Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
First compazine 5mg sale medicine lookup, it was necessary buy generic compazine 5mg line medications gerd determine what behaviors the population was currently practicing and what behaviors the population would be willing buy compazine with amex medications emts can administer adopt deal with tires in their yards. Second, it was necessary identify who within the family structure was, or would be, responsible for implementing the recommended behaviors, and thirdly, it was necessary know what obstacles might exist prevent adoption of the behavior and how those obstacles could be overcome. Researchers conducted laboratory-based entomological tests by pouring lime in varying amounts into tires (8, 68, and 160 grams of lime per liter of water), with all three cases producing 100% larval mortality, whereas in the control tire larvae continued develop normally over the course of the three-week period. Since Aedes does not reproduce in salty water, lime was selected for conducting the tests because it was thought the mosquito would not lay her eggs in water with a low pH. Six families with tires on their property were asked perform one of two possible actions: throw away the tires or pour two handfuls of lime into each tire every month. The practice of pouring lime into the tires exhibited a high degree of acceptance because lime was easy obtain and, moreover, housewives reported satisfaction with this option since it meant we won?t have depend on our husbands do it. To fully develop the educational communication campaign, a number of social science tools, including focus groups and in-depth interviews, were used identify the target audience. Housewives, or female heads of households, were identified as the group which the messages should be directed, as they were directly responsible for the care of the various potential breeding sites of Ae. Identification of the target population (Booth, 1992) made it possible design the campaign messages taking into consideration, among other significant sociocultural factors, the concepts, beliefs, prejudices, language, and information needs of the intended recipients. The in-depth knowledge of the target population made it possible develop a message dissemination strategy with a high degree of precision, using a number of complementary communication channels, specifically, a combination of mass media (radio and television) and interpersonal communication. The broadcast schedule for the radio and television messages was structured in accordance with the level of acceptance given each station or channel and the credibility of the personality or show as a source of information/entertainment reported by the target population (Inette Burgos, 1996). In addition, the use of interpersonal communication activities through direct contact with the target population enabled the adaptation of messages specific physical and cognitive circumstances. What didn?t work It was determined that although housewives did in fact wish throw away the tires in their yards that were not being used, garbage collection employees either refused haul them away or charged an additional fee do so. Sustainability the formative research exercise, in conjunction with a practice conceived and implemented on a dialectical and cross-disciplinary basis, made it possible address 61 and understand the problem both quantitatively and qualitatively, focus on it from both social and entomological standpoints, strike a compromise between the ideal and the feasible, and identify the most effective messages and means of communication based on the characteristics of the target audience. Some of the radio spots developed under the project are still being broadcast today as a means of reinforcing trash clean-up campaigns during the rainy season. The use of lime as a method for controlling tires has been incorporated into the national dengue prevention and control program. Evidence that the practice works the key points be remembered are enumerated below. A number of results obtained during the program period are listed in the following paragraphs (Mendez Galvan, et al. In the pre-intervention surveys, only one person mentioned lime as a tire control method; subsequently, 32 households mentioned using lime in tires, and 19 of these reported that they applied it with the appropriate frequency. These channels included radio and television, as well as the use of interpersonal communication at school-based activities and during home visits. Results from the qualitative evaluation of the communication campaign showed no differences in adoption of the tire control behavior between individuals that reported hearing the messages via radio or television and those that reported hearing it at home or through school-based activities. However, differences were found between the groups when examining behaviors related water storage. This may be due the fact that the tire message was simple and easy disseminate via radio and television, while other messages were more complex. Identification of the most Critical In order ensure productive breeding sites, as success, it is necessary determined by the various identify the most functions assigned the productive sites and containers understand the function that the containers fulfill within the household dynamic. Effectiveness and feasibility of Critical In order design control the measures be promoted measures, it is necessary determine the effectiveness of the measure on controlling the vector, as well as the feasibility of carrying out the behavior at the household level. Use of a number of Critical Use of multiple channels is complementary critical for the communication channels dissemination of messages of varying levels of complexity. Sociocultural characteristics of Very important the success of an the target population and educational identification of the specific communication campaign groups toward which the depends a large extent messages are directed on identification of the specific population groups which the messages are be directed. Levels of acceptance and Very important It is necessary credibility accorded the determine the levels of various communication acceptance and credibility channels by the target accorded the various population channels by the target population. Stratification of the city and Not critical, but very useful Determination of the areas identification of the most of greatest risk make it problematic areas possible put into practice measures focusing on specific problems based on the socioeconomic and cultural characteristics of the residents. Reflexiones metodologicas para la eficaz planeacion de programas de salud publica. Dengue Prevention and Control Project, Ministry of Health, Mexico, under the auspices of the Rockefeller Foundation. Susceptibilidad de infestacion de larvas de Aedes aegypti y determinacion de acciones de control. Taller sobre Avances Recientes en el Control de Aedes aegypti Basado en la Comunidad: Honduras y Mexico, 1995-1996. Management and Control of Water Containers Contributed by: Julia Rosenbaum, ScM, and Elli Leontsini, M. The process identify, modify, or develop Aedes aegypti prevention and control methods is based upon established social science and entomological research methods. Unfortunately, few dengue prevention and control programs have put resources, including staff time and fiscal resources, into evaluating whether the methods currently being recommend for residents are feasible, effective at the household or business level, or acceptable the target population. This example from the Dominican Republic describes the process used develop a feasible, effective, community-based Aedes control methodology that started from the householders point of view. In this best practice there are actually two practices: the first is how a research process was adapted by the national dengue control program become the means by which integrated control activities are conducted; the second is the outcome of the research practice?the use of bleach dabbed onto the sides of water drums on a weekly basis destroy mosquito egg rings. The back-and-forth dialogue between entomology laboratory and household patio and between planners and community members constituted the negotiation. Health workers are no longer just 65 educators, but facilitators of change on an individual basis.
Available at: surveillance purchase compazine 5 mg free shipping medications look up, epidemiology discount compazine 5 mg on line medicine syringe, and end results program at the National buy compazine 5 mg lowest price medicine 5852. Available chemotherapy with trastuzumab followed by adjuvant trastuzumab at. Prognosis of occult breast trastuzumab and docetaxel in breast cancer: preliminary results. Surgical aspects of inflammatory breast studies in axillary metastases from occult breast cancers. Delegates attending this short-course will benefit from an introductory overview of the terminology and classification of breast cancer and principle issues in its treatment. John Allen, Clodagh Burrell, Clara Caplice, Deirdre Collins, Patrick McGreal & Joanne Purcell. To outline the breast cancer provision of services and care pathways in Ireland and abroad. To give a comprehensive description of the role of the physiotherapist and exercise provision in the care of breast cancer patients. To summarise effective communication methods that may be helpful when treating breast cancer patients. Cell Cycle (Langthorne et al, 2007) 7 Pathogenesis of Cancer: Cancer cells differ from their normal cells in that they have abnormal regulation. Six hallmarks form a principle that provides a logical framework for comprehending the diversity of neoplastic diseases. As normal cells progress a neoplastic state, they acquire these hallmark capabilities. The Hallmarks of Cancer 1) Sustaining Proliferation: Cancer cells have the ability sustain chronic proliferation without external stimulation. Normal tissues carefully control the production and release of growth-promoting signals, through proto-oncogenes, thereby ensuring a homeostasis of cell number and maintenance of normal tissue structure and function. In cancer cells, the change of pro-oncogenes oncogenes promotes self-sufficient cell growth. In cancer cells, telomere shortening is averted by the enzyme telomerase, enabling widespread self-replication. Chemotherapy and follow up care will be delivered more locally, according care plans set at the cancer centres. Personal History of Cancer Previously diagnosed breast cancer increases the risk by 4 times of breast cancer in the opposite breast. Previous ovarian, endometrial or colon cancer have been associated with a 1 2 times increased risk over the general population. Early menarche (before 12), late menopause (after 55) and greater total duration of regular menses are associated with an increased risk of breast cancer. The majority of studies indicate that being obese is a poor prognostic factor and are associated with less favourable nodal status as well as increased risk of contralateral disease, recurrence, co-morbid disease and overall mortality (Doyle et al, 2006). Obesity is associated with higher levels of insulin and other hormones in both pre and post menopausal women. Insulin and related proteins have been shown increase the risk of cancer diagnosis and increase risk of cancer recurrence two-fold. Physical Examination the physical breast examination is a step by step process that should be carried out by an experienced practitioner, examining each breast, nipple and regional nodes through observation and palpation in both the erect and supine position. Other causes of breast masses Presentation Diagnosis Treatment Cystic Mass Firm/rubbery, Direct Ultrasound/ Aspiration, Follow-Up in Aspiration 6-8 weeks, Excisional Biopsy (if aspiration bloody) Fibroadenomas Non-tender, round, Triple Test Evaluation Observation/follow-up (Common in women macrolobulated masses (Physical Exam, studies, complete under 40 years) that are firm/ rubbery. After analyzing mammographic images, radiologists classify findings into five categories (see table). A diagnostic mammography includes additional views such as spot compression or magnification views for a more detailed report. Its sensitivity is 65-98% and specificity is 34-100% in diagnosing breast lesions (Irish Cancer Society, 2011). The palpable breast mass is trapped and a fine needle is slowly inserted into the mass. After several advances within the mass along multiple planes the needle is withdrawn and the specimen is placed on a slide for investigation. The patient is usually under local anaesthetic and 21 sedation with placement of the incision determined by both oncologic and cosmetic considerations. Non-invasive or invasive breast cancer Cells Non-invasive breast cancers stay within the ducts/lobules. Tumour Necrosis (Cell death) this is often a sign of a rapidly growing aggressive form of breast cancer. Surgical Margins the surgeon examines the rim of the tissue removed (surgical margin). Vascular or Lymphatic Invasion Describes whether the cancerous cells have infiltrated the vascular/lymphatic system supplying the breast. Ploidy Diploid cancers cells have the same amount of chromosomes as normal cells and tend be slower growing, less aggressive cells. Aneuploid cancer cells have too many/too little amount of chromosomes and tend be rapid growing aggressive cells. Tumour can be any size and has grown into the chest wall or the skin of T4 N0 M0 the breast.
This definition was maintained in the subsequent editions of that document (1980 and 1986) generic compazine 5 mg with visa treatment xeroderma pigmentosum. These departures from the recommended definitions indicate that at the population level (individual doctors or hospitals) purchase 5mg compazine with mastercard medications high blood pressure, or even the national program level generic compazine 5 mg medicine 93 948, there is some adaptation of the criteria local conditions. Unfortunately, it is not possible know how much of the deviation from criteria may be appropriate. Criterion on excessive Critical this is what can kill the vascular permeability patient the excessive vascular permeability that may lead shock. With the earliest suspicion that the patient may be developing a severe illness, an intravenous line should be placed so fluids can be provided. It is important monitor blood pressure, hematocrit, platelet count, the occurrence of hemorrhagic manifestations, urinary output, and the level of consciousness. There is great variability from patient patient, and the physician must carefully adjust treatment using serial hematocrits, blood pressure, and urinary output. Insufficient volume replacement will allow worsening shock, acidosis, and disseminated intravascular coagulation, while fluid overload will produce massive effusions, respiratory compromise, and congestive heart failure. The recommended amount of total fluid replacement in 24 hours is approximately the volume required for maintenance, plus replacement of 5% of body weight deficit, but this volume is not administered uniformly throughout the 24 hours. A bolus of 10?20 cc/kilo of an isotonic solution is given in case of shock and repeated every 30 minutes until circulation improves and an adequate urinary output is obtained. An arterial line will help in the assessment of arterial blood gases, acid-base status, coagulation profiles, and electrolytes in the hemodynamically unstable patient, helping identify early respiratory compromise. Once the patient begins recover, extravasated fluid is rapidly reabsorbed, causing a drop in hematocrit. Before hospital discharge, the patient should fulfill the following six criteria: absence of fever for 24 hours (without the use of antipyretics) and a return of appetite; improvement in the clinical picture; hospitalization for at least three days after recovery from shock; no respiratory distress from pleural effusion or 3 ascites; stable hematocrit; and platelet count greater than 50,000/mm. Because it is frequently difficult obtain convalescent-phase samples, a second blood sample should always be taken from patients on the day of discharge from the hospital. Transfer of patients from a local a referral institution should follow a specified protocol, such as that developed by the Pediatric Hospital No. Describe the process develop the practice these treatment recommendations are the result of decades of clinical experience, especially in Southeast Asia. They have been validated elsewhere, as shown by their acceptance by experienced clinicians in the Americas. Very recent attempts at developing evidence-based recommendations have not produced major changes in the recommendations thus far (Halstead, 2002). Therefore, in locations with little experience in dengue case management, patients often receive steroids, platelet transfusions and blood transfusions, putting great strain on blood banking resources. In general, low platelet counts in dengue cases do not require treatment with transfusions. When patients are diagnosed and treated promptly and appropriately with intravenous fluids, hemorrhages are prevented and requests for blood transfusions are reduced markedly. Blood pressure Critical Monitoring of blood pressure is critical, because shock may develop quickly. Alarm signals Critical Physicians must be aware of indications of impending shock: sustained vomiting, severe abdominal pain, abrupt change in temperature (from fever hypothermia), change in mental status (obtundation or combativeness) Avoidance of aspirin Critical Must educate not just doctors, but the public at large. Dengue and Dengue Hemorrhagic Fever in the Americas: Guidelines for Prevention and Control. Primary School Curriculum for Comprehensive Vector Control Contributed by: Annette Wiltshire, Trinidad and Tobago Why was this practice selected? This best practice example of a curriculum was the first school-based vector control curriculum be developed from the perspective of the Ministry of Education, and is based upon theories for primary school education that reflect the framework within which school subjects are taught in the region. An educator with curriculum development expertise developed this curriculum, with support from a multidisciplinary advisory group that included health professionals and vector control specialists. This was a curriculum intervention that introduced a Reducing Pests and Insect Vectors module into the existing Health and Family Life Education program of 15 primary schools spread across the English-speaking Caribbean. This area represented some 8,000 students between the ages of five and 12 years and 350 teachers. A multidisciplinary group of school principals, teachers, curriculum developers, health educators, environmental health officers, entomologists, environmentalists, and parents developed the curriculum, which reflects a bio-psycho-social framework. The scope of the curriculum was extended from merely teaching about mosquitoes include teaching about other relevant environmental issues that affect the home, school, and community related pests and vectors as well as the disposal of waste materials. Describe the process develop the practice the advisory group determined that the most convenient and desirable method of delivering the curriculum was by means of a combination of infusion into already existing subjects. Teaching strategies were aimed at creating action-oriented and participatory learning experiences with strong links the home and community. Home/school/community communications suggested ways in which support and reinforcement could be provided for classroom activities, and many activities assigned the students were not limited the school environment. Skills taught included collecting and interpreting data, identifying school needs, relating problems causes, predicting future effects/outcomes, interpreting charts, learning problem solve, making informed decisions, learning how cooperate, sorting, basic gardening, interviewing, and training in advocacy. Phase 1: Formative research with school leaders School principals participated in a workshop that introduced them the global problem of dengue, with emphasis on the English-speaking Caribbean. Determining areas where teachers/students have control over their health as it relates the environment. Exploring, as leaders, the feelings, attitudes, and values that contribute the quality of the school environment. Critically examining the effectiveness of approaches currently used in helping children develop requisite knowledge, attitudes, skills, and responses the issues of environmental preservation and enhancement. Exploring strategies for establishing partnerships facilitate achievement of certain goals while striving create support both in and outside the school for curriculum implementation, sharing information, and developing skills. The information gathered influenced curriculum content, development of materials, and home/school/community activities and linkages. Phase 5: Training Monitoring and evaluation of the curriculum were stressed from the beginning.
Benefits the procedure is less invasive than surgical biopsy buy discount compazine 5 mg online medicine cabinet shelves, leaves little or no scarring and can be performed in less than an hour best compazine 5mg treatment quality assurance unit. Stereotactic breast biopsy is an excellent way buy discount compazine line medicine review evaluate calcium deposits or masses that are not visible on ultrasound. Stereotactic core needle biopsy is a simple procedure that may be performed in an outpatient imaging center. No breast defect remains and, unlike surgery, stereotactic needle biopsy does not distort the breast tissue or make it difficult read future mammograms. X-rays usually have no side effects in the typical diagnostic range for this exam. Risks There is a risk of bleeding and forming a hematoma, or a collection of blood at the biopsy site. An occasional patient has significant discomfort, which can be readily controlled by non-prescription pain medication. The chance of infection requiring antibiotic treatment appears be less than one in 1,000. Depending on the type of biopsy being performed or the design of the biopsy machine, a biopsy of tissue located deep within the breast carries a slight risk that the needle will pass through the chest wall, allowing air around the lung that could cause the lung collapse. There is a small chance that this procedure will not provide the final answer explain the imaging abnormality. Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety in X-ray, Interventional Radiology and Nuclear Medicine Procedures page for more information about pregnancy and x-rays. There are some instances in which stereotactic biopsy may not be possible, including if: the target abnormality is located near the chest wall or directly behind the nipple. The mammogram shows only a vague change in tissue density but no definite mass or nodule. The target is composed of diffuse calcium deposits scattered throughout the breast, which on occasion are difficult target. If the diagnosis remains uncertain after a technically successful procedure, surgical biopsywill usually be necessary. Disclaimer this information is copied from the RadiologyInfo Web site. To ensure that, each section is reviewed by a physician with expertise in the area presented. However, it is not possible assure that this Web site contains complete, up-to-date information on any particular subject. Do not attempt draw conclusions or make diagnoses by comparing these images other medical images, particularly your own. Only qualified physicians should interpret images; the radiologist is the physician expert trained in medical imaging. Commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method is prohibited. Quality Measure on Preoperative Diagnosis of Breast Cancer Approved December 15, 2010 2. Performance and Practice Guidelines for Breast Ultrasound Revised April 30, 2012 3. Performance and Practice Guidelines for Stereotactic Breast Procedures Revised April 28, 2010 4. Concordance Assessment of Image-Guided Breast Biopsies and Management of Borderline or High-Risk Lesions Approved November 2, 2016 Methods this is a comprehensive review of the modern literature on this subject. Furthermore, consultations for fertility, plastic surgery, and genetic testing, when appropriate, can be obtained before the definitive surgical excision is performed. A preoperative diagnosis also optimizes oncologic and cosmetic surgical planning, and facilitates preoperative axillary staging minimize the number of surgical interventions. The choice of percutaneous device depends on the target lesion (mass vs microcalcifications), target location (mid-depth breast vs adjacent skin or implant vs axilla), intent remove the entire lesion, and training and experience of the clinician. For smaller lesions (1 cm or less), percutaneous excision using a vacuum-assisted or other enhanced tissue acquisition device along with placement of a marking device. For larger (greater than 1 cm) suspicious masses, 14-gauge core needle biopsy is often sufficient. Neoadjuvant treatment may result in loss of target due tumor regression prior surgical excision. A percutaneous breast biopsy of a palpable mass without the use of image guidance may lead a false-negative result since the biopsy device cannot be confirmed be within the lesion of interest, as some palpable lesions have a surrounding inflammatory reaction that may be palpable but does not contain malignant cells. A comprehensive discussion of the management of patients with high-risk lesions and discordant lesions is beyond the scope of this position statement, but can be found in the references below. Place a clip or other marking device at the time of percutaneous biopsy of all suspicious lesions. Ultrasound, if available, is recommended for image guidance in patients with palpable masses. Concordance of clinical breast examination, imaging, and the biopsy results must always be determined and documented. Discordant biopsy results should prompt a repeat percutaneous biopsy or surgical excision. Evaluation of percutaneous vacuum sonography distinguish between benign and assisted intact specimen breast biopsy device for malignant lesions.
Purchase compazine with amex. Yotam Ben Horin from Useless iD @ Punk Rock Holiday 1.6 (2016).
Identify decision-makers and partners (advocates cheapest generic compazine uk treatment zinc poisoning, prevention strategies (lifestyle modifcations buy compazine 5 mg with mastercard treatment 7, phylactic trusted public fgures order compazine medicine organizer, medical associations, public medicine, prophylactic surgery), breast health health institutions) who can help put breast cancer counseling, including risk counseling. Set priorities and determine feasibility of interventions Identify target population(s) and strategy. Prioritize primary prevention program goals based on interventions by implementing demonstration or pilot at-risk populations, available resources and cultural projects with measurable outcomes. Follow a resource-stratifed pathway for program can be incorporated into early detection efforts or development that identifes available resources complementary public health programs such as across the continuum of care. These goals overlap with prevention prevention intervention for select moderate or high-risk goals for many non-communicable diseases. For example, genetic testing for high-risk women is not a goal for policymakers, health professionals and patients. Risk assessment strategies should cancer have not been a priority for health systems. Research continues inform prevention guidelines regarding risk factors for breast cancer. Prioritize prevention interventions based on population Monitor and evaluate based risk assessments. Preventive efforts should augment, not replace, early detection, timely diagnosis and treatment programs. It is unlikely, even with high participation rates in preventive programs (such as elimination of obesity or universally implementing pharmaceutical prevention in moderate and high-risk women), that the reduction of breast cancer mortality would be as great as would be with interventions that optimize treatment or increase breast cancer screening. Understanding how risk assessment informs effective prevention strategies for a high-risk subgroup of women and how prevention strategies translate into clinical and public health practice can be challenging. See Appendix for prevention strategies by level of resources available in a country, links resources on risk assessment and general lifestyle modifcations. Ensure that priority prevention strategies are targeted those groups that are infuential and Low level of resources can spearhead the process. Strengthen comprehensive evidence-based health promotion and prevention programs and High level of resources ensure nationwide implementation in collaboration with other sectors Establish routine monitoring of ultraviolet radiation levels if the risk of skin cancer is high. Adult weight gain Family history (frst-degree (postmenopausal) ++ relative)b ++ (>35 vs. Indeed, a number of initiatives commenced address a multitude of issues related breast cancer prevention and care, including the need address the diferences in cancer care across European Member States, the importance of diagnosing and treating breast cancer in the early stages, the need for support in the workplace for patients sufering from breast cancer, and the unique needs of patients with advanced breast cancer. In light of the above, this white paper intends provide an up-to-date overview of the health and economic burden of breast cancer in Europe, and present breast cancer not only as a population health problem, but also as a socio-economic problem, as it underlines that European healthcare systems are still heterogeneous with stark inequalities existing in access, quality and patient outcomes. Despite signifcant improvements in screening, diagnosing and treating the disease, cancer continues represent a heavy burden on European society2. While cancer can be considered a silver tsunami predicted increase further, considering the ageing of the European population3 it is also increasingly afecting a younger demographic, as is the case for breast cancer, where about 20% of all breast cancer cases diagnosed in Europe are in patients under 50 years old4. Breast cancer has a profound impact on European society as a whole as it is the most common cancer in Europe. It should be emphasized that this situation varies across Europe and geographical patterns, and stark diferences between regions are emerging. The incidence rate is higher in Northern, Southern and Western Europe where they are amongst the highest in the world8 than in Eastern Europe9. However, while we fnd the highest rates of new cases of breast cancer in Northern and Western Europe, it is in Eastern Europe where we fnd the highest death rates from breast cancer. This concerning situation illustrates the large health inequities that currently exist across and within Member States10. While Eastern European countries demonstrate higher death rates from cancer, the data does not suggest a clear east-west pattern, as there are a number of northern and western European countries with higher mortality than their immediate neighbours. Diferences in incidence and mortality rates may refect the availability of accurate statistics or collection methods. There are, for example, countries (such as Greece) where there are no cancer registries, making it difcult assess geographical patterns or draw conclusions within and across countries13. Breast cancers accounted for the highest healthcare costs (?6?73 billion; 13% of all cancer-related healthcare). However, women of a higher socioeconomic status have a lower rate of death from breast cancer than do those from a lower socioeconomic status. This could be due having greater access mammography screening compared with women of a lower socioeconomic status. For working women, breast cancer can have a signifcant and sometimes devastating impact on their careers through shortened employment, fewer working hours, and loss of income (see section 8). In addition, many households depend on women aged 50+ for social and economic support. A signifcant proportion of these women look after their own children or their grandchildren, or both18. Many also care for elderly and disabled relatives and do voluntary work in the community. If they are unable do some or all of this grey economy work, then replacing their unpaid labour has an estimated replacement cost of around 8,767 per year for each woman, a total of 876?5 billion from 11 European countries19. For healthcare systems and all stakeholders, noticeably policymakers, it is important understand the profound social and economic impact of breast cancer. The overall risk of dying is decreasing, in line with improvements in screening, diagnosis and treatment; however, variation in the rate of reduction exists according stage of disease and country20. The lack of a viable national screening program has disadvantaged patients health in Romania. Indeed, Romania ranks second last in Europe for the percentage of women who have had a mammogram test in their lives. Patients with breast cancer will have improved outcomes and a higher quality of life, their families will beneft as well, and with sustained action the overall societal impact of this disease will lessen.