epidemiological transition from communicable to noncommunicable diseases Looking for big breast today in Trinidadsuch as cardiovascular diseases, diabetes, chronic lung disease, hypertension, and cancer, is now deeply rooted.
Further, the World Cancer Report of 2 estimated that there were In women, the most common type of cancer, and the prevalent cause of cancer-related deaths, was breast cancer. For this reason, component surveillance should be conducted to identify a need for interventions based on the current and future burden of the disease, and to provide the evidentiary basis to formulate future plans and priorities. Data collected by the National Cancer Registry NCR in Trinidad 34 revealed that between andthere were 7, new cases of cancer and 4, cancer-related deaths.
For the period between andthere were 5, new cases of cancer and 3, cancer-related deaths. Breast cancer is the second leading cancer overall in Trinidad and Tobago; in the 5-year interval from —, there were 1, cases of breast cancer, accounting for Similarly in the 3-year period from —, there were cases of breast cancer.
While these statistics provide some evidence of the increasing burden of breast cancer, there has been incomplete collection of data by the NCR. Specifically, accurate statistics on hospitalized patients are lacking, particularly with respect to clinicopathological correlations and advanced disease statistics, which were identified by the WHO framework as equally important components in developing and implementing cancer control initiatives.
Against this background, the need for countries to develop a coordinated, comprehensive, and integrated approach to cancer control based on all available evidence is imperative.
A framework Looking for big breast today in Trinidad develop comprehensive cancer control plans, so as to identify their goals and to prioritize their strategies, must be evidence-based and informed by accurate data. The histological types and cancer stage at presentation were also Looking for big breast today in Trinidad. We used a clinical case series design. The starting point for this study was to identify all patients with an established diagnosis of breast cancer treated at major public tertiary institutions that were offering care for patients with breast cancer in northern Trinidad.
In Trinidad and Tobago, there is a two-tiered system of health care that consists of a public health care system — which is funded by the state and where all services are free for clients — and a private health care system, which adopts a fee-for-service model.
The latter tier is expensive and the client is entirely responsible for all associated costs; hence, this system attracts fewer clients and is logistically difficult to study.
Therefore, patients who were selected for this study were confined to public health care facilities. For entry into the study, the following criteria were used: In other words, if the patient was currently suspected of having breast cancer, but there was no firm evidence of breast cancer, or if the patient was receiving no treatment for breast cancer, he or she was excluded from the study.
Other exclusion criteria included patients who were children 0—12 yearsadolescents 13—19 yearspregnant women, and men with breast cancer. The medical records of all patients diagnosed with breast cancer were reviewed. All patients who satisfied these criteria were selected for the study.
Data based on age, date of diagnosis, histological type, stage, and interventions were abstracted from the medical Looking for big breast today in Trinidad. Breast cancer staging was based on the TNM system, as defined by the American Joint Committee on Cancer, which takes into account tumor size Tthe extent of regional lymph node N involvement, and the presence or absence of metastasis M beyond the regional lymph nodes. The HDI categories can vary from very high 0. Operating rooms ORs are among the most expensive surgical resources in hospitals.
We used this measure to calculate the amount of time consumed in surgical procedures in the management of breast cancer. The protocol for the study was approved by the ethics committee of the University of the West Indies. A total of patients who met the entry criteria were recruited into the study, and while all cases were available for analysis, all of the data from each patient were unavailable.
In fact, in only cases was age at diagnosis recorded. The age group ranging from 51—60 years had the highest proportion of breast cancer cases Table 1. However, in the premenopausal group, the rate of the disease increased with age and peaked at 50—61 years, while in the postmenopausal age group, the disease incidence declined with age Fig.
In addition, the incidence of breast cancer was highest among the unemployed. The distribution of breast cancer cases by age at tertiary health care Looking for big breast today in Trinidad in North Trinidad, — Demographic characteristics of breast cancer treated at tertiary health care facilities in North Trinidad.
The average time utilized in performing a unilateral mastectomy was 2 hours and 21 minutes, which is approximately half the time of a 4-hour 8: The proportion of women who had a diagnostic mammography was 6. Several other methods were employed when confirming the diagnosis, including needle core biopsy, computed tomography and trucut biopsy, ultrasound-guided trucut biopsy, and fine-needle aspiration biopsy.
It should be noted that there are only four licensed oncologists with the local registration body to serve a population of approximately 1. The annual CIR of breast cancer, as determined by this study for the calendar years andin north Trinidad was These findings are consistent with rates reported by the NCR, indicating that Trinidad continues to sustain a high incidence of breast cancer. This falls against a background where global breast cancer incidence rates have increased by about 0.
In addition, in Asian countries that have the most developed data registries such as in Japan, Singapore, and Koreabreast cancer rates have doubled or tripled in the past 40 years. The HDI is categorized by scores that can vary from Looking for big breast today in Trinidad high 0. Bray et al 12 reported in that countries with a high HDI was associated with high incidence rates of female breast cancer, as well as prostate, and colorectal cancers; our findings are consistent with theirs.
We used occupation as a surrogate marker for socioeconomic status SEC. This is in contrast to the developed world where breast cancer is more common in higher socioeconomic groups. Therefore, we provide evidence that in a developing country such as Trinidad, which enjoys a high standard of living based on the HDI, it still remains that the lower SEC groups carry the burden of disease in contrast to those in the developed world. There were no cases of breast cancer among those younger than 15 years Looking for big breast today in Trinidad age, while the occurrence was very low among women at the two extremes of life 20—30 years and 71—80 years; Figure 1.
The Centers for Disease Control and Prevention in confirmed that the risk of breast cancer increases with age. In contrast, in the postmenopausal period, breast cancer occurrence declined sharply with increasing age Fig.
This is occurring during a period that is characterized by a lack of influence of estrogens and progesterone from the ovaries. This finding, therefore, supports the role of endogenous hormones in the etiology or development of breast cancer. However, this role has yet to be clearly defined. On the one hand, there is evidence that strengthens the association between endogenous sex steroids and breast cancer: Yet, we found that the number of cases of breast cancer was higher in married women who are more likely to become pregnant.
In fact, there were twice as many married women with breast cancer than any other group. Several studies have shown that married women have a higher incidence of breast cancer than single women. A number of case control studies nested within large cohorts have suggested a positive association between breast cancer incidence and prolactin levels, although results have been more consistent in postmenopausal women than in premenopausal women.
In Trinidad, there are two major diasporas: We found a significant ethnic disparity in the occurrence of breast cancer in these two ethnic groups.
We provide additional evidence that in developing countries, surgical services though grossly inadequate remain the most widely used treatment for solid tumors, as suggested by Ozgediz and Riviello. In fact, surgery with chemotherapy was the most common combination used out of an array of combinations with radiotherapy and hormone therapy. Unilateral mastectomy and ANC was the procedure used for The majority of women receiving chemotherapy and surgery had stage 2A breast cancer This group of women had the most unilateral mastectomies, as well as the most unilateral mastectomy and axillary clearance combined.
Radiotherapy is now a clinically essential part of the armamentarium against cancer. Mammography is still the most effective and widely used imaging modality for breast cancer screening. Several large randomized clinical trials have shown that mammography reduces mortality from breast cancer. The major limitation in the present study was lack of information on some of the variables examined.
Medical records are handwritten and often incomprehensible, poorly stored in bulky folders, making retrieval difficult and capture of all the data challenging. Only patients who attended public health facilities were entered into the study. Patients seen and treated using private health care facilities would have been logistically difficult to access.
These factors notwithstanding, Looking for big breast today in Trinidad sector is considerably smaller due to the high cost of private health care services. In conclusion, breast cancer prevalence continues to be high in Trinidad. We provide evidence of the extent of, and levels of care currently administered to, patients with breast cancer by a public health care system in a small developing country.
Several challenges emerged; for example, suboptimum delivery of health care can contribute to late diagnosis and poor survival. Essential screening programs are absent. The key challenges, however, revolve around human capacity and training, subspecialization of services, and the need for earlier diagnosis and awareness in the population. These needs have to be tempered against competing interests for small budgetary allocations to health care.
Nevertheless, depending on the resources available and any competing health priorities, all steps must be taken to prevent those cancers that are preventable, to treat those cancers that are treatable, to cure those cancers that are curable, and to provide palliation and supportive care to patients throughout their cancer trajectory. This has important implications for public health as well as other elements of health services in the developing world.
There will be a need for more medical, nursing, and related staff to treat these patients, as well as a need for more hospitals.
The implications for planning are that cancer control programs will need to be formulated and implemented to help reduce the mortality burden. Low-resource countries face numerous challenges in designing and implementing programs to improve cancer care, such as a lack of scientific and Girls looking for sex in Bahrain information to guide resource planning, a shortage of trained professionals to provide necessary clinical care, competing health Looking for big breast today in Trinidad crises, political insecurity or Looking for big breast today in Trinidad, or combinations thereof that divert attention from long-term health care issues, as well as social and cultural factors that obstruct the timely and effective delivery of care.
Author s disclose no potential conflicts of interest. Conceived and designed the experiments: Wrote the Looking for big breast today in Trinidad draft of the manuscript:
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