Prevention Breast Cancer

The goals of the project were to organize the structure, which includes training 100 health care teams from 10 zones of Tbilisi , Conduct preventative examinations for breast and cervical cancer among the 500 women ,hold lectures among wide audience about the breast cancer and set up the network of volunteers, who will continue to work to further promote the goal of the project; publishing brochure:

“Breast cancer”,

“How to do Breast Self-Examination”,

“Cervical cancer”

(Canadian Embassy)

Goals of the project were to educate women in regions about the breast self-examination. 180 health care teams were trained as trainers which continue to work with women in Marneuli, Terdjola, Gurdjaani, Ambrolauri, Ozurgeti, Poty areas to further promote the early reveal of breast cancer.

Was held lectures for wide audience, educated women about the preventive measures of the ontological diseases. Round tables were organized for governmental representatives .The contact with local Church social service was established, created an necklace, publishing brochures:

Cancer of breast;
Risk factor for Breast Cancer
How to do Breast Self-Examination
(World Women's Day of Prayer German Committee)

The goal of the project was to organize a structure teaching women in the regions of compact settlement of minorities in their native language about breast pathology and the breast self-examination; to prepare health care teams (general doctors, dentists, cardiologists, neurologists, therapeutics and nurses of policlinics and health care centers) as trainers for further promotion of the early reveal of breast cancer; to establish a network in the regions of Georgia with compact settlement of minorities (Mtsxeta, Axali-Gori,Gardabani,Tetri-Tskaro,Bordjomi,Axaltsixe,), to continue working in the region; to publish brochures in 3 languages Russian, Azer, Armenian and to distribute special necklaces, to raise awareness through publication the information in newspapers in the above mentioned languages; to examine women. All activities planned within the project were carried out.

The basis of our project was to implement two of three approaches to screening for breast cancer: clinical breast examination (CBE) and breast self-examination relying on manual palpation of breast.

CBE is conducted by health workers who have been taught how to palpate and inspect women's breasts for lumps and other symptoms of cancer (106 doctors and 94 nurses were trained). All 531 women who visited us during our work received annual CBE. Also we invited already operated on Breast Cancer women for examination.

According to literature this technique has been estimated to have a sensitivity of 54 % and specificity of 94 % noting the effectiveness of CBE in reducing mortality. A few studies suggest that this approach may offer some benefit: a large-scale mammography trial in Canada, for example, concluded that CBE alone was as effective in reducing mortality as a combination of CBE and mammography. Mass screening with annual CBE in Japan also has been associated with reduced breast cancer mortality.

The effectiveness of CBE depends entirely on health workers' skills. It is important to use the proven training strategies and standardized techniques. Training in breast examination techniques yields better results when silicone breast model are used to practice palpation. By this reason we held training by using a silicon breast model and also special necklace which consists of beads which are sized according to the size of a tumour a woman should be looking for. The smallest one is the size of a pea and the largest the size of a walnut.

Trained nurses can perform CBE as well as physicians, and it is possible to train community health workers and women to conduct the breast-self examination.

Another manual screening method, breast self-examination, has been endorsed and widely promoted by our organizations. We published booklets and articles in the newspapers in their native languages Azir, Armenian, Russian and Georgian to reach every woman.

It should be noted that CBE has more possibility to reveal breast tumour than mammography.

Mammography can identify cancers and breast abnormalities that are too small to palpate, so its sensitivity (83 to 95%) is far higher than the sensitivity of CBE, particularly, among post-menopausal women who have less dense breast tissue.

Furthermore, mammograms do not find every tumour; they miss 10% of all cancers in women over 50 and even in young women, because mammography is less sensitive in younger women, and because disagree whether it is cost-effective to screen women under age 50.

During our work we didn't use widely the third screening methods of mammography, we sent only 52 women to detect tumours and anomalies in the breast (expenses covered by regional Municipal program)

According to the project 106 doctors and 94 nurses were trained in 6 regional towns of Georgia with compact settlement of minorities.

The doctors and nurses were invited from 43 villages near the regional center.

We Published 3 booklets - Breast Cancer, Mastopatia. How to do breast self-examination (in 3 languages); made necklaces – 300 samples.

In each region we made announcements in the newspapers about the program and invited women for examination, wrote articles in local newspaper in native languages in the regions of compact settlement of minorities. In 2 towns of Axalktsixe and Bordjomi we sent letters to all patients who were registered.

Before beginning the work in the region we met with governmental representatives and received conformation about working on this program and asked their support for opening a room for women to get information.

Total 531 women applied for examination, 90 from them were already operated on breast cancer. Others had some problems or thought that they had cancer.

The results of our work show that from 441 women which for the first time applied to us 32.(7,2%) had breast cancer, 59(13,4%) mastopatia,90(20,4%) fibroadenoma, intraductal papilloma 23 (5,2%).

(World Day Prayer German Committee)

The goals of present project is raising awareness for early detection of Breast Cancer among medical staff , examination of population and set up of a network of 180 person (doctors, nurses). A health care team - volunteers in 6 regional towns of the Autonomy Republic of Adjara (Makhindjauri, Batumi, Kobuleti, Keda, Khulo, Khelvachauri).

We organized a Round table for governmental representatives and Political Parties lobbying the health in each town (total 180 representatives); conducted preventative examinations for breast cancer, thyroid pathology. Showing the prototype of a necklace, explained that the beads are sized according to the sizes of a tumour a women should be looking for. We published booklets, information letters in the newspapers.

The basis of our project was to give information to doctors and nurses about breast cancer prevention and to implement two of three approaches to screening for breast cancer - clinical breast examination (CBE) and breast -self examination relying on manual palpation of breast.

126 doctors and 126 nurses were trained. All 324 women who visited us during our work received annual CBE. Also we invited the women already operated on Breast Cancer for examination and consultation

To reach every woman we published booklets in their native languages, published articles about mastopathia, breast-self examination and breast cancer in the local and central newspapers.

In each region we made announcement in the newspapers about program and invited women for examination, wrote articles in local newspapers in Keda (1 article), in Kobulety (2 article) and 3 articles in Central Newspaper of Adjara (Batumi), Maxindzauri, Xulo, Xelachauri doesn’t have own newspaper.

Total 478.women applied to us for examination, 49 from them were already operated on breast cance; others had some problems or thought they had cancer.

The results of our work show that from 429 women, which for the first time applied to us .25 women were diagnosed breast cancer (5,8%.), Mastopatia 100 women (23,3%) fibroadenoma – 62 women (14,5% ) intraductal papilloma 59 women (13,7 %).

CONCLUSION

Deaths from breast cancer occur disproportionately among women of different ethnic and socioeconomic backgrounds. Studies show that early detection of breast cancer can save lives. Many breast cancer deaths could be avoided by increasing cancer-screening rates among women at risk. By this reason we focus attention of doctors, nurses of women which attend our lectures on risk factors and how reveal breast pathology by BSE; give recommendations for frequency of screening by age (till 20 year BSE –monthly; 20-40 years breast physical examination q.1-2 year; after 40 year once a year physical examination or mammography. Timely mammography, in every 1–2 years for women aged 40 years and older can reduce mortality by approximately 20–25% over 10 years. In Adjara we implemented two of three approaches to screening for breast cancer - clinical breast examination (CBE) and breast self examination relying on manual palpation of breast.

Another manual screening method, breast self-examination has been endorsed and widely promoted by our organizations.

Analysis of our work shows that the main reason of BC development risk factors were the iodine deficiency, epidemic region and radiation levels which is in the Black Sea after Chernobyl disaster. The environmental factor of iodine deficiency is associated with the development of mammary pathology and cancer. During our work we paid attention to the fact of high percentage of breast pathology among young women which we think is in direct connection with the early age of sexual life, wide use of contraception without doctor’s advice since the teenage period, very high percent of abortion, STD, HIV/AIDS.

On way to reduce incident of BC raise awareness, and establishing a screening programs it is necessary to train women about the symptoms characteristic for early stages of those diseases, which can be cured if revealed at the early stages. Absence of information and knowledge is probably one reason why the 4th stage of breast cancer has the highest percentage among new registered cases. That is why the prevention, early diagnosis and treatment of the disease are of great importance.

During the implementation of the project in regions we contacted with local churches, gave them the booklets and information for women where to apply in case of revealing the pathology.

This year Government of Georgia is financing training programs for doctors (to teach doctors the new methods of treatment).

Our project was directed to advocacy of government officials and policy makers to place breast cancer on the national agenda, to encourage the development of systematic health policies and service protocols, and to increase women's access to detection and treatment service.

Our work assists the governmental and medical staff with building capacity of work to provide evidence-based (targeted Breast Cancer) information, education and health services to most vulnerable women of community, to measure effectiveness of interventions and adjusting the response accordingly.

(World Day Prayer German Committee)