1. Lviv Women’s Wellness Center: Breast Health Promotion Services L.S. Gutsal Director

2. Operation Diagnosis Treatment Education Gynecological diseases Prenatal diagnosis Cervical pathology All obstetric, gynecological, and breast conditions Self-education KBLZhD medical personnel education program Patient education program

3. Educational program Breast self- examination Family planning Sexually transmitted diseases Partnership in birth giving Psychological preparation to birth giving Pathological climax Breast feeding

4. Director Ultra- sound 2 Technician 1 Cosme- tologist- derma- tologist 1 Radiologist 2 Obstetrician- gynecologist 6 Oncologist- mammologist 1 Psychotherapist 1 Perinatologist 1 Sexopatho- logist 1 Nurses 10 Information coordinator 1 Medical registrar 1 Subordinate medical personnel 6

5. Services Provided by the WWC 1. Specialist consultations: obstetrician-gynecologist oncogynecologist oncologist-mammologist sexopathologist dermatologist psychotherapist-psychologist 2. Breast screening and diagnostics

6. 3. Ductography 4. Pneumocystography 5. Needle location of nonpalpable tumors using mammograph 6. Breast ultrasound examination 7. Breast aspiration biopsy with ultrasound monitoring followed by cytological examination 8. Breast aspiration cysts with ultrasound monitoring Services Provided by the WWC

7. 9. Wide-bore needle biopsy with ultrasound monitoring followed by cytological examination 10. Needle location of nonpalpable tumors with ultrasound monitoring 11. Excision (surgical) biopsy of nonpalpable tumors preceded by needle location with ultrasound or mammograph monitoring 12. Cytological examination of nipple discharge and aspirated fluid; histological examination of wide- bore needle and aspiration biopsies Services Provided by the WWC

8. 13. Out patient services for pregnant women: complete set of laboratory tests Ultrasound examination alpha-fetoprotein perinatologist-geneticist consultation 14. Colposcopy, biopsy of cervical erosions, electrical coagulation of cervix, insertion and extraction of intrauterine devices, diagnostic abrasion of the cervical channel and uterine cavity, polypectomy, removal of condylomas, ambulatory treatment of gynecological diseases, hysterosalpingography, cytological examination of cervical channel discharge, and smear culturing Services Provided by the WWC

9. 15. Ultrasound examination: pregnant women gynecological patients abdominal organs and kidneys thyroid gland transvaginal examination of gynecological patients examination of children Services Provided by the WWC

10. 16. Sanitary education in all programs: breast self-examination partnership in birth giving prevention of sexually transmitted diseases prevention of osteoporosis family planning Services Provided by the WWC

11. Laboratory 1. Blood test 2. Urine test (qualitative) 3. Blood biochemistry in a Reflotron analyzer: bilirubin AST (aspartate aminotransferase) ALT (alanine aminotransferase) urea glucose

12. hemoglobin cholesterol HDL-cholesterol (high-density alpha-lipoproteins) К + 4. Gynecological smear cytological examination 5. Gynecological smear cultures Laboratory

13. 6. Puncture biopsy of breast tumors 7. Puncture biopsy of breast cysts (centrifuge preparation) 8. Nipple discharge 9. Spermogram Laboratory

14. Local out- patient clinic Railway Ministry healthcare facilities in Lvov Self-sustained Regional cancer clinic Health care facilities Medical registry Obstetrician- gynecologist Surgeon (oncologist- mammologist) Psychotherapist Ultrasound diagnostic techniques Mammography Laboratory tests

15. Cytological examination of cervical smears Vaginal smearsCytological examination of nipple discharge Cytology of breast cyst punctate Intraoperational rapid cytological examination Blood chemistry Urine tests in pregnant women

16. Ultrasound diagnostic suite Prenatal diagnosis Gynecological diseases Separate diagnosis of uterine and ectopic pregnancy Transvaginal examination Preparation of patients for IVF Breast ultrasound examination prior mammography CystNeoplasm Solid neoplasm Intracystal neoplasm Mammography Biopsy Puncture Cyst

17. Breast Screening Program Report for 1998, 1999, and 2000 (through August) I Total number of female patients examined, 2893 -screening, 1388 -diagnosis, 4505 II Mammography -total number of procedures, 4863 -needle location of nonpalpable tumors, 59 -ductography, 11

18. III Breast ultrasound examination, 1510 -cyst aspiration with ultrasound monitoring, 206 IV Biopsy -aspiration of solid formations, 227 -wide-bore needle biopsy for cytological examination, 49 -excision, 59 V Cytological examinations, 519 VI Histological examinations, 132 Breast Screening Program Report for 1998, 1999, and 2000 (through August)

19. Diagnoses VII Healthy, 1605 VIII Gynecomastia- 12 IX Mastopathy- 4130 -diffuse, 2848 -nodal, 1282: cystic, 368 fibrous, 384 cystic-fibrous, 530

20. X Breast cancer, 146: Stage I, 56 (preclinical form, 27) Stage II, 53 Stage III, 31 Stage IV, 6 Diagnoses

21. Breast Screening Program Report for 2000 I Total female patients examined, 27704 -railway employees, 21642 -screening, 615 -diagnosis, 3663 II Mammography -total number of procedures, -needle location of nonpalpable tumors, 14 -ductography, 6

22. III Breast ultrasound examination, 729 -cyst aspiration with ultrasound monitoring- 81 IV Biopsy -aspiration of solid formations, 108 -with wide-bore needle for histological examination, 14 -excision, 22 V Cytological examinations, 388 VI Histological examinations, 36 Breast Screening Program Report for 2000

23. Diagnoses VII Healthy, 731 VIII Gynecomastia, 2 IX Mastopathy- 4216 -diffuse, 2775 -nodal: cystic, 322 fibrous, 331 cystic-fibrous, 803

24. X Breast cancer, 72 Stage I, 44 (including 12 nonpalpable) Stage II, 41 Stage III, 24 Stage IV, 4 Diagnoses

25. Early breast cancer diagnosis allowed us to: 1. Cure cancer in situ 2. Increase life span of cancer patients in stages I and II 3. Improve the patients’ quality of life over the longer life span by using the most effective approach: organ-preserving surgery combined with chemotherapy and radiotherapy

26. 4. Alleviate psychosocial traumas caused by cancer to family members 5. Decrease treatment costs (government and private) Early breast cancer diagnosis allowed us to:

27. Breast Screening Program Report for 2000 Mammography- 4278 Diagnostics- 3663 Screening- 615

28. 1. Mastopathy Diffuse- 2775 (65,8%) Nodal- 1463 (34,7%) -cystic- 322 (22%) -fibrous- 331 (23%) -cystic-fibrous- 803 (53,4%)

29. 2. Breast Cancer- 72 (1,68%) stage I- 44 (61,1%) stage II- 41 (56,6%) stage III- 24 (33,3%) stage IV- 4 (5,5%)