TAP CHi Y HOC VlgT HAM TAP 455 - THANG 6 • SO 1 - 2017 giau ehat beo nhy dd chien ran, quay, Idng ldn...
nhffng thy'c pham nay deu la nguyen nhan t3ng lipid mau, hdn nffa nhuYig thyc pham nay cung vdi rffdu bia thffdng ed nhffng bffa an ciia nam gidi nen nam gidi cd nguy cd mac rdi loan md mau cao hdn nff gidi.
Viing ngoai co nguy cd bj rdl loan lipid mau cao hdn viing trong gap 3',i lan vdi 95%CI = 1,4-6,9. Sff khac biet la rat cd y nghTa thdng ke vdi p<0,01. Dieu nay do viing ngoai giao thdng thuan ldi nen ngydi dan co thuan tien cho viec di lai mua sam cac thffc pham do dd thyc pham da dang phong phii hdn va cac thffc an giau chat beo cung xuat hien nhieu hdn trong cac buci an edn vung_trong thydng xuyen xff dung,thyc pham cd s i n trong vudn nhff rau xanh va ft trao doi budn ban hdn nen nguy cd rdl loan md mau thap hdn viing ngoai.
V KET LUAN
- Ty le rdi loan dinh dffdng lipid mau chung tffdng doi cao.
- Mpt sd yeu to lien, quan tdi rdi loan lipid mau la: gidi tfnh, ddi sdng kinh te dja phffdng va thdi quen an mdn xao, ran.
T A I UEU T H A M KHAO
1. Nguyen Cong Khan (2006), "Chuyen tiep dinh diiSng d Viet Nam", Tap chl Dinh dudng va didc pham, 3+4, tr. 6-13.
2. Ha Huy Khoi (2006), Mot so van dS dinh du&ng cong dong d Viet Nam, Nha xuat ban Y hoc, HN.
3. Td Van Hai, Nguyen Thi Phuc (2003), " Rdi loan lipid mau d ngu'di benh dai tJiao dUdng", Hoi nghi khoa hgc toan quoc lln I I , tr. 262-266.
4. Kham Pheng Phun^Ma Keo, Hoang Trung Vinh (2006), "Dac diem lam sang, hoa sinh man va bien chiTng d benh nhan dai thao du'dng t/p 2 tai mot so benh vien Vieng Chan - Lao", Tap chf Y hoc tliyc hanh, (548), tr. 179-184.
5. Tran Van Hien, Ta Van Binh va c$ng SM"
(2007), "Nghien cffu roi loan lipid mau d benh nhan dai thao dydng typ 2 [ah dau dUcfc phat hien tai Benh vien Npi tiet Trung u'dng". Hoi nghj khoa hoc toan quoc chuyen nganh ndi tiet va chuyen hoa lan thff 3, tr. 66-669.
6. CDC (2012), "Prevalence of cholesterol screening and high blood cholesterol among adults-United States, 2005, 2007, and 2009", MMWP Morb Mortal
WklyRep, 61, pp. 697-702.
7. Gabriel S. E. and Michaud K. (2009),
"Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases", Arthritis Res Ther, 11(3), pp. 229.
DANH GIA KET QUA TU* VAN, KHAM SANG LOC VA PHAT HIEN saM UNG THU v u 6" P H U NU TREN 40 TUOI TAI T H A N H PHO H A NOI
VA CAC TINH LAN CAN NAM 2 0 1 6
T O M TAT
Muc ti^u nghien cffu: Danh gia ket qua tU van, kh^m "sang Ipc va phat hien sdm ung thU vii d phu nff b-en 40 tudi tai thanh pho Ha Not va cac tinh lan can nSm 2016. Phu'dng phap nghien cihi: Mo ta cat ngang tren 768 phu nff tr§n 40 tuoi tai thanh phd Ha Npi va cac b'nh ISn can dUde t y van, kham sang Igc phit hien sdm ung thy vii tai Trung tam Y hoc hat nhan va Ung bydu Benh vien Bach Mai trong bon nqay thff 7bj' 22/10 den 12/11 ham 2016. Ket qua:85,4%
phu nff tronq do tudi tff 40 - 59, 27,9% phu nff tu' kham vu hanq thanq.166 trUdnq hop phat hien bat thydnq (chiem 21,6%), tronq do 90,3% phu nff tronq do tudi tff 40 - 59 va 65,7% phu nff chUa man kinh.
Tronq cac tru'dnq hdp phat hien co bat thUdnq tai vu chi cd 34,3% phu nff t y kham vu hang thang (57
*Tt Yhgc Hat nhan va Ung Bddu, Benh vien Bach Mai Chiu trach nhi?m chinh: Pham Cam Phydng Email: [email protected] Ngay nhan bai: 8.3.2017 Ngay phan bi^n khoa hgc: 26.4.2017 Ngay duyet bai: 15.5.2017
Pham Cam Phirong*, Mai Trong Khoa*
tru'dnq hdp); Ton thu'dng hay gap nhat qua khim lam s&ng la viem xd (70 trUdng hpp, chiem 42,2%) va u xd (59 trUdng hdp, chiem 35,5%).Phat hien thay 5 trUdng hpp ung thu vu, chiem 0,7% tronq tonq so trUdnq hdp tham qia kham sanq locKet luan: nen to chffc dinh kv cac hoat donq kham sanq loc unq thU vu cho phu nff tren 40 tuoi, tuven truyen ve each t y kham vu hang thing de phat hien va dieu tn ung thd vil tdt hdn.
T&khoa: ung thd vu, t y kham vu, phu nff, kham sang Igc.
SUMMARY
EVALUATING THE RESULTS OF CONSULTATION, SCREENING AND EARLY
DETECTION OF BREAST CANCER FOR WOMEN OVER 40 YEARS OLD I N HA NOI CITY AND NEIGHBORING PROVINCES, 2016
Objective: Evaluating the results of consultation, screening and early detection of breast cancer for women over 40 years old in Ha Noi city and neighboring provinces, 2016. Methods: a cross- sectional study of 768 more than 40 years of age in Ha Noi city and neighboring provinces women, who
VIETNAM MEDICAL JOURNAL H^1 - JUNE - 2017 wereconsulted, screened and detected earlv of breast
cancer in the Nuclear medicine and oncologycentsr, Bach l^ai hospital on 4 Saturdays from 22"" October to 12* November in 2016. Results: 85.4% of women aged 40-59 27.9% of women peform monthly breast self-examination. Through screening, 166 cases of breast abnormalities were detected (21.6%), in which 90 3% of women ages 40-59 years and 65.7% of women without menopausal. In the case of detecting breast abnormalities, only 34.3% of women perform monthly breast self-examination (57 cases);the most common injury through clinical examination is fibrositis {70 cases: 42.2%) and fibroids (59 cases:35.5%). 5 cases of breast cancer, accounting for 07% of total cases were found. Conclusion: The activities of breast cancer screening should be periodically organized for women over 40 years old, dissemination of monOily self breast exam to detect and freat breast cancer better.
Keyword: breast cancer, breast self- examimination, women, screening.
I. OAT VAN OE
Ung thy vii la loai ung thff pho bien thff hai tren the gidi chi sau ung thff phoi. Tuy nhien ung thff vil hoan toan co the chffa khdi neu dffdc phat hien sdm. Tai Viet Nam, theo ghi rihan ung thy nam 2010, t^ le mac ung thff vii chuan theo tuoi la 29,9/10^ va chu yeu gap Mia tuoi dydi 50 [2].
Phffdng phap tff kham vii hang thang sau saeh kinh hoac kham djnh ki vu 6 thang mot tan tai cae cd sd y te da dffdc khuyen khich thffc hien de phat hien ung thff vii d giai doan sdm va lam giam t / le tff vong do ung thff vu. Chup X quang tuyen vu va xet nghiem te bao hpc cung la cac phydng phap rat co gia tri trong chan doan, CO the phat hien sdm khoi u vii trffdc khi phat hien tren lam sang [3]. Dae jjiet doi vdi phu nff nguy ed eao mac benh: do tuoi ngoai 40, tien sff gia dinh cd ngffdi mac ung thff vii, day thi sdm, man kinh muon, tien sff sff dung thuoc tranh thai, ehieu xa vao viing ngffe...[1],[2],[6].
Viec kham sang loc dinh ki rat quan trong trong phat hien sdm eac tdn thffdng d vii. Cac khoi u vu lanh tfnh thffdng gap la u xd tuyen vu (ehiem 50%) va loan san lanh tinh tuyen vu (chiem 13%). Trong khi dd ton thffdng ac tfnh ung thff tuyen vu chiem khoang 10% trffdng hdp. Theo ket qua kham sang Ipc ung thff vu nam 2015 tren hdn 1.600 phu nff tren 40 tuoi tai Trung tam III. KET QUA
3 . 1 0 | c diem cua doi tu'dng nghien cu'u
Ung bffdu Benh vien Baeh l^ai, 17,7% tru'dng hdp cd bat thffdng viing vu, trong do chii yai nam trong dp tuoi tff 40- 59 tuoi. Trong QC trffdng hdp phat hien co u vu, thi 1,8% tn/cbig hdp la, ung t h d [ 3 ] ,
Do vay can eo them nhieu hoat dong tir van kham sang toe dinh ky cho cac doi tffdng nguy cd eao, dae biet la phu nff tren 40 tuoi, giiip i^at hien sdm eac bat thffdng vung vu. Tiep noi thanii cong ciia chffdng trinh kham sang loc ung thi/vii nam 2015, chung toi tiep tuc thffe hien kham sang tpc va tff van cho gan 800 phu nif tren dja ban Ha Noi va cac khu vffc tan can nam 2016 v^i muc tieu la phat hien sdm benh ung thy vd va cac bat thffdng tai vu.
II. €)dl TU'ONG VA PHU'ONG PHAP NGHIEN CUU 2.1 Ooi tu'dng nghien cihi: 768 phu n^>
40 tuoi tai thanh pho Ha Npi va cac tinh lan can, Tieu ehuan lffa chon bao gom: 1) Phu nif > 40 tuoi. 2) Dong y tham gia nghien cu'u.
2.2 Oja diem va thdi gian nghien cu'u:
Nghien cii'u dffde tien hanh tai trung tam Y hgc hat nhan va Ung bffdu Benh vien Baeh I^ai trong bdn ngay thff bay tff 22/10 den 12/11 nam 2016 2.3 Thiet ke nghien cu'u: mo ta eat ngang 2.4 Cong ciJ va phu'dng phap thu thap so lieu: Sff dung' bp cau hoi dddc thiet kg sin, phdng van tryc tiep doi tddng cac thong fn ca nhan, tien sff gia dinh va benh ^ t . Sau do, fen hanh kham lam sang tuyen vu, sieu am tuyen vu cho 100% doi tffdng tham gia va chup X-quang tuyen vii vdi nhii'ng trffdng hdp nghi ngd mac ung t h y vil.
2.5 Xu" ly va phan tich so lieu: So liei dyde thong ke bang phan mem EXCEL 2016 va phan tfch bang STATA 12.0.
2.6 €>?o du'c nghien cffu: Cac dot tifi?ng dyde eung cap thong tin cu the ve muc dicK mue tieu cua nghien cffu, quyen tdi khi tham gia va' quyen dong y hoac tff choi tham gia nghien CLrtJ. Thong tin cua dol tffdng nghien cuM du^c dam bao giff bf mat va chi diing eho muc dicli nghien effu.
Bang 1: Thong tin chung cua doi t&dng Dac diem Dja phffdng
Trinh dp van hda
Ha noi Cac tinh khae
Cap I Cap I I
n 505 263 24 175
1
___34i^—-
_ _ _ 2 2 i 8 _ J
TAP CHi Y HOC VIET NAM TAP 455 • THANG 6 - SO 1 - 2017
Nghe nghiep
Tinh trang hon nhan Tonq Nhan xet. Tronc
Cap I I I Trunq cap, cao danq Dai hoc, sau dai hoc Nonq, iam, nqu' nqhiep
Conq nhan Buon ban Sl/ nqhiep hanh chinh
Khac Khonq chonq Danq co chonq
Chonq chet Ly than, iy di
tong so 768 doi tu'dng tham gia i<ham sang 240 109 220 135 91 113 232 197 16 700 36 16 7 6 8 igc, cac doi tu'dng
31,3 14,2 28,6 17,6 11,9 14,7 30,2 25,6 2,1 91,2 4,7 2,0 1 0 0 chu yeu den tii He Npi (ehiem 65,8%), trinh dp van hda hpc het cap 3 (31,3%) va hien dang cd chong (ehiem 91,2%).
Bang 2: Tien s& berth tat cua ddi tu'dng nghien cihi
Tien su* benh t a t Ty le %
Tien sff ban than bi ung thff vii/ung t h d
buong trffng Khong 5,9
94,1
Tien sff co me hoac chj em gai bi ungthffvu Khong 726
5,2
94,8
Tong 768 100
Nhan xet: So Iffdng dol tffdng cd tien sff ban than cung nhff tien sff gia d n h mac ung thff vii tham gia kham sang ipc ft (5,9% va 5,2%).
Bang 3: Phan bo theo nhom tuoi Nhom tuoi
40-49 tudi 50-59 tuoi
> 60 tudi Tong
Nhcin xdt: Nhom tuoi tham gia r do la do tuoi tii 50-59 tuoi, chiem 38
n 361 295 112 7 6 8 hieu nhat ia tii 40 - 49 tuoi, 4 % vdi 295 doi tUdng tham
Ty le o/o 47,0 38,4 14,6 1 0 0
CO 361 phu nij' chiem 47,0%, tiep ia. Thap nliat ia nhom tuoi tren 60 tuoi, chi CO 112 ngffdi tham gia, chiem 14,6%.
3.2 Ket qua chu'dng trinh kham sang loc
Tu' khSm vu s'' Khong tgkham vu
Bieu do 1 : Ty le t i t kham vu d phu nu*
Nhan xet! Trong so nhffng phu nff tham gia kham sang Ipc, da so phu nff (ehiem 72,1%) khong CO y thffc tff kham vii hang thang. ^
Bang 4: Tv le phat hien bat thu'dng theo nhom tuoi
Bmh thu'dng _ Bat thu'dng
Nhdm tuoi TV le o/o TV le %
40-49 57,2
39,9 33,1
Tong I 6 0 2 , ^ , /VAJ/f xet: Trong 166 trffdng hdp phat hien nhffng ton thffdng bat thffdng d vii qua tham kham
lam sang, do tuoi hay gap nhat la tff 40 - 49 tuoi, ehiem 57,2%, dp tuoi it gap nhat la nhom tuoi tren
VIETNAM MEDICAL JOURNAL N°1 - JUNE - 2017 60 tuoi, chi phat hien CO 16 tru'dng hdp, Chiem 9,7%. _
Bang S: Ty le td kham vd trong nhom doi tu'dng phat hien bat thu'dng va khong phit
[""
TU icham vu Khdnq tu' kham vu
Tdng Nhan xet: Trong nhdm do
Binh thu'dng n
158 444 6 0 2 tu'dng phat hier
Ty le »/o 26,2 73,8 100
BatthtTdnq n 1 Tv le % 57 34,3 109 65,7 1 6 6 1 100 u vu qua l<ham iam sang, chi co 57 trtldng Iwp (chiem'34,3%) t u kham vii hang thang.
Bang 6: Tien s& ban than va gia dinh d nhom doi t&dng phat hien bat ffi&dng vi khdng
Dac diem Tien sii ban than bi ung thu' vu/ung
thi/ buonq trCmq Tien sii' CO me hoac chj em gai bi ung
thirvu Tong
Co Khonq
Co Khonq
Binh n 26 576 24 578 6 0 2
thu'dng Ty le o/o
4,3 95,7
4,0 96,0 100
Ba n 19 147 16 150 166
thu'dnq Ty ie »/o
11,5 88,5 9,6 90,4 100 Nhan xet Trong tong so phu nff kham thay u vu, nhffng doi typng ed tien sff ban than hoacfien sff gia'dinh (co me hoac chj em' gai) bi ung thff vu ehi ehiem ty le thap, lan Iffdt la 11,5% (19 doi tffdng) va 9,6% (16 doi tffdrig).
Bang 7: Ty IS bat bh&img phat hien qua kiiam lam sang
Ton thu'dng Ty le o/o
70
42,2U nang
16,3
Ung thffvu
3,0
Ton thffdng khae
Tong I 166 [^ 100
yvfta/; j r e f ; Trong nhffng ton thffdng phat hien qua kham lam sang, ton thffdng hay gap nhat la viem xd (chiem 42,2%) va u xd (chiem 35,5%). Co 5 trffdng hdp ung t h y vu, chiem 3,0%.Trong tong so phu nff tham gia kham sang loc, phat hien ra 5 trffdng hdp ung thff vii, chiem ty te 0,7% va ea 5 benh nhan nay deu du'dc phat hien sdm d giai doan I.
Bang 8: Phan bo ton th&dng tai vutheo tinh trang man kinh va chu^ man kinh Sac diem
Man i<inh Chu'a man kinh
Tong
n 57 109 166
Ty le Vc 34.3 65,7 100 Nhan xet. Thu'dng gap cac biEt thu'dng tai vu d
IV. BAN LU{lN
Nghien cull da kham sang loc cho 768 doi tu'dng vdi dp tuoi chu yeu la tiT 40 - 49 tuoi, chiem 47,0%, trong khi do do tuoi tren 60 chi chiem 14,6%. Boi tudng nghien cdu chu yeu den tii Ha Ngi (chiem 65,8%) va co trinh do van hoa kha cao: 31,3% doi tu'dng co trinh dp tiot nghiep cap ba va co den 42,5% ddi tifdng cd trinh dp cao dang, dai hpc trd ien.
Qua trinli kham sang loc da phat hien 166 trudng hdp cd ton thu'dng bat thu'dng 6 vii, dp tuoi hay gap^nhat la tu" 40 - 49 tuoi, chiem 57^2%, dp tuoi ft gap nhat la nhdm tuoi tren 60 tuoi, chi phat hien co 16 trudng hdp, chiem
nhuYig phu 01? chu^ man kinh (65,7%).
9,7%. Nghien cii'u ciia chung toi co sir khacbiet so vdi cac tac gia tren the gidi (u vii hay gap^
dp tuoi 15- 30). Dieu nay du'dc giai thicli ia ilo cliifdng trinh kham Sang Ipc Ung thu' vii chi l«a chpn nhuing doi tu'dng phu nif tren 40 tuoi -1>
cac benh nhan co nguy cd cao mac ung tliif vu.
Trong nhifng ton thutrng phat hien qua kiiam iam sang, viem xd hay gap nhat, cd 70 trifSng hdp, chiem 42,2%, tiep den la u xd cp 59 trittij hdp, chiem 35,5%. Ty ie nay cao hdn so vdi OT so nghien ciru khac, sif khac biet nay co tlie * nghien ciili ciia chiing tdi tap trung vao » tu'dng phu nif tren 40 tuSi, nen cac bat tliifffl phat hien much hdn va ty le bat thudng »u klH
TAP CHi Y HOC VIET NAM TAP 455 - THANG 6 • SO 1 - 2017 nhau d cac \iia tuoi khac nhau. Hdn nffa, viec sang
Ipc ung thff vu diidc chii trpng nhieu hdn d cac nffdc j)hat trien giiip tang kha nang phat hien sdm eae bat thydng viing vii ngay tff khi con tre.
Chffdng trinh sang Ipc ung thu" vu nam 2016 phat hien 166/768 trffdng hdp bat thddng, chiem ty te 21,6% thap hdn so vdi chffdng trinh Sang Ipe ung thff vii nam 2015 tai Benh vien Baeh Mai, ty le nay la 32,3% [ 3 ] . I^hu" vay, cd the thay ciing vdi cac chydng trinh hddng dan va kham sang Ipc khac, da cd cai thien dang ke hieu biet ciia phu nff ve viec tff kham vii thu'dng xuyen va dung caeh^ Nhd do phu nff cd the sdm tff phat hien cae ton thffdng viing vii. Tuy nhien ty le doi tffdng cd y thffc tff kham vu hang thang eon thap, ehi co 57 trydng hdp (chiem 34,3%) va co den 66,7 % doi typng kliong eo y thffc tff kham vu. Day chfnh la mpt trong nhffng ly do da phan ung thff vil d Viet Nam chi phat hien dyde d giai doan mupn.
Mpt trong nhffng nguyen nhan u xd tuyen vii dypc cho la cd lien quan den sy thay dot hormon sinh due. Ket qua nghien cirff cua chiing toi cho thay eac khoi u vii thffdng gap d nhffng phu nff ehffa man kinh, co 109/768 trydng hdp (chiem 14,2%), nhom bJoi da man kinh it gap hdn, chi CO 57 trffcfng hdp (chiem 7,4%). Trong tong so 166 trffdng hdp c6 bat thffdng, phat hien ra 5 trffdng hdp ung thff vii, chiem t^ le 3,0% va tinh tren tong so doi tu'dng nghien cffu, ty te ung thff vii la 0,7%. Ty le nay eao hdn so vdl nghien cffu cua Tran Van Thuan va cong sy" cho thay: Ha Npi CO b/ le mac ung thff vii ehuan theo tuoi d nff eao nhat 146/100.000, tiep do la TP.Ho Chi Minh 131,5/100.000 [ 4 ] . Su- khac biet nay la nhffng phy nff CO nguy cd cac da co y thffc tff di kham vLi trong chffdng trinh ciia chiing toi, con nghien cifu djch te cua tac gia Tran Van Thuan la tren so Iffdng toan dan. Cac trffdng hdp phat hien ung thff vu trong chffdng trinh sang Ipc nay deu d giai doan I. Day la giai doan sdm va co kha nang dieu tri khoi benh hoan toan.
Thong qua chffdng trinh tff van, kham sang Ipe va phat hien sdm ung thff vu, ehung toi da hffdng d i n each t y kham vu hang thang thydng xuyen va dung each eho cac dot tffdng. Tff dd nang cao nhan thffc va tuyen truyen phdng benh va phat hien sdm cac bat thffdng vung vii, dae biet la ung t h f f v u .
V. K ^ t L U A N
-85,4% phu nff trong dp tuoi tff 40- 59.
-553 phu nff khong ed y thffe tff kham vu hang thang chiem ty le 7 2 , 1 % , chi co 215 trydng hdp kham vu hang thang (chiem 27,9%).
-166/768 trddng hdp phat hien nhffng ton thydng bat thddng 6 vii (chiem 21,6%). Da so nhu^g trydng hdp bat thydng nam trong dp tuoi tff 40 ~ 59 tuoi, ehiem 90,3% va chffa man'kinh, chiem 65,7%.
-Trong eac tru'dng hdp phat hien cd trat thffdng tai vii chi cd 34,3% phu nff t y kham vu hang thang.
-Ton thffdng hay gap nhat qua kham lam sang la viem xd 70 tru'dng hdp (ehiem 42,2%) va u xd 59 trffdng hdp (ehiem 35,5%).
-Phat hien thay ^5 trydng hdp ung thff vu, chiem 0,7% trong tong so trffdng hdp tham gia kham sang tpc va 3% trong so cac trffdng hdp cd bat thffdng.
KIEN NGH!
Nen to chffc eac hoat donq kham sanq toe unq thy vil cho phu nff tronq do tudi sinh san, dac biet la nhffnq phu nff tren 40 tuoi va nhuYiq phu nff ed nquy ed cao. Lonq qhep vao dd la nhffnq buoi tuyen truyen ve sy can thiet va tac dunq ciia viec tff kham vu hanq thanq eho phu nff de phonq nqffa va phat hien sdm unq thffvu, nanq eao ty le cunq nhff chat lydnq tronq qua trinh phat hien va dieu tri ung thff vii, giam ganh nang cho gia dinh, xa hpi.
TAI UEU T H A M KHAO
1. Nguyen Ba Dffc, Tran Van Thuan, Nguyen Tuyet Mai (2010). Dieu tri ngi khoa tienh ung thd. Nha xuat ban Y hoc _ '
£. Nguyen Ba Dffc, Nguyen Chan Hiing, Huynh Quyet Than^ va cpn^ SLT (2004). Ket qua bddc dau nghien cuU dich te hoc mo ta mot so benh ung thd tai 6 vung dia ly Viet Nam giai doan 2001 - 2003. Tap chi Y hoc thyc hanh, (498), 27 - 31.
3. Mai Trong Khoa, Ph^m Cam Phu'dng, Nguyen Thi Hoa Mai va cs (2015). Danh gia kit qua td van, kham sang Igc va phat hien sdm ung thd vu d nd gidl tai thanh pho ha noi va cac tinh lan can nSm2015.
4. Tran Van Thuan, Biii Dieu, Nauven Ba Du'c, va conq su" (2012). Ganh nanq benh unq thd va chiin Iddc phonq chonq ung thd quoc gia den nSm 2020. Tap chi ung thu' hgc.
5. American Cancer Society (2015). Breast Cancer Facts & Figures 2015-2016. AHanta:
American Cancer Society.
6. DeSantis C, Ma J, Bryan L, Jemal A llQlH^Breast cancer statistics 2013, CA Cancer J Clin. 2014Jan-Feb;64(ll:52-62.
7. GLOBOCAN 2012, Estimmated cancer incidence mortality and prevalence worldwide in 2012, Intemational Agency for Research on Cancer.
