Save Women!

In both national and world-wide statistics cancer represents the second cause of death following to the cardiovascular disease.

Breast cancer represents the first death cause of women with a frequency rate of 56.84/100000 and a rate of mortality of 39.28/100000.

Due to ignorance, fear, lack of sanitary education and of public awareness of the already existing screening programs, the diagnosis of cancer occurs only in the advanced stages of the disease, when the treatment is often optional and also very expensive for the society as well as for the individual. Fear to face the reality and the perspective of death make people to address to specialist physicians too late, when the disease is in an advanced stage.

We must not forget that, in case of both breast and cervix cancer, an early detection and an adequate treatment for the incipient cases is equivalent with cure. Knowing the pathology of the pre-cancer lesions, whose detection and correct treatment prevent this disease from occurring, has an important role in decreasing of mortality due to the genital and breast cancer. For example, the survival rate for breast cancer is five years, depending on the evolutive stages of the disease, is 100% for phase 0, 98% for phase I, 76-88% for phase II, 49-56% for phase III and only 16% for phase IV.

The results of the screening through an active program made it to be more efficient than the spontaneous one, especially in those cases where sanitary education is deficient. Only an organized program can be assessed correctly regarding the efficiency of the detection but also regarding the cost-benefit ratio. Plus, an organized program can allow differentiated approaches, based on age, the degree of risk and the results of the first tests. It is possible that screening via regular mammograms to reduce the mortality due to breast neoplasm with at least 30% for women over 40-ies.

Therefore, we consider that the initiation of a program regarding feminine oncological pathology with a strong accent on public awareness and the development of a Center of Genital and Breast Cancer Prevention and Early Detection within the Romanian Cancer League, as an alternative to the already existing governmental programs, would be a huge step in this unfair fight with cancer and a gain for the entire society.

Purposes of this programme:

1. Decreasing of cancer’s incidence, treatment costs and mortality by genital and breast cancer;
2. Training and involvement of the family physicians as well as of gynecologists in the accomplishment of this program;
3. Involvement of both Oncological Institutes of Bucharest and Cluj-Napoca, as well as of the medical university centers, in the accomplishment of this program;
4. Setting up a Center of Genital and Breast Cancer Prevention and Early Detection, as a part of Romanian Cancer League, also available for women with social and economical problems;
5. Treatment of patients that have proven to have forerunning lesions or cancer;
6. Post treatment and social and professional reintegration;
7. Fund-raising in order to support this program.

Epidemiological data of genital and breast cancers

In Romania, in 1999, regarding the incidence the breast cancer was on the first place (41.29/0000 inhabitants), and cervix cancer on the second place (26.16/oooo inhabitants)..

The same cruel reality is revealed in indicators of mortality through breast cancer: 25.31/0000 individuals, versus a standardized European (22.90/0000 individuals.) or world mortality rate (16.33/0000 individuals.)

In Romania of the year 1999, mortality through cervix cancer was 15.81/0000 individuals, compared to a standardized European (14.81/0000 individuals.) or world mortality rate (11.14/0000 individuals.), which ranks Romania as no 1 from the point of view of mortality by cervix cancer.

After the year 2000, it seems that the mortality due to genital and breast cancer has increased with 7%, also its prevalence has increased significantly.

Patients who were diagnosed with breast or cervix cancer were in advanced stages (III-IV), situations when survival rate, despite all the therapeutic efforts and treatment expenses, decreases to 20%.

Description of the project

1. Decreasing of cancer’s incidence, treatment costs and mortality by genital and breast cancer;The incidence and mortality rate of genital and breast cancer are especially high in Romania, compare with other nations. This reality is mainly due to the lack of sanitary education (in our country), even so prevention and screening programs had been initialized even before 1989. Through the “Save Women” Program, the Romanian Cancer League wants to inform the feminine population and not only, about genital and breast cancer (risk factors, signs, symptoms, means of detection, prevention and treatment), and to help them to understand the need of regularly medical exams, as well as how important is this for early detection of cancer and pre-cancerous lesions.Sanitary educational programs will be addressed to all segments of population, starting with children under or of school age, but especially we will address to adolescents or young women, through the medical educational programs, with the intent to determine a decrease of incidence and mortality rates by genital and breast cancers. Concerning women over 30 years age, the medical educational program will also include screening programs for early detection, with the intent to decrease short-term mortality rate and treatments costs.
   1. Elaboration of informative materials about risk factors of breast and cervix cancer and methods of early detection:
      • Leaflets for each localization, containing a short presentation of risk factors and how they can be reduced, modalities of self-examination, importance of regularly medical controls (plus their timing), useful addresses, and also a presentation of alarming signs and symptoms which require clinical exam;
      • Posters directing the feminine population towards specialized centers, where they could receive useful information; these posters could be placed in schools, universities, clinics, units with important female personnel and other public places;
      • Video tapes and short movies about methods of self -examination, examples of cases that have been correctly or incorrectly treated; these video tapes were presented during conferences and seminars, and movies at TV and cinema like publicity spots.
      • Guide books for all women, written in accessible terms.
      • Thematic articles edited in newspapers and women’s magazines.
   2. Distribution of these materials through:
      • mail – in collaboration with the Population Surveillance Department
      • medical appointments for the female population, according to their age
      • stands and book fairs
      • society meetings
      • recruitment of volunteers
   3. Organizing seminars about this issue addressed to women. We have contacted schools, universities, public authorities, and managerial staff of enterprises with female personnel, and we organized meetings that had the goal to stress the subjects published in these mentioned materials.
   4. Involvement of church in the support of the program through promoting the program among people.
   5. Involvement of governmental institutions, based on partnership protocols, to support this program: town halls, schools, hospitals, the Ministry of Health
   Starting with 2001 we have carried out a screening of 12000 women for detection of breast and cervix cancer that implied a free-tax package of medical services that included: a short medical training, a mammogram, a Papanicolau test. ^ summary
2. Training and involvement of the family physicians as well as of gynecologists in the accomplishment of this program
   • Training courses for family physicians in order to improve the activity of prevention and early detection taking into account that they are the firsts solicited by population and their activity is a baseline for screening. These courses will be sustained with the support of both oncological Institutes, and Oncology Department of “Carol Davilla” University of Medicine and Pharmacy, Bucharest.
   • Organization of conferences, symposiums, round tables, eventually in different medical specialized societies, where will be presented the latest news/data in domain of prevention, detection and treatment of pre-cancerous lesions of malignant maladies with the attendance of oncologists and physicians of other specialties.
   • Exchange of experience between oncologists from Romania and from outside, regarding the prevention and early detection cancer strategies.
   • Publishing and distribution of a magazine of oncology education.
   • The magazine will include, besides articles regarding oncology, intermediary results obtained by the League into its programs and information meant to attract medical personnel towards activities of cancer prevention and early detection. The magazine will be distributed among family physicians as well as among physicians of other specialties; its publishing and distribution will be done in collaboration with different medical societies, the Romanian Medical Association etc. ^ summary
3. Involvement of both Oncological Institutes of Bucharest and Cluj-Napoca, as well as of the medical university centers, in the accomplishment of this program
   • Since the National Cancer Program is achieved with the help of the “Al Trestioreanu” Oncological Institute of Bucharest and of Cluj-Napoca, and that of University Centers throughout the country, their involvement in the “Save the Women” program is mandatory;
   • The early detection centers into oncological Institutes, the university centers with pilot cancer detection centers as well as territorial pilot centers will map the population who need to be undergone to screening program and also they’ll perform the detection tests;
   • Into these university centers, will be created commissions for accreditation of screening units (endowment, personnel abilities, working procedures, quality control procedures) that will compare periodically the results and quality of different centers. Commissions of Accreditation will recommend administrative and legislative measures concerning early detection;
   • The compounds of Accreditation Commission are: 1 physician medical management; 1 physician pathologist – cytologist; 1 physician oncologist-gynecologist; 1 radiologist physician with experience in mammography; 1 statistician-mathematician; 1 secretary;
   • Epidemiological indicators: during the first screening cycle (incidence rate of targeted population > incidence rate in the general population), and subsequently the decrease of incidence of invasive cases compare with the first cycle; progressive decrease with number of cycles of the incidence of invasive cases; decreasing of mortality through genito-mamary cancers in target population compare with general population.
   • The sensibility and specificity of each procedure. ^ summary
4. Setting up a Center of Genital and Breast Cancer Prevention and Early Detection, as a part of Romanian Cancer League, also available for women with social and economical problemsThe program stipulates the setting up of a proper center of the League for detection of genital and breast cancers with possibility to perform the clinical exams, laboratory tests for early detection, which will work 12 hours per day so that all women can benefit of them.For setting up of this center the followings are required:
   1. Space and organization:
      • space: a minimum of 300 sqm is required, that will include:
        • 2 consulting rooms;
        • 1 mammography laboratory;
        • 1 pathology and cytology laboratory;
        • 1 laboratory for common tests and tumoral markers;
        • 1 room for obtaining of analysis;
        • 1 ward for treatment and rest;
        • 1 psychology department
   2. Necessary equipment:
      • an X-ray machine with tip-up table;
      • a Doppler echograph;
      • a video – colposcope;
      • a diagnosis hysteroscope;
      • a gynecological table;
      • a laser-cauther;
      • an analyzer;
      • instruments.
   Purchasing of this modern equipment, mentioned above offers the possibility of performing complex examinations such as:
   • digital mammography – compare with the standard one, allows the electronic storage and transmission of the image;
   • stereotactical mammography – allows the composing of the bi-dimensional image through computer, as well as targeted biopsies for suspect lesions, or marking them for surgical excision;
   • breast’s echography – for the detection and evaluation of cystic lesions and examination of women who have dense breasts or who are forbidden to take a mammography;
   • ductography – for detecting lesions at the level of the galactophore channels using a contrast substance;
   • breast’s scintigraphy, based on the intravenous injection of a radioactive contrast substance (Technetiu Sesta MIBI), that can fix on a preferential basis (a method less sensitive than mammography);
   In the future, we have planned to open a center for genetic consulting for detecting the oncogenes (BRCA 1 and BRCA 2) as well as for estimating the risk of cancer in persons with a positive medical history. ^ summary
5. Treatment of patients that have proven to have forerunning lesions or cancerThe treatment of patients that have proven to have pre-cancerigene lesions or cancer will be applied in university or county oncology centers, where oncological committees are available for therapeutic recommendations. Mandatory, these committees will be made up of an oncologist surgeon, a medical oncologist and a radiotherapist. These committees will also ensure the post-therapy check-ups of patients that have finished their treatment. ^ summary
6. Post treatment and social and professional reintegration
   • creating a supporting group for patients that have survived cancer, where they can find specific support and counseling for their problems;
   • the supporting group will include a psychologist, 1 or 2 nurses and specially trained volunteers;
   • involving the members of this group in the League’s sanitary educational activities, concerning prevention and early cancer detection;
   • providing optimal clues for familial and socio-professional reintegration of patients with genital and mammary cancer that have undergone oncology treatment;
   • volunteer involvement of cancer-suffering women in this group can be a solution in itself and a first step towards their social and professional reintegration, and in the same time a real help for those who are still facing the disease. ^ summary
7. Fund-raising in order to support this program
   • organizing social-cultural charity actions for the financial support of the program;
   • contacting organizations or international foundations that have similar activities, for collaboration;
   • adjoining of economical factors, for financial support;
   • presentation of the program to the authorities, in order to solicit financial support;
   • publishing of a booklet of information that details the activities of the Romanian Cancer League concerning the “Save the Women” Program, its results obtained till now and farther projects. ^ summary