Management of Breast Lesions by Breast Physicians in a Heavily Populated South Asian Developing Country

Background: In Asia, from 1998 to 2002, the highest annual-age standardized incidence rates of breastcancer per 100,000 women were recorded as follows: in the Karachi South district of Pakistan 69.0 and in theIsraeli Jews 96.8. At Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore, Pakistan,in 15-years from Dec. 1995-Dec. 2009, among adult females, approximately 46% (8,915) of malignancies wererecorded as breast tumors. Further, according to Pakistan’s population estimates (2009), the total population ofthe country is 177 million; females 85 million (40-69 years: 13.6 million). Discussion: Screening of asymptomaticwomen: Basing the recommendations on biennial mammograhic screening for average-risk women in the 40-69year age-band, about 6.8 million women will have to be screened every year. In a resource-constrained countrylike Pakistan, early detection by this method is not possible. As most symptomatic women present with advanceddisease, clinicians skilled in breast diseases are required. The Australasian Society of Breast Physicians hasdeveloped a formal three year training model for General Practitioners to qualify as breast physicians by: i)developing their skills in the areas of clinical breast-examination, interpretation of mammography and breastultrasound; performance of image-guided interventional procedures; counseling of and planning/coordinatingtreatment of females with breast cancer and assessment/monitoring of women at potentially ‘high-risk’ of cancer;and ii) working in consultation with surgeons, radiologists, pathologists, oncologists, and other members of themultidisciplinary team. Summary: Easily accessible one-stop breast clinics staffed by trained breast physicianscan help reduce morbidity/mortality from breast cancer in developing countries, and improve the quality of lifeand survival.