Misbah Riaz, Muhammad Adnan Shakeel.
Compliance of surgeons to the triple assessment protocol in Khyber Pukhtunkhwa, Pakistan.
Pak J Surg Jan ;37(3):184-7.

Objective: To determine the frequency of breast cancer patients who are diagnosed on the basis of accession of biopsy of breast lump and the causes of why the triple assessment protocol is not being practiced in Khyber Pukhtunkhwa, one of the province of Pakistan. Material and Methods: This cross-sectional study was conducted from May 2019 to April 2020 in Surgical B Unit of MTI, Khyber Teaching Hospital, Peshawar. The study comprised of 263 consecutive female patients between the ages of 20-80 years belonging to different regions of Khyber Pukhtunkhwa who presented to the surgical out-patient department (OPD) with the diagnosis of breast cancer. Relevant data was entered into a structured proforma and analyzed using SPSS 22. Results: Mean age of the patients was 41.1+-15.4 years. A small portion of the population (20.9%, n=9) belonged to district Peshawar while the remaining (79.1%, n=34) belonged to cities outside Peshawar. A major portion of the population comprised of married women (79.1%) with a low literacy rate (62.8%). More patients (76.7%) consulted surgeons for initial checkup of breast lump yet, out of 263 patients, 43(16.34%) were diagnosed with breast cancer after having a surgical biopsy (lumpectomy) without prior evaluation by triple assessment. In more than two-thirds of cases (69.8%), patients were not informed about triple assessment protocol by the doctor concerned and hence not followed. Conclusion: Triple assessment is a mandatory tool in the diagnosis of breast cancer as it has a diagnostic accuracy of 99.9%. Surgeons in Pakistan must strictly adhere to this protocol while dealing with breast cancer patients.

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