002 Chatterjee Presentation1...Delegate Project 2014NCBC Sponsored International Delegate Project • Country – China • City – Beijing • Area – Total 9,600,000 km2 – Beijing

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2014 NCBC Sponsored International Delegate Project

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Kausik Chatterjee, MD; DRMConsultant Nuclear Medicine & PET‐CT ,

Nagpur, Maharashtra, India

Activities:•In‐charge of the Nuclear Medicine Department which performs Radioisotope Mammography & Bone Scan•Consultant of the only PET‐CT Center in this region•Promotion of nuclear medicine awareness in this region



• State• Maharashtra• Area[1]

• • Total• 97,321 km2 (37,576 sq

mi)• Population (2011)• • Total• 2,30,03,179• • Density• 240/km2 (610/sq mi)• Languages• • Official• Marathi• Time zone• IST (UTC+5:30)• Largest city• Nagpur

3/5/2014

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Ying Zhang, MD; PhDOncology Department of Guang'anmen HospitalChina Academy of Chinese Medical Sciences

Beijing, ChinaActivities: Engaging in applying Chinese Medicine (TCM) to treat breast cancer and other cancers. Doing the research works of the mechanisms of TCM medicine regulating the biological behaviors of cancer stem cells.



• Country– China

• City– Beijing

• Area– Total

9,600,000 km2

– Beijing 16,410 km2

• Population (2011)– Total 1.3 bilion– Beijing: 21million

• Density– 0.78m2 /person

• Beijing is the Largest city in China

• Languages– Chinese

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Breast cancer has been becoming one of the most common cancers among Chinese women. There are more than 300,000 new case per year. The overall incidence and mortality rates of breast cancer in Chinese women are still at a medium or low level in the world. TCM is an common therapy method which is applying in breast cancer treatment. Most of the herb medicine aimed to the side effect of the modern therapies.

Obstacles to breast care in China The relapse and the metastasis were key element of the

death of breast cancer, especially the ER(‐) and PR(‐)patients.

Due to the evidence based medicine methods were lately applying in the TCM clinical trial, so there are seldom data of clinical about TCM applying in breast cancer treatment to share.

The complicated intervention of TCM limited the standard evidence based medicine methods applying in the TCM clinical trial.

There are some obstacles in translating the results in lab of TCM into clinical practice.



Proposed Solutions: Reduce the incidence: such as Pink Ribbon Breast Cancer

Awareness Action, General Investigation of Breast Cancer in Million Women, and Two Cancer Screening, etc.

High scientific research fund: such as international cooperative projects from NSFC and Ministry of Science and Technology

Communicating: accessing the membership of NCBC will give a chance to share the research work of China to the experts of other countries.

Promote the research work of Chinese Medical sciences : How to applying evidence based medicine methods in the TCM clinical trial

effectively. Cooperation: attracting the scientist of other countries to do the lab research

and the clinical research of TCM

3/4/2014

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NCBC INTERNATIONAL DELEGATE PROGRAM


International Prevention Research Institute


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PURPOSE & MISSION


• An NCBC International Delegate could be a physician, nurse,technologist, administrator, educator, researcher, government regulator, etc., who isactively involved with breast care delivery outside of the USA and Canada, and hasbeen proposed to, and accepted by, the NCBC International Liaison Committee toserve as an NCBC International Delegate

• A Sponsored NCBC International Delegate has successfullycompleted a transparent competitive process, has been provided funding to attendthe annual NCoBC Interdisciplinary Breast Center Conference. Additionalresponsibilities include presenting a poster for the Annual Conference, participating inthis plenary panel on International Breast Care, and helping the NCBC to raise fundingto sustain this program for future International Delegates


NCBC INTERNATIONAL MINI FELLOWSHIP PROGRAM

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2/28/2014

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Mohamed Al-Bashir, MD, FACSConsultant Surgeon, Tawam Hospital

Director of Breast Care CenterDirector of Breast Fellowship

Adjunct Associate professor Surgery, CMHS, UAE University

Obstacles to breast care in UAE

Main obstacle to breast care is

many patients have no access to our specialized center due to insurance

limitations

Solutions

• Regionalization of the breast care center• Other Suggestions?

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2014 Sponsored International Delegate Project

Dr Deborah PfeifferBreast Physician and Medical Director

BreastScreen Queensland Sunshine Coast

Population breastscreening and diagnostic assessment of screen‐detected lesions

Nambour, Queensland, Australia

2014 Sponsored International Delegate ProjectPopulation

of Australia:

• 23,380,000

Population

of Queensland:

• 4,659,000

Population

of Brisbane:

• 2,200,000

2014 Sponsored International Delegate ProjectCurrent challenges to best breast care in Australia:

1. Distance‐ women may live hundreds of miles from appropriate diagnostic and treatment services

2. Disparity‐ economic and geographic factors influence the time and choice of treatment

3. Discrepancy‐ high levels of expectations versus achievable outcomes

4. Deliverability‐ workforce shortages and funding sources limit provision of services

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2014 Sponsored International Delegate ProjectSolutions to resolving some of the obstacles to best breast care in Australia:

1. Education: public and professional‐ risk factors, early detection

2. Innovation: digital imaging, information technology, telehealth, workforce substitution

3. Agreement: best evidence, cost‐ effectiveness, policy and practice

2/28/2014

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Mohamed Al‐Bashir, MD, FACSConsultant Surgeon, Tawam Hospital

Director of Breast Care Center

Director of Breast Fellowship

Adjunct Associate professor Surgery, CMHS, UAE University

Al‐Ain, United Arab Emirates



• UAE population 9.2 M

• Al‐Ain is 2nd largest city of Abu Dhabi Emirate and 4th largest in UAE

– Population of Abu Dhabi 1.42 M

– Population of Al‐Ain 0.63 M

• It is about 160 KM East of Abu Dhabi and 120 KM South of Dubai

• Al‐Ain is served by two governmental hospitals and multiple private hospitals


• Tawam breast center

– Weekly multidisciplinary meetings

– Full range of surgical, radiological, and oncological services as well as lymphedema clinic

– Chosen by NAPBC as one of three international pilot centers

– On average 210‐230 new breast cancer cases seen annually at our center

– One NCBC‐certified navigator

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• Obstacles to breast care in Al‐Ain

– many patients have no access to our specialized center due to insurance limitations

– Lack of specialized genetic counselors

– No quality measures are enforced or monitored

– Genomic assays not covered by insurance

– Shortages in breast radiologist


• Possible solutions

– Regionalization of the breast care center

– Genetic counseling by telephone

– Participation in international quality measures by NQMBC or NAPBC

2/28/2014

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NATIONWIDE PROMOTION OF MULTIDISCIPLINARY CARE IN SPECIALIZED BREAST UNITS

On behalf of the

Argentinean Society of Mastology

Ignacio L. McLean, MDBreast Surgeon, Director

Centro Mamario delHospital Universitario Austral

Francisco Terrier, MDBreast Surgeon

Centro Mamario delHospital Italiano de La Plata

Roberto Elizalde, MDBreast Surgeon, VicePresident

Argentinean Society of Mastology

INTRODUCTION

• In Argentina, there is little knowledge of multidisciplinary teams working in specialized breast units.

• Most health centers taking care of women with breast diseases work in a fragmented way, with little to no communication between different specialists looking after the patients.

• A few centers work partially with a multidisciplinary approach, but without proper integration between them, without regular multidisciplinary meetings, without consensus guidelines, established protocols and procedures, and other key disciplines.

Centro MamarioHospital Universitario AustralPilar, Pcia de Buenos Aires

Centro MamarioHospital Italiano de La PlataLa Plata, Pcia de Buenos Aires

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INTRODUCTION

• Another important problem that we are facing is the health care system, which is partially based on a poor public health system.

• Small towns or communities far from the major cities in Argentina do not have adequate diagnostic equipment’s and the available mammography equipment tends to be obsolete.

• Many specialists must work in two or three different places within the same week or even day in order to make a decent income.

OBJETIVE

• The Argentinean Society of Mastology (SAM), the scientific organization that gathers most breast specialists in our country, aware of the advantages of a multidisciplinary approach and its direct impact on reducing cancer mortality, has decided to address this situation

METHODS

• SAM’s Board of Directors created the “Mastology Units Committee”, a specific task force to coordinate the activities related to the promotion and establishment of breast centers in Argentina.

• A specific survey around the country is been taken, to know the availability of facilities and equipment

• Contacts with the NAPBC and NCBC began; as a result Dr C. Kaufman attended the 2013 Argentinean Congress of Mastology as a speaker

• Within a national expert forum, this initiative was presented and a survey was taken to assess the acceptance of it

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RESULTS

As a recommendation of the committee, the SAM resolved that:

• Publication of an official document (SAM), defining breast center in Argentina, its key components and expected quality controls.

• Communication of the experience of the existing breast center in Argentina, the advantages derived from this approach and the better outcomes for patients.

• In a second stage, the SAM plans to start a program of quality control and accreditation.

CONCLUSION

• We anticipate that this will be a slow process, involving visits to healthcare institutions and encourage them to begin the process of putting together multidisciplinary teams to look after patients with breast problems.

• This is a long way that we have just initiated. Positive results will appear gradually, but these will undoubtedly represent an improvement in breast health and care

We appreciate the invitation and support from the NCoBC

THANK YOU

[email protected]

[email protected]

2/28/2014

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Elvis Ahmedi, MD, MScHead of National Board for Cancer Control

Consultant Surgeon, Breast Surgery Unit

Poliklinika Gjinolli Day Hospital

Prishtina, Kosovo

Primary activity: Breast Surgery, since 1991

Concurrent activities:

International Support for Kosovo, since 2008

National Board for Cancer Control, since 2011

Kosovo• Area: 4,212 sq miles

(10,908 km²)• Population:

1.8 million• Gross domestic product:

6.446 billion USD (2011) World Bank

• GDP per capita: 3,453.10 USD (2012) World Bank

• Fertility rate: 2.20 births per woman (2011) World Bank

• Life expectancy: 70.15 years (2011) World Bank

Southeastern Europe

Italy

Greece

Lowest (in EUROPE):

• GDP

• Total Health Expenditure per capita PPP Int.$

• Total Health expenditure as % of GDP

$117

2.9%

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Population Pyramid & BrCa Incidence

2013:

214 new cases

Median Stage: II

(since 2012)

• UNIVERSITY HOSPITAL OF• KOSOVO IN PRISHTINA• > 2,000 beds• > 11,000 surgeries • > 84,000 inpatients• 2,800 employee• 522 specialists• 555 in administration

• Inst. Of Oncology

• MO+RT: Solid tumors

Objectives

• Improving breast healthcare in existing diagnostic and treatment modalities, and

• Start feasibility programs introducing missing aspects of comprehensive care, i.e. breast cancer screening and palliative care.

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Current challenges & some possible solutions

Non‐NCBC

• Increasing Health Expenditures (KOSOVO GOVERNMENT)

• Early Detection & Screening (EU SUPPORT)

• Improving Population‐based & Hospital CANCER REGISTRIES

NCBC

BUILDING CAPACITIES OF MULTIPLE SPECIALTIES:

• “KNOW HOW”:

• Visiting experts (hands‐on training)

• Mini‐Fellowships

Previous International Support

Fundraising

EuroMed-UpM Cancer Screening and Early

Diagnosis Project

European Schools of

Screening Management

Community Outreach

and Education

Videoconference calls

Teaching & Hands on training

Capacity Building

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Aim:• To use nuclear

medicine in early detection, staging, management strategy‐making and follow up of breast cancer patients

• Promotion of nuclear medicine in this region for wider application and better availability of this facility

Methods:• Mammography and

scintimammography for early detection

• Radioisotope bone scan in patients with established breast cancer to rule out skeletal metastasis

• Positron Emission Tomography (PET‐CT ) scan in selected patients for staging and therapeutic response assessment

• Follow up (mainly in suspected cases of relapse)


Challenges:• Absence of nuclear medicine department in any of the local Medical Colleges or tertiary care hospitals

• Nuclear medicine is not included in the undergraduate medical curriculum unlike radiology

• Lack of government fund to promote nuclear medicine• Reactors and medical cyclotrons are not available in Nagpur.

• Wide spread perception among government health authorities and officials that nuclear medicine is too sophisticated modality to be included in the road map of breast health care.

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Proposed Solutions:• Nuclear medicine departments in Government Medical Colleges and tertiary hospitals

• Dedicated cancer hospitals with nuclear medicine facilities

• Corporate and international funding with no profit‐no loss basis for medical cyclotrons and availability of medical isotopes locally

• International technology and know‐how sharing for promotion and establishment of nuclear medicine centers.

Documents

002 Chatterjee Presentation1...Delegate Project 2014NCBC Sponsored International Delegate Project • Country – China • City – Beijing • Area – Total 9,600,000 km2 – Beijing