Abstract
Background This study was performed in knowledge of the increasing gap between breast disease treatment in countries with restricted resources and developed countries with increasingly sophisticated examination methods. Methods The authors present the analysis of a breast disease register consisting of diagnostic cases from Mazar e Sharif and Herat in 2018 and 2019. The study comprises a total of 567 cases, which were presented to experts via telemedicine for final diagnosis. 62 cases (10.9%) were excluded due to inacceptable data or insufficient image quality. These data provided by daily diagnostic classification were used for the built-up of a profile for each frequent breast disease and a breast cancer register. All images and cases were seen by at least 3 independent experts. The diagnoses were made in 60% of cases by cytology of fine needle aspiration and in 40% by histological images. Results For each entity of breast diseases (e.g., fibroadenoma), a profile of context variables was constructed allowing to assist medical decisions, as “wait and see,” elective surgery or immediate surgical intervention with R0 (complete) resection. These “profiles” could be described for fibroadenoma, mastitis, galactocele, fibrous-cystic disease, and invasive breast cancer. Conclusions The presented preliminary data set could serve as a cost-effective basis for a North Afghan breast cancer registry, with option to extent to a national model. These preliminary data are transformed in profiles of breast diseases, which are used by the local physicians in charge of breast disease patients. Each new case can be compared by the local treating physician with the profile of all preceded cases with the same diagnosis.
Highlights
The topic of breast cancer highlights the problem of delayed diagnostic and therapy of Noncommunicable Diseases (NCD) in middle- and low-income countries (MLIC)
International Journal of Breast Cancer reconstruction of the health system in Afghanistan is currently being tackled by numerous groups, including the Afghan and foreign governments and several nongovernmental organizations (NGOs)
This study presents the profile of breast disease in Northern Afghanistan and evaluates the prevalence of inflammatory, benign and malignant diseases in the area of Masar E Sharif and Herat with the aim (1) to provide an overview of the situation of breast patients, (2) to collect data for the further development of disease profiles, (3) to sensitize political decision makers to this special medical problem and enable low cost diagnostic and treatment decisions, and (4) to establish a local register for breast diseases
Summary
The topic of breast cancer highlights the problem of delayed diagnostic and therapy of Noncommunicable Diseases (NCD) in middle- and low-income countries (MLIC). The indicators of weak medical infrastructures in low-income countries [1, 2] are delayed time to diagnosis and a higher frequency of advanced breast cancer This applies particular in Afghanistan, with a health system in disarray for many years due to ongoing conflicts and violence. 62 cases (10.9%) were excluded due to inacceptable data or insufficient image quality These data provided by daily diagnostic classification were used for the built-up of a profile for each frequent breast disease and a breast cancer register. The presented preliminary data set could serve as a cost-effective basis for a North Afghan breast cancer registry, with option to extent to a national model These preliminary data are transformed in profiles of breast diseases, which are used by the local physicians in charge of breast disease patients. Each new case can be compared by the local treating physician with the profile of all preceded cases with the same diagnosis
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