April 2014 (blue mission)

1. Breast Cancer in Lebanon
Prepared and presented by Najla El Bizri, MD
Laboratory Medicine
April 25th, 2014. Saida Public Library, Saida Municipality.

2. INTRODUCTION

3. • Worldwide, breast cancer is the most frequently diagnosed life-
threatening cancer in women and the leading cause of cancer death
in women.
• In the US breast cancer accounts for 29% of all cancers in women and
is second only to lung cancer as a cause of cancer deaths.
• 1/8 women with Breast cancer are < 45y
• 2/3 women with Breast cancer are > 55y

4. Uptodate 20.3

5. What about Breast cancer in
Lebanon?
• Breast cancer was the most frequent malignancy in females in
Lebanon (Over one third of all female cancers).
• Same rates observed in all earlier hospital-based studies in the
country. Azar HA. Cancer in Lebanon and the near east. Cancer January-February 1962;15:66-74. Ghosn M et al.
The cancer registry at the Hotel Dieu de France Hospital. Leb Med J 1992;40:4-10. El-Saghir NS et al. Cancer in
Lebanon: analysis of 10220 cases from the American University of Beirut Medical Center. Leb Med J 1998;46:4-10.
• ASR (38.9 per 100,000, 1998).
• Lower than that observed for the US (90.7), UK (68.8), France (78.8) or
Occupied Territories (77.4)
• Much higher than other developing countries of the region such as Algeria.

6. 5.8 5.2
2.2 1.8
16
4.5
0.7
42.3
17.6
15.2
3.5
5 4.1 3.2
2 1.4 0.9 0.4 0.2
0
5
10
15
20
25
30
35
40
45
Colon Rectum Lung Breast Prostate NHL L LeukemiaBladder M Leukemia Other leukemia
Males
Females
RELATIVE FREQUENCY OF CANCER SITES BY GENDER
7.1 6.4
1.5 1.4
15.7
5.9
0.9
38.2
15.4 15.6
3
7.6
5.9
2.5 1.6 1.8 1.1 0.2 0.2
0
5
10
15
20
25
30
35
40
C
olon
R
ectum
Lung
B
reast
Prostate
B
ladder
N
H
L
L
Leukem
ia
M
Leukem
ia
herLeukem
ia
2003
2004
Colon Rectum Lung
Breast Prostate NHL L LeukemiaBladder M Leukemia Other leukemia
38.2

7. PRIMARY SITES N
AGE-SPECIFIC RATES PER 100,000 CRUDE
RATES
ASR
UN 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+
Oro-pharynx 46 2 0.59 1.44 0.63 3.52 1.96 7.59 9.93 16.55 2.54 2.59
Stomach 88 10 0.00 0.58 0.94 6.17 9.82 14.41 23.17 38.62 4.85 5.13
Colon-rectum 151 24 0.20 0.86 2.51 7.93 25.52 39.44 81.65 154.4 8.32 14.65
Liver 26 4 0.00 0.00 0.44 2.62 2.82 14.34 13.79 1.43 1.43 1.53
Pancreas 50 0 0.00 0.31 0.00 5.24 6.07 24.27 30.34 2.76 2.76 2.93
Lung & bronchus 224 13 0.00 0.63 7.49 19.63 49.30 70.62 121.37 12.34 13.35 13.17
Bone 32 2 1.73 0.00 0.44 3.93 1.52 2.21 0.00 1.76 1.76 1.92
Skin melanoma 26 6 0.00 0.63 1.76 5.24 2.28 6.62 8.28 1.43 1.43 1.55
Breast 1302 137 0.58 17.26 134.82 244.09 203.28 221.78 262.05 71.74 71.76 78.26
Cervix uteri 81 4 0.29 0.31 4.41 16.36 13.69 24.27 11.03 4.46 4.46 4.95
Corpus uteri 88 10 0.29 0.63 3.08 14.40 16.69 25.38 30.34 4.85 4.85 5.30
Ovary 16 8 0.00 0.00 0.00 5.89 3.79 2.21 0.00 0.88 0.88 1.06
Kidney 38 7 0.29 0.31 2.20 2.62 4,55 11.03 8.28 2.09 2.09 2.21
Bladder 106 21 0.00 0.31 2.20 10.47 21.24 33.10 71.71 5.84 5.84 6.25
CANCER INCIDENCE RATES AMONG FEMALES IN LEBANON 2003

8. PRIMARY SITES N
AGE-SPECIFIC RATES PER 100,000 CRUDE
RATES
ASR
UN 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+
Oro-pharynx 31 5 0.5 0.5 0.3 2.0 2.4 1.4 0.5 1.0 1.6 1.55
Stomach 134 30 0.5 0.3 0.6 4.8 9.0 13.9 3.2 5.1 6.7 6.70
Colon-rectum 283 65 0.4 0.0 1.7 1.0 23.4 34.2 5.2 14.0 14.2 14.2
Liver 42 10 0.0 0.3 0.0 1.6 3.6 3.5 0.9 1.8 2.1 2.10
Pancreas 57 8 0.0 0.0 0.0 2.4 4.2 7.7 1.5 2.5 2.9 2.85
Lung & bronchus 215 38 0.2 0.0 0.6 3.6 22.2 34.2 5.5 6.4 10.8 10.75
Bone 39 6 1.8 1.6 1.7 2.4 1.2 0.7 0.3 0.5 2.0 1.95
Skin melanoma 23 3 0.0 0.0 0.0 2.4 1.2 2.1 0.6 0.8 1.2 1.15
Breast 1383 267 0.2 1.3 11.1 96.9 194.2 183.3 16.9 19.3 69.5 69.15
Cervix uteri 94 20 0.0 0.0 0.9 6.0 11.4 12.5 1.3 1.5 4.7 4.70
Corpus uteri 125 29 0.0 0.0 0.0 3.6 18.0 20.2 1.7 2.8 6.3 6.25
Ovary 166 35 0.3 1.0 1.6 8.2 23.4 14.6 3.1 3.1 8.3 8.30
Kidney 37 6 0.9 0.3 0.6 0.4 3.6 3.5 0.6 1.3 1.9 1.85
Bladder 110 37 0.4 0.5 0.3 1.2 6.6 12.5 1.6 5.1 5.5 5.50
CANCER INCIDENCE RATES AMONG FEMALES IN LEBANON 2004

9. • Screening programs are widely adopted by most academic and
health centers
• Changes in certain reproductive factors:
• Mean age at marriage of women has increased from 23.2 years in 1970 to
27.5 in 1996
• Total fertility rate has steadily declined from 4.4 to 2.5
United Nations. Health and reproduction. In: The female and male in Lebanon: a statistical
profile. The Lebanese Republic, 2000 pp.57-65
Why Breast Cancer has increased
in Lebanon?

10. Hospitalized Cases of Malignant Neoplasms
of the Breast by Age, 2010-2011.

11. Hospitalized Cases of Malignant Neoplasms
of the Breast by Age, 2010-2011.
• Breast Cancer is spread over all age groups with a peak of cases in
the age group 45-50. There were 1742 breast cancer female patients
admitted 7088 times either for surgery or chemotherapy.
• There was an increase in the number of cases between 2011 and
2010, which could be due to increased awareness and hence early
diagnosis. The shift in peak cases to older age groups deserves further
investigation.

12. Percent Breast Ca out of total Female Neoplasms
by Qadaa, 2011

13. Percent Breast Ca out of total Female
Neoplasms by Qadaa, 2011
• 40.9% of those are Breast cancer cases with a proportion ranging from as
low as 30.6% in Baalback to as high as 54.6% in Matn.
• Comparing with last year’s percents, the lowest percent ever recorded then
was for Baalback (22.9%).
• Taking a quick look at the comparison between the two years 2009 and
2010, there are district with a significant increase in percent of Breast Ca
out of total female neoplasms (Aley,Baalback, Batroun, Beirut, West Bekaa,
Bint Jbeil, Hermel, Kesserwan, Zahleh, and Marjeyoun), while Koura
experienced a significant drop in that percent, with a National increase by
2.6%.

14. • The age pattern at diagnosis is typical of that in low-risk countries
• Increase in the rate up to the 5th decade, around menopause, and a
decrease thereafter. Rodriguez-Cuevas Et al. Breast carcinoma presents a decade earlier in Mexican women
than in women in the United States or European countries. Cancer 2001;91:863-868
• Median age at diagnosis was 52 years (range 22-92).
• Around 43% of cases presenting before the age 50 compared to median
age of 63 years for developed countries such as the US.
Bosch X. Early development of breast cancer in Mexican women. The Lancet Oncology 2001;2:194
What about Breast cancer in
Lebanon?

15. Breast Cancer incidence in Lebanon,
by ICD-O.

16. RISK FACTORS

17. • The presence of breast cancer risk factors does not mean
that cancer is inevitable: many women with risk factors
never develop breast cancer.
• Instead, risk factors help to identify women who may benefit
most from screening or other preventive measures.

18. • It is important to remember that breast cancer can also
occur in women who have no identifiable risk factors.
• The average woman has about a 10 to 15 percent chance of
developing breast cancer if she lives into her 90s.
• On the other hand, the risk of developing breast cancer in a
woman with a strong family history of the disease who has
inherited one of the genes that predispose her to breast
cancer is over 50 percent.

19. STRONG RISK
FACTORS
MODERATE RISK
FACTORS
OTHER RISK
FACTORS

20. STRONG RISK FACTORS
• Increasing age
Overall, 85 percent of cases occur in women 50 years of age and older,
While only 5 percent of breast cancers develop in women younger than age 40.
• Family history
Women who have a family history of breast or ovarian cancer are at a higher risk for breast
cancer.
Women who have an especially strong family history (eg, two or more first-degree relatives
[a mother, daughter, or sister] with breast or ovarian cancer, particularly before menopause)
have a greater than 50 percent chance of developing breast cancer.
This represents an approximately five- to 10-fold increase in a woman's baseline risk of
developing breast cancer.
• Inherited genetic mutation in one of two genes, called BRCA1 and BRCA2.
• Previous breast cancer
Women who have had cancer in one breast have an increased risk of developing cancer in the
other breast (x3-4 times). This is especially true if a woman has an inherited BRCA mutation.

21. • 20-30% of women with breast cancer have at least one relative with a
history of breast cancer.
• However, only 5-10% of women with breast cancer have a hereditary
predisposition .
• Having 1 first-degree relative: multiplies risk by 2
• Having 2 first-degree relatives: multiplies risk by 5.

22. • BRCA1 and BRCA2 mutations: responsible for 3-8% of all cases of
breast cancer, and 15-20% of familial cases.
• BRCA1: x 55-65% increased risk in both breasts.
• BRCA2: x45% increased risk in both breasts.

23. MODERATE RISK FACTORS
• Density of the breasts on mammogram
Women whose mammograms show many dense areas of tissue have an
increased risk.
• Biopsy abnormalities
Women who have had a prior breast biopsy that revealed a proliferative
abnormality (excessive growth of the glandular breast tissue, also called
hyperplasia) have an increased risk for breast cancer.
• Exposure to radiation
Women who have undergone high-dose radiation therapy to the chest region,
usually as part of cancer treatment, have an increased risk for breast cancer.

24. OTHER RISK FACTORS
• Age at time of reproductive events
The longer a woman is exposed to estrogen, the greater her risk for breast cancer.
Estrogen exposure is increased if a woman began menstruating at or before 11 years of
age, or if she experiences menopause at age 55 years or older.
• Pregnancy and breastfeeding
 Women who have never given birth are more likely to develop breast cancer after
menopause than women who have given birth multiple times.
The timing of a first pregnancy also appears to play a role.
• Hormone replacement therapy (HRT)
 As a woman ages, the breast's glandular tissue, the tissue in which breast cancer arises,
is gradually replaced by fat. HRT includes estrogen, which slows or reverses this process.

25. • Weight
 Obese women are more likely than thin women to develop breast cancer
after menopause.
• Alcohol
 Women who drink alcohol have an increased risk of breast cancer, perhaps
due to elevated levels of estrogen in the body.
• Presence of other cancers
 Women who have been diagnosed with cancer of the endometrium, ovary,
or colon are more likely to develop breast cancer than women who do not
have these cancers.

26. SYMPTOMS

28. BREAST LUMP
• You or your healthcare provider may find a breast lump by looking at or feeling
your breast.
• It is difficult to determine by examination alone if a lump is caused by breast
cancer.
• All new breast lumps should be evaluated by a healthcare provider to determine
if further testing is needed.

29. Women age 30 and older:
• Women who are age 30 or older who find a new breast lump will
need a diagnostic mammogram, and usually an ultrasound, as well.
• If the lump appears suspicious on the mammogram and/or the
ultrasound, a breast biopsy is usually recommended.

30. Women under age 30:
• If you are under 30 years and you find a lump before your menstrual period, you
may be advised to have a repeat breast examination after your period has
ended.
• In this age group, breast lumps are often caused by hormonal changes and will
resolve after your menstrual cycle.
• If the lump does not go away when your period is over, you will likely need
further testing with a breast ultrasound or needle aspiration biopsy to
determine whether the lump is fluid filled or solid.
• Mammograms are not usually performed in women under 30 years old,
although a mammogram may be needed if the ultrasound does not provide
enough information.

31. CYST
• Ultrasound of the breast
may be recommended to
determine whether a lump is
fluid filled or solid.
• Fluid-filled cysts are not
usually caused by cancer.
Treatment for a fluid-filled cyst,
if necessary, usually includes
draining the fluid with a needle.

32. • Ultrasound of the breast
may be recommended to
determine whether a lump is
fluid filled or solid.
Women with a solid or
"complex" (fluid and solid)
breast nodule are usually
advised to have a biopsy.

33. TAKE-HOME MESSAGE

34. BREAST CANCER SCREENING
RECOMMENDATIONS

35. • Breast cancer screening includes tests to detect breast cancer at an
early stage, before a woman discovers a lump.
• The chance of dying from breast cancer has declined by about a 1/3
over the past few decades. This is due, in part, to the use of breast
cancer screening to find cancer at an earlier stage.

36. BREAST CANCER SCREENING METHODS
• There are 3 main ways to screen for breast cancer:
Breast self-
exam
Breast exam
with your
doctor or nurse
Mammogram

37. Breast exam by your doctor or nurse:
Clinical Breast Exam (CBE).
• Your doctor or nurse might
perform a breast exam on a
regular basis as part of breast
cancer screening.
• During the exam, the doctor or
nurse will look at the breasts
and then carefully feel
• Both breasts
• And the area under both arms.

38. • The ACS recommends that women
in their 20s and 30s should have a
clinical breast exam (CBE) every 3
years.
• Starting at age 40, women should
have a CBE every year.

39. Breast Self-Exam (BSE).
• Breast self-exam (BSE) is an option for women starting in their 20s.
• It’s a way of finding changes in your own breasts.
• The best time to perform breast self-exam is about one week after
your menstrual period ends, when the breasts are least lumpy.
• If you do not have menstrual periods, you can pick one day each
month.

44. Mammogram
• A mammogram is a breast x-ray.
• Each breast is X-rayed individually.
The breast is flattened between two
panels.
• If possible, try to avoid scheduling
your mammogram just before or
during your menstrual period, when
the breasts are more sensitive.

45. When to start mammograms?
• The American Cancer Society recommends beginning
mammograms at age 40.

46. How often to have a mammogram?
• Women who choose to have breast cancer screening
beginning at age 40 are usually screened once per year until
age 50.
• After age 50, most expert groups recommend breast cancer
screening every 1 to 2 years, depending on the woman's
individual risk of breast cancer.

47. When to stop mammograms?
• Most expert groups recommend that women continue to get
routine mammograms and clinical breast exams as long as
the woman is expected to live at least 10 years.

48. Mammogram results
A radiologist will review and
interpret the mammogram.
Can detect lesions
• as small as
100 um
• 1-2 y before
being noticed
by BSE

49. What if my mammogram is abnormal?
• If your mammogram is abnormal, you will need further testing.
• In 90 percent of cases, breast cancer is not found.

50. Breast MRI
• Magnetic resonance imaging (MRI) uses a
strong magnet rather than X-rays to create a
detailed image. It requires injection of a
contrast agent into a vein.
• It is not as good as a mammogram for
certain breast conditions, such as ductal
carcinoma in situ (a type of noninvasive or
early breast cancer). In addition MRI testing
is more likely to identify suspicious findings
that turn out not to be cancer.
• Breast MRI may be recommended, in
addition to mammography, to help find
breast cancer in young women (particularly
those with dense breasts) with a high risk
for developing breast cancer (such as those
with a very strong family history or a breast
cancer gene).

51. Breast biopsy
• If breast cancer is suspected, the
next step is to sample the
abnormal area with a core needle
biopsy to confirm the diagnosis.
• If possible, the technique should
be performed using x-ray
guidance, with mammography,
ultrasound, or MRI.
• It is performed with local
anesthesia and do not require
sedation.

52. What is a breast biopsy?
• Doctors use different methods to
do breast biopsies.
• They can:
1. Use a large needle to take 1
or more small samples of
tissue from the breast
(Fine needle biopsy).
2. Use a needle with a special
tip and special imaging
equipment to do a Core
needle biopsy.
3. Do an operation to take out
part or all of the abnormal
tissue (surgical biopsy).

54. What happens after a breast biopsy?
• After a biopsy, you might have bruising, bleeding, or get an infection.
These problems are less common with fine or core needle biopsy than
after a surgical biopsy.
• You will likely get the results of your biopsy in about a week.

55. Benign?
Premalignant?
Malignant?

56. Benign

57. Malignant

58. In situ cancers
Invasive cancers
Types of Breast Cancer

60. In situ breast cancer
• The earliest breast cancers are called "in situ"
cancers.
• Ductal carcinoma in situ (DCIS)
• If cancers arise in the ducts of the breast
(the tubes that carry milk to the nipple
when a woman is breastfeeding) and do
not grow outside of the ducts, the tumor is
called ductal carcinoma in situ .
• However DCIS may develop into invasive
cancers if not treated.
• If abnormal cells arise in the lobules of
the breast (where breast milk is made),
and they do not extend outside of the
breast lobule, this are referred to as
lobular carcinoma in situ (LCIS).
• LCIS is not considered a true cancer but
instead is considered a risk factor for
developing cancer in the future in either
breast.

61. Invasive breast cancer
• The majority of breast cancers are referred to as invasive breast
cancers because they have grown or "invaded" beyond the ducts or
lobules of the breast into the surrounding tissue.
• Several varieties of invasive breast cancers are possible (eg, ductal,
lobular, medullary, tubular, metaplastic).
• In general, they are all treated similarly.

62. HAS THE BREAST CANCER SPREAD?
• Once a diagnosis of breast cancer is established, the next important
questions to be answered are the following:
• How extensive is the cancer involvement within the breast?
• Is there evidence that the tumor has spread outside of the breast?

63. Metatstatic breast cancer
• When tumors spread to areas outside the breast through the blood
and lymph vessels, they are called "metastatic cancers."

64. The importance of the axillary lymph nodes
• One of the first sites of breast cancer
spread is to the lymph nodes located
in the armpit (axilla).
• These nodes (referred to as axillary
lymph nodes) can become enlarged
and can sometimes be felt during a
breast examination.
• The presence or absence of lymph
node involvement is one of the most
important factors in determining the
long-term outcome of the cancer
(prognosis), and it often guides
decisions about treatment.

65. PREVENTION

66. Lifestyle changes
• Minimize the use of postmenopausal hormones.
Consider non-estrogen alternatives (eg,
bisphosphonates for treatment of osteoporosis rather
than hormones)
• Although this may not necessarily be a lifestyle choice,
having a first child at an earlier age may decrease risk.
• Breast feeding for at least 12 months can decrease
breast cancer risk.
• Avoiding adult weight gain and maintaining a healthy
weight may reduce postmenopausal breast cancer risk.
HOW TO PREVENT BREAST CANCER?

67. HOW TO PREVENT BREAST CANCER?
• Bilateral mastectomy is effective in preventing new breast cancers but is
not an accepted strategy for most women except for the few with very
high genetic risk.
• Removal of the ovaries is not recommended for breast cancer prevention
in most women, except for those with BRCA1 or BRCA2 gene mutation.
• Medications: Women who are already at higher than average risk can
significantly lower their risk of developing breast cancer by taking
tamoxifen, raloxifene, or an aromatase inhibitor, such as exemestane, for
five years.

69. TREATMENT

70. • Surgery is considered primary treatment for early-stage breast cancer;
many patients are cured with surgery alone.
• The goals of breast cancer surgery include complete resection of the
primary tumor with negative margins to reduce the risk of local
recurrences and pathologic staging of the tumor and axillary lymph nodes
(ALNs) to provide necessary prognostic information.

71. • Adjuvant treatment of breast cancer is designed to treat
micrometastatic disease.
• Adjuvant treatment for breast cancer involves radiation therapy and
systemic therapy (including a variety of chemotherapeutic, hormonal
and biologic agents).

72. Choice of treatment
• At the time breast cancer is diagnosed and/or treated, the cancer
should be studied for the presence of two types of proteins:
 Hormone receptors (estrogen and progesterone receptors)
 HER2.

73. Hormone receptors (estrogen and
progesterone receptors)
• More than one-half of breast cancers require the female hormone
estrogen to grow, while other breast cancers are able to grow without
estrogen.
• If hormone receptors are present within a woman’s breast cancer,
she is likely to benefit from treatments that lower estrogen levels or
block the actions of estrogen. These treatments are referred to as
endocrine or hormone therapies.
• In contrast, women whose tumors do not contain any ER or PR do
not benefit from endocrine therapy, and it is not recommended.

74. HER2
• HER2 is a protein that is present in about 1out of every 5 breast
cancers.
• The presence of HER2 in the breast cancer identifies women who
might benefit from treatments directed against the HER2 protein.
• Drugs that target the HER2 protein include trastuzumab (Herceptin)
and lapatinib (Tykerb®).

75. RECONSTRUCTIVE BREAST
SURGERY

77. BREAST CANCER SURVIVORSHIP

78. • 5 year survical in localized breast cancer: 80%

79. Frequently asked questions:
• Do deodorants and perspirants cause breast cancer? No
• Does drinking warm bottled water causes breast cancer? No
• Does injury to the breast causes breast cancer? No
• Does smoking increases the risk of breast cancer? Yes (proven in
2012).
• Can women having silicone breast implants still do mammograms?
Yes.
• Women who are breastfeeding can still have mammograms? Yes, but
the result will be less accurate (more dense tissue).

80. Where to get more information?
• National Cancer Institute
(www.cancer.gov/cancertopics/pdq/screening/breast/Patient)
• National Library of Medicine
(www.nlm.nih.gov/medlineplus/mammography.html)
• People Living With Cancer: The official patient information website of the American Society of Clinical
Oncology
(www.cancer.net/portal/site/patient)
• National Comprehensive Cancer Network
(www.nccn.com)
• American Cancer Society
(www.cancer.org)
• Susan G. Komen Breast Cancer Foundation
(www.komen.org)

84. ‫المعتمدة‬ ‫المراكز‬ ‫الئحة‬‫في‬‫بيروت‬
‫خاصة‬ ‫مستشفيات‬
‫الوردية‬ ‫راهبات‬ ‫حداد‬ ‫مستشفى‬
‫الجعيتاوي‬ ‫اللبناني‬ ‫مستشفى‬
‫جاورجيوس‬ ‫القديس‬ ‫مستشفى‬
‫بيروت‬ ‫مستشفى‬
‫والطفل‬ ‫باألم‬ ‫العناية‬ ‫مستشفى‬
‫خوري‬ ‫فؤاد‬ ‫مستشفى‬
‫األعظم‬ ‫الرسول‬ ‫مستشفى‬
‫الساحل‬ ‫مستشفى‬
‫الطبي‬ ‫والمركز‬ ‫طراد‬ ‫مستشفى‬(‫السبت‬ ‫يوم‬ ‫فقط‬ )
‫البرج‬ ‫مستشفى‬
‫الزهراء‬ ‫مستشفى‬
‫مستشفيات‬‫حكومية‬
‫الكرنتينا‬ ‫مستشفى‬
‫الجامعي‬ ‫الحريري‬ ‫رفيق‬ ‫مستشفى‬
‫خاصة‬ ‫طبية‬ ‫مراكز‬
‫الطبي‬ ‫مارك‬ ‫السان‬ ‫مركز‬
‫المتحدة‬ ‫الطبية‬ ‫المجموعة‬
‫لألشعة‬ ‫األطباء‬ ‫مركز‬
‫مخزومي‬ ‫مؤسسة‬
‫لألشعة‬ ‫الياس‬ ‫مار‬ ‫مركز‬
‫الطبي‬ ‫الظريف‬ ‫مركز‬
‫الدولية‬ ‫الطبية‬ ‫المراكز‬ ‫فرع‬ ‫األشرفية‬
‫الدولية‬ ‫الطبية‬ ‫المراكز‬ ‫فرع‬ ‫الطيونة‬
‫الكندي‬ ‫اللبناني‬ ‫المركز‬
‫اللبناني‬ ‫االحمر‬ ‫الصليب‬
‫كاريتاس‬ ‫مركز‬
‫المصيطبة‬ ‫األحمر‬ ‫الصليب‬ ‫مركز‬
‫الطبية‬ ‫التحاليل‬ ‫المركز‬
‫الصحي‬ ‫الحوراء‬ ‫دار‬ ‫مركز‬ ‫اإلسالمية‬ ‫الصحية‬ ‫الهيئة‬
‫الصحي‬ ‫الجديدة‬ ‫طريق‬ ‫مركز‬ ‫الطبية‬ ‫الحريري‬ ‫مؤسسة‬
‫اإلجتماعي‬
‫الدورة‬ ‫الشعاعي‬ ‫للتصوير‬ ‫الطبي‬ ‫المركز‬

85. ‫المعتمدة‬ ‫المراكز‬ ‫الئحة‬‫في‬‫المتن‬
‫خاصة‬ ‫مستشفيات‬
‫يوسف‬ ‫مار‬ ‫مستشفى‬
‫جودة‬ ‫أبو‬ ‫مستشفى‬
‫الصحي‬ ‫األوسط‬ ‫الشرق‬ ‫مركز‬ ‫مستشفى‬
‫بحنس‬ ‫مستشفى‬
‫هارون‬ ‫مستشفى‬
‫خاصة‬ ‫طبية‬ ‫مراكز‬
‫الطبي‬ ‫جورج‬ ‫سان‬ ‫مختبر‬
‫الطبي‬ ‫مارك‬ ‫السان‬ ‫مركز‬
‫لبنان‬ ‫في‬ ‫األمهات‬ ‫لجنة‬/‫عاليه‬
‫بعبدا‬ ‫الشعاعي‬ ‫للتصوير‬ ‫الطبي‬ ‫المركز‬
‫الصحي‬ ‫حمانا‬ ‫مركز‬

86. ‫المعتمدة‬ ‫المراكز‬ ‫الئحة‬‫في‬‫لبنان‬ ‫جبل‬
‫مستشفيات‬‫حكومية‬
‫بعبدا‬ ‫مستشفى‬ ‫الحكومي‬
‫كسروان‬ ‫فتوح‬ ‫البوار‬ ‫مستشفى‬ ‫الحكومي‬
‫خاصة‬ ‫مستشفيات‬
‫الحياة‬ ‫مستشفى‬
‫شارل‬ ‫سان‬ ‫مستشفى‬
‫بهمن‬ ‫مستشفى‬
‫المشرق‬ ‫مستشفى‬

87. ‫المعتمدة‬ ‫المراكز‬ ‫الئحة‬‫في‬‫وجبيل‬ ‫كسروان‬
‫خاصة‬ ‫مستشفيات‬
‫لبنان‬ ‫سيدة‬ ‫مستشفى‬
‫مارتين‬ ‫سيدة‬ ‫مستشفى‬
‫المعونات‬ ‫سيدة‬ ‫مستشفى‬
‫جورج‬ ‫سان‬ ‫مستشفى‬
‫لويس‬ ‫سان‬ ‫مستشفى‬
‫خاصة‬ ‫طبية‬ ‫مراكز‬
‫للتصوير‬ ‫جونيه‬ ‫مركز‬ ‫الرادار‬ ‫وتشخيص‬ ‫األشعة‬ ‫على‬
‫تريز‬ ‫سانت‬ ‫سنتر‬
‫الطبي‬ ‫فيفدال‬ ‫مختبر‬
‫الدولية‬ ‫الطبية‬ ‫المراكز‬ ‫فرع‬ ‫الذوق‬

88. ‫المعتمدة‬ ‫المراكز‬ ‫الئحة‬‫في‬‫الشمال‬
‫مستشفيات‬‫حكومية‬
‫طرابلس‬ ‫مستشفى‬ ‫الحكومي‬
‫الحكومي‬ ‫الضنية‬ ‫سير‬ ‫مستشفى‬
‫بشري‬ ‫مستشفى‬ ‫الحكومي‬
‫تنورين‬ ‫مستشفى‬ ‫الحكومي‬
‫الحكومي‬ ‫إهدن‬ ‫مستشفى‬
‫الحكومي‬ ‫حلبا‬ ‫الراسي‬ ‫هللا‬ ‫عبد‬ ‫الدكتور‬ ‫مستشفى‬
‫خاصة‬ ‫مستشفيات‬
‫عكار‬ ‫مستشفى‬-‫رحال‬
‫البرجي‬ ‫مستشفى‬
‫هيكل‬ ‫البير‬ ‫مستشفى‬
‫الخيري‬ ‫االسالمي‬ ‫مستشفى‬
‫المظلوم‬ ‫مستشفى‬
‫المنال‬ ‫مستشفى‬
‫النيني‬ ‫مستشفى‬
‫الكورة‬ ‫مستشفى‬
‫االستشفائي‬ ‫الشمال‬ ‫مركز‬ ‫مستشفى‬
‫الطبي‬ ‫اليوسف‬ ‫مركز‬ ‫مستشفى‬
‫الخيري‬ ‫الحنان‬ ‫مستشفى‬
‫الخير‬ ‫مستشفى‬
‫شاهين‬ ‫مستشفى‬
‫االنطونيات‬ ‫الراهبات‬ ‫السالم‬ ‫سيدة‬ ‫مستشفى‬
‫خاصة‬ ‫طبية‬ ‫مراكز‬
‫الطبي‬ ‫الشعاعي‬ ‫التصوير‬ ‫مركز‬
‫الصحي‬ ‫طرابلس‬ ‫مركز‬ ‫الطبية‬ ‫الحريري‬ ‫مؤسسة‬
‫اإلجتماعي‬
‫مركز‬ ‫لألشعة‬ ‫الجسر‬ ‫محمد‬

89. ‫المعتمدة‬ ‫المراكز‬ ‫الئحة‬‫في‬‫الشوف‬
‫خاصة‬ ‫مستشفيات‬
‫وزين‬ ‫عين‬ ‫مستشفى‬
‫الطبي‬ ‫بعقلين‬ ‫مركز‬ ‫مستشفى‬
‫خاصة‬ ‫طبية‬ ‫مراكز‬
‫الشعاعي‬ ‫والتصوير‬ ‫الطبية‬ ‫للتحاليل‬ ‫خالدة‬ ‫مركز‬
‫الصحي‬ ‫عرمون‬ ‫مركز‬ ‫الطبية‬ ‫الحريري‬ ‫مؤسسة‬
‫اإلجتماعي‬
‫عثمان‬ ‫مستشفى‬
‫مركز‬ ‫الطبي‬ ‫التشخيصي‬

90. ‫المعتمدة‬ ‫المراكز‬ ‫الئحة‬‫في‬‫الجنوب‬
‫مستشفيات‬‫حكومية‬
‫صور‬ ‫مستشفى‬ ‫الحكومي‬
‫مرجعيون‬ ‫مستشفى‬ ‫الحكومي‬
‫النبطية‬ ‫مستشفى‬ ‫الحكومي‬
‫صيدا‬ ‫مستشفى‬ ‫الحكومي‬
‫الحكومي‬ ‫الجبل‬ ‫ميس‬ ‫مستشفى‬
‫الحكومي‬ ‫حاصبيا‬ ‫مسشتفى‬
‫الحكومي‬ ‫سبلين‬ ‫مستشفى‬
‫خاصة‬ ‫مستشفيات‬
‫الدين‬ ‫عالء‬ ‫مستشفى‬
‫دالعة‬ ‫مستشفى‬
‫غندور‬ ‫مستشفى‬
‫حمود‬ ‫مستشفى‬
‫عامل‬ ‫جبل‬ ‫مستشفى‬
‫الجنوب‬ ‫مستشفى‬-‫شعيب‬
‫جبيلي‬ ‫مستشفى‬
‫الطبي‬ ‫لبيب‬ ‫مركز‬ ‫مستشفى‬
‫مستشفى‬ ‫اإليطالي‬ ‫اللبناني‬ (‫)نجم‬
‫حيرام‬ ‫مستشفى‬
‫جبيل‬ ‫بنت‬ ‫مستشفى‬(‫اإلسالمية‬ ‫الصحية‬ ‫الهيئة‬ )
‫خاصة‬ ‫طبية‬ ‫مراكز‬
‫إبل‬ ‫عين‬ ‫اإلجتماعي‬ ‫الطبي‬ ‫العناية‬ ‫مركز‬
‫الصحي‬ ‫الحلوة‬ ‫عين‬ ‫مركز‬ ‫الطبية‬ ‫الحريري‬ ‫مؤسسة‬
‫اإلجتماعي‬
‫الطبي‬ ‫صيدا‬ ‫مركز‬
‫الطبي‬ ‫للتشخيص‬ ‫الجنوب‬ ‫مركز‬
‫البازونية‬ ‫األحمر‬ ‫الصليب‬ ‫مركز‬
‫الصرفند‬ ‫المعوقين‬ ‫لتأهيل‬ ‫بري‬ ‫نبيه‬ ‫مجمع‬
‫النبطية‬ ‫الطبي‬ ‫الجنوب‬ ‫مركز‬ ‫اإلسالمية‬ ‫الصحية‬ ‫الهيئة‬

91. ‫المعتمدة‬ ‫المراكز‬ ‫الئحة‬‫في‬‫البقاع‬
‫مستشفيات‬‫حكومية‬
‫بعلبك‬ ‫مستشفى‬ ‫الحكومي‬
‫الهرمل‬ ‫مستشفى‬ ‫الحكومي‬
‫الحكومي‬ ‫راشيا‬ ‫مستشفى‬
‫الحكومي‬ ‫الهراوي‬ ‫الياس‬ ‫الرئيس‬ ‫مستشفى‬-‫زحلة‬
‫خاصة‬ ‫مستشفيات‬
‫الجامعي‬ ‫األمل‬ ‫دار‬ ‫مستشفى‬
‫فرحات‬ ‫حامد‬ ‫الدكتور‬ ‫مستشفى‬
‫شيحا‬ ‫تل‬ ‫مستشفى‬
‫الططري‬ ‫مستشفى‬
‫الفرنسي‬ ‫اللبناني‬ ‫مستشفى‬
‫رياق‬ ‫مستشفى‬
‫البقاع‬ ‫مستشفى‬
‫البتول‬ ‫مستشفى‬-‫الهرمل‬(‫اإلسالمية‬ ‫الصحية‬ ‫الهيئة‬ )
‫خاصة‬ ‫طبية‬ ‫مراكز‬
‫اإلجتماعي‬ ‫الصحي‬ ‫بعلبك‬ ‫مركز‬
‫الثدي‬ ‫وأمراض‬ ‫العظم‬ ‫لترقق‬ ‫البقاع‬ ‫مركز‬
‫اإلجتماعي‬ ‫الصحي‬ ‫الحكومي‬ ‫عرسال‬ ‫مركز‬
‫اإلجتماعي‬ ‫الصحي‬ ‫البقاع‬ ‫مركز‬ ‫الطبية‬ ‫الحريري‬ ‫مؤسسة‬
‫اإلجتماعي‬ ‫الصحي‬ ‫القرعون‬ ‫مركز‬ ‫الطبية‬ ‫الحريري‬ ‫مؤسسة‬
‫الصحي‬ ‫شمسطار‬ ‫مركز‬ ‫اإلسالمية‬ ‫الصحية‬ ‫الهيئة‬
‫الصحي‬ ‫شيت‬ ‫النبي‬ ‫مركز‬ ‫اإلسالمية‬ ‫الصحية‬ ‫الهيئة‬
‫الصحي‬ ‫بلوق‬ ‫فرج‬ ‫مركز‬ ‫اإلسالمية‬ ‫الصحية‬ ‫الهيئة‬

92. References
• Uptodate 20.3
• Robbins and Cottrans pathologic basis of diseases.
• Lebanese Ministry Of Public Health website
• Lebanese National Cancer Registry website
• Various internet resources