BREAST CANCER care

In jordan

INTRODUCTION

Breast cancer is the most common malignancy in Jordan and the third leading cause
of cancer death after lung and colorectal cancers . Jordan has an average income,
however ;patients from neighboring countries prefer to go for treatment in jordan
because it has one of the most advanced health care in the world.The country’s
health care is a two tiered system provided through the public and private sector، The
public sector is composed of the Ministry of Health ، the military’s Royal Medical
Services, and 2 university hospitals. The private sector runs 62 hospitals that account
for approximately 33% of all hospital beds،as well as the King Hussein Cancer
Center (KHCC), a nongovernmental, nonprofit cancer tertiary center founded in
1997 that currently treats approximately 60% of cancer occurrences in Jordan and
provides cancer treatment to patients from several countries in the surrounding
region.

MATERIALS AND METHODS

They used data from the latest annual report published by the Jordan Cancer Registry
(JCR) in 2015. They estimate the Overall survival from the data of diagnosis to the
data of death.And they used Global burden of disease for cancer incidence and
mortality data to compare our breast cancer rates with regional and international
ones.
EPIDEMIOLOGY OF BREAST CANCER

breast cancer is the most common cancer in Jordan، Breast cancer is found in men as
well as women.The number of breast cancer occurrences in women has increased by
69% during the past decade, the highest cases rate is in the age group 60 to 64 years

Women of 51 years as the average diagnosis age for breast cancer in Jordanian
women, that is 10 years younger than the average of women in western countries.
However, women aging from 40-49 and more than 60 years old with a higher
incidence risk.

BREAST CANCER SCREENING AND EARLY DETECTION

Our strategy is early detection and downstaging of breast cancer rather than
treatment because of limited resources in jordan .

Jordan Breast Cancer Program (JBCP) is a specific screening and early detection
program , was established in 2006 to achieve our goal in reduce morbidity and
mortality, by provide universal access to screening mammography for all women age
more than 40 years and has set a guidelines for diagnosis and screening are followed
by many health care practitioners.

The jBCP recommends to start screening mammography at 40,16 ,17 because of

the younger age of onset in Jordan: 50% of cases is younger than 51.

And the JBCP conducts yearly awareness campaigns and educational programs to
improve public awareness about breast cancer to improve women’s knowledge about
breast cancer screening and early detection practices.

DIAGNOSIS AND STAGING

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There are more than 60 mammography units nationwide,25 and several private
hospitals offer 3- dimensional digital breast tomosynthesis that allow to more women
to undergo breast biopsies.

There are many of screening test for staging and monitoring response to therapy like
: Chest x-ray, magnetic resonance imaging, computed tomography scanning, bone
scans, and positron emission tomography scans and they are widely available in
jordan .

GENETIC TESTING

Mutations in one of the BRCA genes account for most inherited breast cancers, most
important inherited gene changes are in the BRCA1 and BRCA2 genes.although
testing mutations in these genes become a standard practice for patients in many
places in Western countries,genetic screening is not routinely performed in most
Jordanian hospitals.

Genetic testing was limited to high risk patients but it becomes more expanded and
include : all those diagnosed at age 40 or more , all patients younger than age 50 who
have one or more close relatives with breast cancer, those younger than age 60 with
TN breast cancer, and those diagnosed at any age with 2 or more close relatives with
breast cancer, with one or more close relatives with invasive ovarian cancer, or with
a close male relative with breast cancer.

TREATMENT AND SUPPORTIVE CARE

Surgery

Most women with breast cancer have some type of surgery as part of their treatment,
more than half of patients in jordan have their surgery done by surgical oncologist

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more than ten of them are practicing at the KHCC , university hospital and in the
private sector.

There are many suboptimal outcome if the surgery done by General surgeon in a
secondary hospital such as positive margins, partial removal of the breast mass, or
inadequate management of the axilla.

Anticancer Drugs

There are a large number of chemotherapeutic agents are available in jordan Despite
its high prices such as Trastuzumab and pertuzumab( a HER2 monoclonal
antibody), have been approved by FDA.

Endocrine drugs are available ( such as fulvestrant) and covered by cancer insurance,

Endocrine resistance modulator ( such as everolimus a mTOR kinase inhibitor,

palbociclib and ribociclib a CKD4/6 inhibitors ) they are available in private and
puby sectors.

Supportive drugs like (colony-stimulating factors, antiemetics) are widely available

too.

Radiotherapy

In jordan, according to guidelines radiation therapy is available as an adjuvant

Treatment after surgery for : high risk women for recurrence , those with tumor size
5 cm or more , positive lymph nodes, positive resection margins, and those
undergoing breast-conserving surgery .

There are 15 accelerators in jordan ; 6 linear accelerators at KHCC , 2 At MOH , 3 at

military medical services, 2 in a private hospital, and two more at the King Abdullah
Hospital

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Accreditation and Quality of Care

KHCC has been awarded the Joint Commission International Clinical Care Program
Certificate for its oncology program. However, 30 hospitals including KHCC and 7
private hospitals and 2 university hospitals have been accredited by the Health Care
Accreditation Council for established health care quality standards.

Treatment Outcomes and Survival Estimates

Breast cancer treatment outcomes are available at the KHCC .this figure below
clarify Survival analysis of 4,561 patients with breast cancer treated and followed at
our institution between July 2006 and December 2017 Depending on the stage of
cancer :

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