Background
In Egypt more than one‐third of colorectal cancer (CRC) cases occur in individuals aged 40 years and younger, and are diagnosed at advanced stages; currently, CRC screening is not done as ...a routine part of preventive care. To lay the foundation for the development of a CRC multilevel screening program in Egypt, this qualitative study aimed to explore the perspectives of Egyptian physicians.
Materials and Methods
The PRECEDE‐PROCEED model, which focuses on predisposing (intrapersonal), reinforcing (interpersonal), and enabling (structural) factors inherent in health behaviors, served as our theoretical framework. Primary health care physicians, oncologists, and gastroenterologists practicing in Alexandria, Egypt, participated in 1 one‐hour semistructured interview. Interviews were audio recorded, transcribed, translated into English, and analyzed by thematic analysis.
Results
Seventeen physicians participated (n = 8 specialists and n = 9 primary care physicians). Barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention, fear, and cost (predisposing); a belief that only high risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately (reinforcing); and cost, lack of availability of the tests, and inadequate training for laboratory technicians and providers (enabling). Potential facilitators included implementing a media campaign emphasizing early detection, curability and prevention (predisposing); educating physicians and eliciting physician engagement (reinforcing); and decreasing costs, making screening tests widely available, and providing well‐trained providers (enabling).
Conclusion
A CRC screening program is needed in Egypt, and to be successful it would likely need to address barriers at multiple levels.
Implications for Practice
In Egypt, colorectal screening is not a routine part of preventive care, and colorectal cancer is often diagnosed at an advanced stage in individuals aged 40 years or younger. Screening can prevent and detect colorectal cancer in its early stages, but before designing any screening program, understanding the context is important as cultural beliefs may impact the acceptability of screening methods. By exploring the perspectives of Egyptian physicians, this study found important insights into how screening program components should be considered in the Egyptian culture and lays the foundation for the development of a multilevel colorectal screening program in Egypt.
To provide a foundation for the development of a colorectal cancer screening program in Egypt, this article explores perspectives of primary care physicians and specialists related to knowledge, perceptions, and attitudes about colorectal cancer screening.
Background: There have been system inefficiencies in the profiling and management of female breast cancer in Alexandria, Egypt. Aims: To identify barriers to full implementation of international ...guidelines for the management of female breast cancer patients. Methods: Female breast cancer data were extracted from records of 3 public oncology services in Alexandria, Egypt, from 2007 to 2016 and analysed. Results: A total of 5236 of the available 7125 records were usable. Median age of the patients was 54 years, and the median duration of pre-diagnosis complaint was 3.1 months. Some 522 (31.5%) of the patients had a family history of cancer. For tumour stage, 2527 (55.2%) were early, 1717 (37.6%) were locally advanced, and 331 (7.2%) were at stage IV. Estrogen receptor, progesterone receptor, and HER2 were positive in 3869 (85%), 3545 (78%), and 461 (15.3%) patients, respectively. Chemotherapy started after a median 1.03 months. Adjuvant chemotherapy was given to 3667 (91.7 %) patients and neoadjuvant chemotherapy to 333 (8.3%); 3686 (92.1%) received anthracycline-based combination chemotherapy, and 3613 (86%) received hormonal treatment. One hundred and eighty of 317 eligible patients received Trastuzumab. Local and/or distant recurrence was seen in 1109 (21.2%) patients. In nonmetastatic cases, median overall and disease-free survival were 149.1 and 77.1 months, respectively. In metastatic cases, median progression-free survival was 19.6 months. Conclusion: We observed defects in the record system, there was delay in diagnosis and treatment, and nonadherence to targeted therapy in many patients. Strengthening of national and hospital-based registries is needed in Alexandria, Egypt, with a robust patient navigation system and targeted information, education and communication strategies. Continuous outcomes monitoring and adaptation to implementation needs should be sustained.
Molecular targeted drugs are the first line of treatment of advanced hepatocellular carcinoma (HCC) due to its chemo- and radioresistant nature. HCC has several well-documented etiologic factors that ...drive hepatocarcinogenesis through different molecular pathways. Currently, hepatitis C virus (HCV) is a leading cause of HCC. Therefore, we included a unified cohort of HCV genotype 4-related HCCs to study the expression levels of genes involved in the insulin-like growth factor 1 receptor (IGF1R) pathway, which is known to be involved in all aspects of cancer growth and progression.
Determine the gene expression patterns of IGF1R pathway genes in a cohort of Egyptian HCV-related HCCs. Correlate them with different patient/tumor characteristics. Determine the activity status of involved pathways.
Total ribonucleic acid (RNA) was extracted from 32 formalin-fixed paraffin-embedded tissues of human HCV-related HCCs and 6 healthy liver donors as controls. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) using RT
Profiler PCR Array for Human Insulin Signaling Pathway was done to determine significantly up- and downregulated genes with identification of most frequently coregulated genes, followed by correlation of gene expression with different patient/tumor characteristics. Finally, canonical pathway analysis was performed using the Ingenuity Pathway Analysis software.
Six genes - AEBP1, AKT2, C-FOS, PIK3R1, PRKCI, SHC1 - were significantly overexpressed. Thirteen genes - ADRB3, CEBPA, DUSP14, ERCC1, FRS3, IGF2, INS, IRS1, JUN, MTOR, PIK3R2, PPP1CA, RPS6KA1 - were significantly underexpressed. Several differentially expressed genes were related to different tumor/patient characteristics. Nitric oxide and reactive oxygen species production pathway was significantly activated in the present cohort, while the growth hormone signaling pathway was inactive.
The gene expression patterns identified in this study may serve as possible therapeutic targets in HCV-related HCCs. The most frequently coregulated genes may serve to guide combined molecular targeted therapies. The IGF1R pathway showed evidence of inactivity in the present cohort of HCV-related HCCs, so targeting this pathway in therapy may not be effective.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
PURPOSE
Colorectal cancer (CRC) screening is not routinely performed in Egypt, and more than one third of CRC cases occur in individuals age 40 and younger, with overall survival estimated at only 2 ...years, presumably because of late diagnoses. To lay the foundation for the development of a CRC multilevel screening program in Egypt to promote CRC prevention and early detection, this qualitative study aimed to explore the potential barriers to and facilitators of screening from the perspectives of physicians and residents in Alexandria.
METHODS
We conducted one-on-one, 1-hour, semistructured interviews with primary health care physicians and specialists—oncologists and gastroenterologists—practicing in Alexandria, Egypt. Focus groups of residents, stratified by social class and gender, were also held. Interviews and focus groups were conducted in Arabic by trained interviewers/moderator, and were audio recorded, transcribed, translated into English, and analyzed using thematic analysis.
RESULTS
Seventeen physicians participated—8 specialists and 9 primary care physicians—and 7 focus groups—7 to 8 participants each—were held. According to both interview and focus group participants, individual-level barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention in the culture, fear, and cost. Provider-level barriers as mentioned by physicians included a belief that only high-risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately. Structural-level barriers, discussed by physicians and focus group participants, included cost and a lack of testing availability. Potential facilitators of screening mentioned by physicians included implementing a media campaign emphasizing early detection and curability. Focus group participants focused on making screening tests free or low cost, obligatory, and convenient.
CONCLUSION
On the basis of the perceptions of physicians and residents of Alexandria, Egypt, multiple barriers to and facilitators of CRC screening exist. Addressing these would be important in designing a successful screening program.
Portal hypertensive gastropathy (PHG) is an overlooked complication of liver cirrhosis, as it is a source of acute upper gastrointestinal bleeding and cause of chronic blood loss.
To assess the role ...of narrow band endoscopy in the diagnosis of PHG in cirrhotic patients.
Fifty patients with liver cirrhosis were examined by both conventional White Light Endoscopy (WLE) and Narrow Band Technology Variable Intelligent Staining Technology (VIST) using Sonoscape endoscope HD500. Biopsies were taken from the body of gastric mucosa during endoscopy.
The prevalence of PHG among patients with liver cirrhosis is around 94% by WLE, 92% by VIST, and 55.3% by pathology. There is no statistical significance between VIST and WLE in case of PHG p = 0,750. The risk of developing oesophageal varices grade 3 in severe PHG is higher than in no or mild PHG (OR = 6.8571, 95% CI 1.6270 to 28.9001, p = 0.0087).
VIST is comparable and complementary to WLE in diagnosis of PHG. There is poor correlation between pathology and WLE in diagnosis of PHG.
Background
Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) are two different pathologies that cause bleeding in cirrhotic patients. These two pathologies are still ...difficult to be distinguished by white light endoscopy (conventional), as they both appear as red spots in the gastric antral mucosa in the case of severe PHG. The aim of our study was to assess the efficacy of Versatile Intelligent Staining Technology (VIST) in comparison to histopathology in the diagnosis and classification of GAVE.
Methods
A cross-sectional study included 50 patients with liver cirrhosis recruited from Alexandria Main University Hospital. Patients with connective tissue diseases and chronic kidney disease were excluded. All patients were examined by both conventional white light endoscopy (WLE) and image enhancement technology (VIST) using Sonoscape HD500 endoscope. GAVE was diagnosed as tortuous columns of ectatic vessels in the gastric antrum. Histopathological examination was used as the standard tool for the diagnosis of GAVE.
Results
A total of 50 patients were included, 28 patients (56 %) were diagnosed as GAVE by pathology vs 22 (44 %) as non-GAVE. Twenty-three of 28 (78.6 %) cases of GAVE were detected by VIST. VIST had superior sensitivity than WLE in the detection of GAVE, 82.1 % vs 7.1 %, while WLE had higher specificity 95.5 % vs 59.1 % by VIST. There was statistical significance between VIST and pathology in the diagnosis of GAVE,
p
<0.035, but no statistical significance between WLE and pathology. VIST has identified two types of GAVE: focal in 12/28 cases and diffuse in 11/28, and five were not diagnosed by VIST.
Conclusions
Versatile Intelligent Staining Technology could be used as an alternative tool to histopathological diagnosis of GAVE. GAVE can present as a focal group of ectatic vessels which adds a new class to GAVE classification that was previously misdiagnosed.
Background: There have been system inefficiencies in the profiling and management of female breast cancer in Alexandria, Egypt. Aims: To identify barriers to full implementation of international ...guidelines for the management of female breast cancer patients. Methods: Female breast cancer data were extracted from records of 3 public oncology services in Alexandria, Egypt, from 2007 to 2016 and analysed. Results: A total of 5236 of the available 7125 records were usable. Median age of the patients was 54 years, and the median duration of pre-diagnosis complaint was 3.1 months. Some 522 (31.5%) of the patients had a family history of cancer. For tumour stage, 2527 (55.2%) were early, 1717 (37.6%) were locally advanced, and 331 (7.2%) were at stage IV. Estrogen receptor, progesterone receptor, and HER2 were positive in 3869 (85%), 3545 (78%), and 461 (15.3%) patients, respectively. Chemotherapy started after a median 1.03 months. Adjuvant chemotherapy was given to 3667 (91.7 %) patients and neoadjuvant chemotherapy to 333 (8.3%); 3686 (92.1%) received anthracycline-based combination chemotherapy, and 3613 (86%) received hormonal treatment. One hundred and eighty of 317 eligible patients received Trastuzumab. Local and/or distant recurrence was seen in 1109 (21.2%) patients. In nonmetastatic cases, median overall and disease-free survival were 149.1 and 77.1 months, respectively. In metastatic cases, median progression-free survival was 19.6 months. Conclusion: We observed defects in the record system, there was delay in diagnosis and treatment, and nonadherence to targeted therapy in many patients. Strengthening of national and hospital-based registries is needed in Alexandria, Egypt, with a robust patient navigation system and targeted information, education and communication strategies. Continuous outcomes monitoring and adaptation to implementation needs should be sustained. Keywords: breast cancer, disease management, service delivery, implantation, Egypt Contexte : Des lacunes dans le systeme ont ete constatees en ce qui concerne le profilage et la prise en charge du cancer du sein chez les femmes a Alexandrie (Egypte). Objectifs : Identifier les obstacles a la mise en oeuvre complete des lignes directrices internationales pour la prise en charge des patientes atteintes d'un cancer du sein. Methodes : Des donnees sur le cancer du sein chez les femmes ont ete extraites des dossiers de trois services publics d'oncologie a Alexandrie, en Egypte, de 2007 jusqu'a 2016 et ont fait l'objet d'une analyse. Resultats : Au total, 5236 des 7125 dossiers disponibles etaient utilisables. L'age median des patientes etait de 54 ans et la duree mediane des plaintes avant le diagnostic etait de 3,1 mois. Pres de 522 (31,5 %) des patientes avaient des antecedents familiaux de cancer. En ce qui concerne le stade de la tumeur, 2527 (55,2 %) etaient de stade precoce, 1717 (37,6 %) etaient localement avances et 331 (7,2 %) etaient au stade I V. Les recepteurs d'oestrogenes, de progesterone et de HER.sub.2 etaient respectivement positifs chez 3869 (85 %), 3545 (78 %) et 461 (15,3 %) patientes. Une chimiotherapie a ete mise en route apres un delai median de 1,03 mois. Une chimiotherapie adjuvante a ete administree a 3667 patientes (91,7 %) et une chimiotherapie neoadjuvante a 333 patientes (8,3 %) ; 3686 patientes (92,1 %) ont recu une chimiotherapie combinee a base d'anthracycline et 3613 patientes (86 %) etaient sous traitement hormonal. Cent quatre-vingt des 317 patients eligibles se sont vu administrer le trastuzumab. Une recidive locale et/ou a distance a ete observee chez 1109 patientes (21,2 %). Dans les cas non metastatiques, la survie mediane globale et la survie sans maladie etaient de 149, 1 et 77, 1 mois, respectivement. Dans les cas metastatiques, la survie mediane sans progression etait de 19,6 mois. Conclusion : Nous avons observe des defauts dans le systeme d'enregistrement, un retard dans le diagnostic et le traitement, et une non-adhesion a la therapie ciblee chez de nombreuses patientes. Il est necessaire de renforcer les registres nationaux et hospitaliers a Alexandrie (Egypte), par un systeme de navigation des patients solide et des strategies d'information, d'education et de communication ciblees. Le suivi continu des resultats et l'adaptation aux besoins de la mise en oeuvre doivent etre soutenus.
Abstract
Purpose: Colorectal cancer (CRC) incidence and mortality rates continue to climb in Egypt and other low- and middle-income countries, where few screening intervention programs exist. In ...Egypt, CRC screening is not a routine part of preventive care and most CRC diagnoses happen with advanced disease and poor prognosis. This pilot study aims to develop, implement, and examine the feasibility of a culturally relevant intervention to promote CRC screening among healthy adults in Alexandria, Egypt.
Methods: This feasibility study was conducted in two clinics in Alexandria, Egypt in December 2019-March 2020. Participants were individuals age 50 and above who were visiting the clinics. Medical students were trained to recruit patients, increase awareness on the importance of CRC screening, and provide a voucher and instructions for returning a guaiac fecal occult blood test (gFOBT) kit. Students followed up with phone call reminders to return the kit, report results, and encourage participants with abnormal results to receive further no-cost testing. Our outcome measure was the number of total participants returning the gFOBT kit. We hypothesized that 20% of patients who received the intervention would return the kits, assuming a null screening rate of 2% and target screening rate after the intervention of 20%. A sample size of 120 would achieve 99% power to detect a difference of 18% at a 1% significance level.
Results: Of the 117 patients who were recruited, 44 patients (37.6%) returned a kit, with 95% exact confidence interval of (28.8, 47.0). Of the 44 patients who returned a kit, five (11.4%) had a positive FOBT test, with 95% exact confidence interval of (3.8, 24.6). Of these five patients, three (60%) followed up with colonoscopy.
Conclusion: This feasibility study provides promising findings to lay the foundation for a larger pragmatic trial that would address barriers to CRC screening in Egypt
Citation Format: Lori Brand Bateman, Ahmed Nawwar, Somaia Khamess, Mona N. Fouad, Waleed Arafat, Salah-Eldin Abdelmoneim, Sejong Bae, Katie Falkner, Laura Q. Rogers, Isabel Scarinci. Examining a Culturally Relevant Intervention to Promote Colorectal Cancer Screening in Egypt abstract. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 59.
Abstract
Purpose: Compared to the U.S., colorectal cancer (CRC) in Egypt is more prevalent among younger individuals (under age 40) and diagnosed at an advanced stage leading to higher mortality ...rates. Given these higher mortality rates, focusing on tertiary prevention strategies, such as physical activity, is warranted. Our study purpose was to assess physical activity behavior in colorectal cancer survivors living in Egypt.
Methods: Egyptian study staff recruited 86 participants from the Alexandria University Oncology Department. Eligible participants were post-primary or currently undergoing treatment for CRC. Study staff administered the World Health Organization physical activity questionnaire (GPAQ; www.who.int/chp/steps/GPAQ/en/) and Godin Leisure-Time Exercise Questionnaire (GLTEQ). Both assessments were translated into Arabic.
Results: The median age of study participants was 52 years old with 43% being male, 64% reporting early stage cancer, 77% reporting one or more years of school, and 79% living in an urban location. Most participants (76%) had a normal or overweight BMI. According to the GPAQ, the median total MET mins/wk for participants was 1440 with interquartile range of 225 to 6720; 63% of participants met the GPAQ WHO recommendations of ≥600 MET mins/wk. Occupational and transportation contributed to the majority of total MET mins/wk. According to the GLTEQ, the median for weekly minutes of ≥moderate intensity physical activity was 0 with interquartile range of 0 to 23 minutes per week. Only 14% were meeting physical activity recommendations of ≥150 weekly minutes of ≥moderate intensity physical activity based on the GLTEQ.
Conclusion: The prevalence of meeting physical activity recommendations varies depending on measurement tool used. Considering sources of physical activity beyond recreational alone is important for more fully understanding physical activity behavior. The low levels of recreational or leisure exercise provides an opportunity for increasing the prevalence of sufficient physical activity in CRC survivors in Egypt.
Citation Format: Salma Mohamed Aly, Doaa Genena, James Shikany, Lori Brand Bateman, Mona Fouad, Waleed Arafat, Salah-Eldin Abdelmoneim, Sejong Bae, Isabel Scarinci, Marwa Hussein, Miriam A. Zaki, Somaia Khamess, Laura Q. Rogers. Self-Reported Physical Activity Patterns among Colorectal Cancer Survivors in Egypt abstract. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 107.
Breast cancer and HCV are two frequent diseases in Egypt. There is a considerable probability of concurrent affection. This concurrence creates a subpopulation, which needs special evaluation and ...care.
To evaluate a subset of Egyptian breast cancer patients receiving Doxorubicin based adjuvant chemotherapy, with HCV seropositivity (group 2) compared to HCV seronegative patients (group 1).
102 breast cancer patients, planned to receive Doxorubicin based adjuvant chemotherapy, at the Oncology Department, Alexandria Faculty of Medicine, were recruited since June 2009. Pretreatment evaluation included serological testing for HCV. FAC Adjuvant chemotherapy was given for six cycles.
HCV seropositivity was detected in 52 cases. Two cases in the seropositive group developed toxic hepatitis and discontinued treatment and follow up. The remaining 100 patients suffered comparable toxicities, except for more frequent liver enzyme elevations in the seropositive group. Diarrhea was also more frequent in the seropositive group. Treatment delays and dose reductions were more frequently observed in the seropositive group. The 36month disease-free survival and relapse pattern were not significantly different between the two groups.
Patients receiving chemotherapy should undergo screening for the virus. Most patients with HCV were able to tolerate chemotherapy and continue the initial chemotherapy plan, without a significant change in the toxicity profile or the natural course of their malignancy. Dose or regimen adjustments may be of help to less tolerant patients. A preemptive 10% initial Doxorubicin dose reduction might reduce the frequency of severe toxicity for selected patients. The assistance of a gastroenterologist in HCV positive breast cancer patients, planned for chemotherapy is important.
PDF
