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Öğe Correlations Between Oncotype DX Recurrence Score and Classic Risk Factors in Early Breast Cancer: Results of A Prospective Multicenter Study in Turkey(Aves, 2016) Ozmen, Vahit; Atasoy, Ajlan; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, EnginObjective: Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the correlations between Recurrence Score (RS) and routine risk factors. Materials and Methods: Ten academic centers across Turkey participated in this prospective trial. Consecutive patients with breast cancer who had pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at tumor conferences. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classic risk factors were evaluated using univariate and multivariate analyses. Results: Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of the 165 patients, 57% had low RS, 35% had intermediate RS, and 8% had high RS, respectively. Multivariate analysis indicated that progesterone receptor (PR) and Ki67 scores were significantly related to RS. Conclusion: Oncotype DX Recurrence Score does not seem to have a significant correlation with the majority of classic risk factors, but it may have a correlation with PR score and Ki67 score.Öğe Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study(Aves, 2019) Ozmen, Vahit; Cakar, Burcu; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, EnginObjective: Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective. Materials and Methods: A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57% had low recurrence score (RS), 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33%. Results: The cost of adjuvant chemotherapy in public hospitals was estimated at $3.649, and Oncotype Dx test was $5.141. Based on the cost-effectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be $7207.9 per QALY gained and $5720.6 per LY gained versus current clinical practice. Conclusion: As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey.Öğe Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases Societies(Oxford Univ Press, 2015) Ozmen, Vahit; Boylu, Sukru; Ok, Engin; Canturk, Nuh Zafer; Celik, Varol; Kapkac, Murat; Girgin, SadullahBackground: One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. Methods: A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. Results: The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. Conclusion: TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres.Öğe Factors affecting time to seeking medical advice and start of treatment in breast cancer (BC) patients in Turkey(Lippincott Williams & Wilkins, 2013) Ozmen, Vahit; Boylu, Sukru; Ok, Engin; Canturk, Zafer; Celik, Varol; Kapkac, Murat; Girgin, Sadullah[Abstract Not Available]Öğe Impact of Oncotype DX Recurrence Score on Treatment Decisions: Results of a Prospective Multicenter Study in Turkey(Springernature, 2016) Ozmen, Vahit; Atasoy, Ajlan; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, EnginIntroduction: Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX (R) 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the impact of the Recurrence Score (R) (RS) on treatment decisions and physician perceptions in Turkey. We also studied correlations between RS and routine risk factors. Patients and Methods: Ten academic centers across Turkey participated in this prospective trial. Consecutive breast cancer patients with pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at multidisciplinary tumor conferences. The initial treatment decision was recorded before tumor blocks were sent to the central laboratory. Each case was brought back to tumor conference after receiving the RS result. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classical risk factors were evaluated using univariate and multivariate analyses. Results: Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of 165 patients, 57% had low RS, 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in treatment decision was 33%. Initially, chemotherapy followed by hormonal therapy (CT+HT) was recommended to 92 (56%) of all patients, which decreased to 61 (37%) patients post-RS assay (p<0.001). Multivariate analysis indicated that progesterone receptor (PR) and Ki-67 scores were significantly related to RS. Conclusion: Oncotype DX testing may provide meaningful additional information in carefully selected patients.Öğe ORGANIZING EARLY DIAGNOSIS AND SCREENING PROGRAMS FOR BREAST CANCER IN TURKEY The report of Breast Cancer Early Detection and Screening Sub-Committee, National Cancer Advisory Board, The Ministry of Health of Turkey(Aves, 2009) Ozmen, Vahit; Fidaner, Caner; Aksaz, Erol; Bayol, Umit; Dede, Ismet; Goker, Erdem; Gulluoglu, Bahadir M.Background: Breast cancer is the most commonly seen and cause of cancer deaths in women in most of the developed and developing countries. Breast cancer awareness and organized population based screening programmes have resulted in early diagnosis, reduction in mortality, and breastconserving surgery. Therefore, body image of women suffered from breast cancer has been protected, and overall survival rate has increased. Eighty-four KETEM's (Cancer Early Detection and Screening Center) in 81 provinces in Turkey has been founded by Cancer Control Department of The Ministry of Health of Turkey. Opportunistic screening has been performed in these centers; however there are no available data regarding the effect of opportunistic screening on breast cancer mortality. Population based organized screening programmes should be implemented to reach this aim. Aim: The aim is to organize national early diagnosis and screening programs consistent with the conditions of country, that are necessary for early diagnosis and treatment of breast cancer which is the most frequently seen female cancer with gradually increasing incidence in our country. Methods: National Cancer Advisory Board, Breast Cancer Early Detection and Screening Sub-Committee organized three meetings in Ankara in 2008. In addition to those three-day workshops, a fourth one was performed in January 22-24, 2009 to provide reports from those studies. In these meetings, expert panelists selected by The Ministry of Health, National Cancer Advisory Board, and National Federation of Breast Societies shared their experiences and knowledge on early detection and screening of breast cancer in Turkey. Two representatives from the World Health Organization also attended to the third meeting. During those meetings, targets and strategies for early detection and screening for breast cancer had been evaluated. Possible barriers to screening, their eliminations, methods of follow up the prepared programme step by step had also been discussed. Results: To reach the success with early detection and screening programs is not possible without community awareness about the importance of early detection and especially high-level awareness of the target population. For this reason, education of women and increasing breast cancer awareness should be the first step. Health care providers (physicians, nurses, midwives etc.) and their administrators (health administrators, chief of staff in hospital etc.) should also be trained and included in those programs. A realistic budget for screening projects should be prepared and carried out. There should be a high-level coordination and a comprehensive organization among study groups, screening centers, and institutions. Social, cultural, and other possible regional barriers against the implementation of projects should be explored and eliminated. Activities, performance status and available data should be controlled, evaluated and published periodically. Targets, strategies, activities, criteria relationships with other related organizations should be re-evaluated, and performance should be monitored regularly. Conclusions: Organizing and implementing breast cancer early detection and screening programmes could be possible only with comprehensive, planned in details, and well determined studies. Resources should be used carefully and timely whenever necessary. As a result of this, downstaging of breast cancer and reduction in mortality rate in community could be possible.Öğe Results of the Turkish prospective multi-center study utilizing the 21-gene Oncotype DX assay: Decision impact analysis.(Amer Soc Clinical Oncology, 2015) Ozmen, Vahit; Atasoy, Ajlan; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Emine Nilufer; Uras, Cihan; Ok, Engin[Abstract Not Available]
