002 chatterjee presentation1...delegate project 2014ncbc sponsored international delegate project...
TRANSCRIPT
2/28/2014
1
2014 NCBC Sponsored International Delegate Project
*
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
2014 NCBC Sponsored International Delegate Project
2014 NCBC Sponsored International Delegate Project
• 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
1
2014 NCBC Sponsored International Delegate Project
*
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.
2014 NCBC Sponsored International Delegate Project
2014 NCBC Sponsored International Delegate Project
• 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
3/5/2014
2
2014 NCBC Sponsored International Delegate Project
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.
2014 NCBC Sponsored International Delegate Project
2014 NCBC Sponsored International Delegate Project
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
1
NCBC INTERNATIONAL DELEGATE PROGRAM
NCBC INTERNATIONAL DELEGATE PROGRAM
International Prevention Research Institute
NCBC INTERNATIONAL DELEGATE PROGRAM
3/4/2014
2
NCBC INTERNATIONAL DELEGATE PROGRAM
PURPOSE & MISSION
NCBC INTERNATIONAL DELEGATE PROGRAM
• 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 DELEGATE PROGRAM
NCBC INTERNATIONAL MINI FELLOWSHIP PROGRAM
3/4/2014
3
NCBC INTERNATIONAL DELEGATE PROGRAM
2/28/2014
1
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?
2/28/2014
1
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
2/28/2014
2
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
1
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
2014 NCBC Sponsored International Delegate Project
2014 NCBC Sponsored International Delegate Project
• 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
2014 NCBC Sponsored International Delegate Project
• 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
2/28/2014
2
2014 NCBC Sponsored International Delegate Project
• 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
2014 NCBC Sponsored International Delegate Project
• Possible solutions
– Regionalization of the breast care center
– Genetic counseling by telephone
– Participation in international quality measures by NQMBC or NAPBC
2/28/2014
1
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
2/28/2014
2
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
2/28/2014
3
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
2/28/2014
1
2014 NCBC Sponsored International Delegate Project
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%
2/28/2014
2
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.
2/28/2014
3
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
2/28/2014
2
2014 NCBC Sponsored International Delegate Project
2014 NCBC Sponsored International Delegate Project
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)
2014 NCBC Sponsored International Delegate Project
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.
2/28/2014
3
2014 NCBC Sponsored International Delegate Project
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.