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Herceptin is a biologically engineered, monoclonal antibody designed to target and block the function of HER2 human epidermal growth factor receptor-2 ; , a cancer gene associated with aggressive disease. Herceptin therapy is different from conventional chemotherapy as it does not destroy normal, healthy cells, which is the primary cause of unwanted side effects associated with chemotherapy. Herceptin is used to treat women with advanced breast cancer, whose tumours overproduce HER2, known as HER2-positive breast cancer. Approximately 2030 percent of breast cancer patients have HER2-positive disease, which has a 1 poor prognosis. Herceptin has demonstrated efficacy in treating advanced breast cancer when given on its own as monotherapy, as well as in combination with standard chemotherapy. It improves response rates and overall survival while maintaining quality of life in women with HER2-positive advanced breast cancer 2-6. Herceptin is available for the treatment of advanced breast cancer in approximately 90 countries worldwide. In Europe, it is indicated for use in combination with Taxotere as a first-line therapy for HER2-positive disease in patients who have not received chemotherapy for their metastatic disease, as a first-line therapy in combination with Taxol where anthracyclines are unsuitable, and as a single agent in second- and third-line therapy. In the US, Herceptin in combination with paclitaxel is indicated for treatment of patients with metastatic breast cancer whose tumors overexpress the HER2 protein and who have not received chemotherapy for their metastatic disease. Herceptin as a single agent is indicated for, for instance, flovent hfa 110mcg.
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Through the combination of preventative examination in children, adolescents and pregnant women, a total of 60% of all goiters may ideally be prevented. For example, the prenatal examinations alone should detect about half of those goiters, 20% of the absolute total, that occur between the 20th and 30th years of life. It has been proposed to limit thyroid sonography within the framework of the standard health check to the 35-45 year old group, as with increasing age the relative benefits of prophylaxis or medical therapy lessen. The current participation quota of 17% for the two year interval means that with a population of 10.3 million persons in these age groups, half of the participants, or about 880, 000 persons will be examined and 264, 000 goiters detected per year. The total costs for sonography would be 17.6 million DM, those of the additional examinations, 7.4 million DM, and those of iodide substitution at 100 mg person daily would amount to 7.7 million DM. In total, thyroid prophylaxis would cost 32.7 million DM per year for the 35-45 year old group. COST-BENEFITS From the above considerations, about 70% of the increases in thyroid size can be detected early enough so that prompt iodine substitution can prevent pathological changes that would otherwise lead to an operation. The total costs described above are 122 million DM per year, including 46 million in sonography, 14 million in additional examinations, and 62 million for iodine substitution therapy. When this figure is related to the annual costs of 2 billion DM for iodine deficiency, as described in the first part of this paper, the 70% reduction achieved by early detection and prompt treatment, saves 1, 400, 000, 000 DM annually. These benefits cannot be realized at once, of course, but depend on the rate of acceptance of the preventive measures and on early detection, as well as on the decrease in goiter patients currently in the population. A comprehensive program for goiter prevention would lead to a change of consciousness in consumers and industrial producers of goods. This heightened awareness in turn would increase the use of iodized salt in the household as well as in commercial production of foods. Eventually, the use of thyroid exams and prophylaxis with iodide tablets would become unnecessary. CONCLUSION This report has several important implications. First, even the mild iodine deficiency found in Germany entails major financial losses from medical procedures and lost work time. These are only some of the costs; this article does not address the expenses of mild mental retardation, decreased efficiency, reproductive problems, that also accompany iodine deficiency. Second, attention to the economic consequences may prove to be more powerful in persuading countries to correct iodine deficiency than are humanitarian motives; advocacy programs should consider this point in developing and targeting their advocacy messages, particularly to politicians and businessmen. REFERENCES.

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