The incidence, age at diagnosis of breast cancer in the Iraqi Kurdish population and comparison to some other countries of Middle-East and West

Factors causing delayed presentations of breast cancer among female patients in Sulaimani Governorate, Kurdistan region, Iraq

BACKGROUND

Since breast cancer (BC) has the best chance of being effectively treated when it is tiny and has not spread, encouraging early disease detection remains a fundamental goal in improving prognosis.

OBJECTIVE

To quantify the magnitude of the delay in BC presentation as well as the contributing factors related to this delay.

PATIENTS AND METHODS

Data was collected at the Breast Diseases Treatment Clinic, Shar Teaching Hospital, Sulaimani, Iraq from January 2017 to December 2021 of 429 patients. A validated questionnaire was distributed to women about their demographics, health, and general awareness of the disease. The patient delay was calculated by collecting information on when they initially began experiencing symptoms and when they saw a doctor. We also gleaned information about the tumour's clinicopathological features from the patient's medical records.

RESULTS

The participants' ages ranged from 24 to 85 years, with a mean of 49.6 ± 11. Most women were middle-aged (53.8%), from urban areas (80.2%), illiterate (41.7%), married (86.5%), housewives (79.0%), given birth to > 4 children (34%), practised breastfeeding (78.8%), and non-smokers (91.4%). Regarding patients' health behaviours, there were highly significant correlations between early and late presentation (p < 0.001). Concerning the patient's awareness of BC symptoms, there were highly significant correlations between early and late presentation (p < 0.001). In addition, the late presentation was strongly correlated with bilateral BC, lymph node involvement, inflammatory BC, grade III BC, and T4 status.

CONCLUSIONS

Our findings shed light on possible causes of late presentation and identified those at risk of delayed consultation. Our communities need to be educated about BC, and encouraging them for early detection decreases the incidence of advanced BC.

Association between Metabolic Syndrome Risk Factors and Immunohistochemical Profile in Women with Breast Cancer

Background

The association between metabolic syndrome (MetS) and breast cancer may significantly impact the mortality and incidence of breast cancer. This study aimed to assess the association between MetS risk factors and immunohistochemical (IHC) profiles in women with breast cancer.

Methods

This cross-sectional study used the medical records of 300 breast cancer patients with an average age of 53.11±12.97 years in the Chemotherapy and Radiation Therapy Clinic of Dr. Anbiai, Tehran, Iran (2020-2021). The cases were divided into five subgroups including luminal A, luminal B (HER-2-), luminal B (HER-2+), HER-2 overexpressing, and triple negative.

Results

There was no difference in the prognostic indicators between the presence and absence of MetS in women with breast cancer. A higher proportion of luminal A tumors (39.3%), luminal B (HER-2+) (25%), triple-negative (17%), luminal B (HER-2-) (10.7%), HER-2 overexpression (8%) was observed in women with MetS than those without MetS. Multivariate logistic regression analysis showed that patients with MetS had a 41% higher chance of developing luminal A than those without MetS, and patients with a BMI≥30 Kg/m2 had an 80% higher chance of developing luminal B (HER-2+) than those with a BMI<30 Kg/m2. Moreover, women with a waist circumference higher than 88 cm had a 14 % lower chance of developing Luminal B (HER-2+) than those with a waist circumference less than 88 cm.

Conclusion

There was no difference in prognostic indicators and IHC profile in patients with and without MetS.

Temporal Pattern and Age-Period-Cohort Analysis of Breast Cancer Incidence in Iranian Women (2009-2017)

BACKGROUND

Breast cancer accounted for 28.1% of all female cancers in 2020 in Iran. This study was conducted to evaluate the time trend of breast cancer incidence and to identify the changes of breast cancer incidence in age, period, and birth cohorts in Iran, in the 2009-2017 timeframe.

METHODS

Annual cancer statistics for female breast cancer were obtained from the Iranian National Population-based Cancer Registry (INPCR) database from 2009 to 2017. The age-period-cohort (APC) analysis was used to evaluate the time trend of breast cancer incidence in age, period and birth cohorts between 2009 and 2017. R package (Epi) was used to analyze data. Results were considered statistically significant at P<0.05.

RESULTS

The age effect showed an increased incidence of breast cancer until the age of 45, and after this age the speed of increase was slower until 65 years. There was an increased diagnosis in 2015-2017 (period effect) for many age groups, especially in the 70- and over 80-year-old group.

CONCLUSION

Our findings indicated that breast cancer incidence peaks in the age of 45 in Iranian women, which is a decade earlier compared to the Western world. The period effect in 2015-2017 can be explained by the fact that in 2014, the former Iranian pathology-based cancer registry was upgraded to a population-based cancer registry, which resulted in improved coverage of cancer registry and case finding.

Long-term Survival and Prognostic Factors of Breast Cancer

BACKGROUND

Breast cancer survival rate is an important index for assessment of treatment effect in reducing the mortality. Weaimed to determine the fifteen-year survival rate for breast cancer at a referral center in Iran and its correlated factors.

METHODS

This survival study enrolled patients with breast cancer who referred to Motamed Cancer Institute (MCI) from 1998 to2016. The survival rate was calculated using the Kaplan-Meier method. The relationship of demographic, clinical and therapeuticfactors with overall survival (OS) was studied using Cox's proportional hazard model.

RESULTS

Totally, 3443 patients were studied. Their mean age and follow-up period were 47.7 (±11.43) years and 61.66 (±52.1)months, respectively. The median follow-up time was 48.4 months (range: 1-413 months), 49.7% of the patients had high schoolor higher education, and 71.3% presented in the early stage of the disease. Death occurred in 505 (14.7%) of the patients. Theoverall 2-, 5-, 7-, 10- and 15-year survival rates were 93%, 82%, 78%, 74%, and 66%, respectively. Lymph node involvement(HR=2.07; 95% CI: 1.38-3.09), tumor size≥5 cm (HR=2.83; 95% CI: 1.59-2.04), being single/divorced/widowed (HR=1.65;95% CI: 1.13-2.4), and education level

CONCLUSION

The five-year breast cancer survival rate in this study was higher than reported by some other studies in Iran, whichcould be due to the multidisciplinary treatment approach in MCI. Tumor size and lymph node involvement as indicators ofdelayed diagnosis may affect breast cancer survival, even though their true effect due to lead-time bias should be considered. Thecorrelation of education level with survival confirms the importance of awareness and the need to establish strategies for earlydiagnosis in Iranian women.

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Key Words

• Breast cancer
• Iran
• Survival rate

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MESH Headings

• Humans
• Female
• Breast Neoplasms/drug therapy
• Prognosis
• Iran/epidemiology
• Proportional Hazards Models
• Lymph Nodes/pathology
• Retrospective Studies
• Survival Rate

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Grants Collapse

Affiliation(s)

Asiie Olfatbakhsh Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
Leila Heidari Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
Zahra Omidi Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
Esmat-o-Sadat Hashemi Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
Maryam Ansari Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
Samaneh Mozaffarian Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
Shahpar Haghighat Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran

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Women's fertility decision-making with a diagnosis of breast cancer: A qualitative evidence synthesis

AIM

To synthesize qualitative evidence of premenopausal women's experiences of fertility decision-making with a diagnosis of breast cancer.

BACKGROUND

Breast cancer is increasingly more common in premenopausal women who may have not yet considered starting a family or have completed their families.

DESIGN

Qualitative evidence synthesis guided by Thomas and Harden's three-stage approach to thematic analysis.

DATA SOURCES

Twelve electronic databases were searched: CINAHL, Embase, Pubmed, Proquest, PsychINFO, Lenus, Scopus, Web of Science, Rian.ie, Medline, EThOS e-theses online and DART Europe. No year limit was set.

REVIEW METHODS

The 'Enhancing transparency in reporting the synthesis of qualitative research guidelines' (ENTREQ) statement was followed.

RESULTS

Fifteen qualitative studies were included in the synthesis. Seven review findings under four major themes were identified: (1) first comes survival, (2) making decisions 'under the gun', (3) health-care professionals should not make assumptions and (4) we want accurate, detailed information and we want it early. High confidence in six of the review findings was agreed.

CONCLUSION

Most women experienced rushed fertility preservation decision-making at a time when they also faced cancer treatment decisions. Women want detailed, clear information on fertility preservation early after their diagnosis.

Determinants of screening methods utilization among Iraq/Sulaimani women

PURPOSE

This study aims to find out the participation rate of women in the utilization of screening methods to determine the relationship of sociodemographic health characteristics and breast cancer (BC) awareness with the utilization of screening methods. The authors' study aims to examine the relationship between women's belief and the utilization of screening methods.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional study was conducted in three health centers from December 13, 2016 to June 12, 2017. A questionnaire was constructed for data collection about sociodemographic characteristics, screening awareness and medical and health background variables. Additionally, BC awareness measure and champion health belief model scales were used to measure women's perceptiveness about BC.

FINDINGS

Despite the awareness among 78.9% of women regarding clinical breast examination (CBE) as a screening method, only 9.5% women utilized it for screening. Due to prescription by physicians for diagnosis of BC, 23.6% women had done mammography at least once in their life. Having jobs and a good education significantly influenced the utilization of CBE as a screening method. The logistic regression analysis found that old age, family history of BC, good knowledge about BC, perceived susceptibility, low rate of perceived barriers to mammography and CBE predicted participation in screening.

ORIGINALITY/VALUE

Enhancing knowledge about BC and screening, emphasizing the susceptibility to BC and the benefits of screening will help in better participation. Importance should be given to illiterate and unemployed women.

The TP63 Gene Polymorphism rs17506395 is Associated with Early Breast Cancer in Cameroon

BACKGROUND

Breast cancer (BC) is a leading female cancer worldwide and cause of cancer-related death, especially in developing countries. Genetic predispositions to BC development in African population is poorly studied, and meanwhile the SNP rs17506395 in TP63 gene locus has been associated with the development of breast cancer in Asian women, no investigation has been undertaken within African population. We investigated the impact of this polymorphism in a representative African population.

METHODS

We undertook a case-control study including 335 women, of which 111 were breast cancer patients and 224 controls. Using blood-derived germline DNA, PCR-RFLP was used to investigate the polymorphism of TP63 gene at rs17506395 locus. Unconditional logistic regression was used to study the association between the TP63 gene polymorphism and risk of BC development. After stratification into different age and ethno-linguistic groups as well as menopausal status, the Cochran-Mantel-Haenszel test was used to measure significance of the associations.

RESULTS

Comparing cases with controls, no significant associations between genotype and disease development was observed. Similarly, when cases were stratified according to menopausal status and ethno-linguistic groups, no significant association was observed between genotype and disease development. However, in women of 40 years and below, TT and TG genotypes were associated with breast cancer development. The minor G allele seems to protective against early breast cancer onset OR of 0.5 (95%CI = 0.26-0.94, p = 0.03).

CONCLUSION

Our data revealed an association between rs15706395 and the risk of early breast cancer onset. The GG genotype seems to reduce the risk of early breast cancer. Larger studies are needed to confirm the potential of this SNP as biomarker for breast cancer prognostic.
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Comparison of prognosis and safety of pacemaker implantation in patients aged less than or 85 years and older

PURPOSE

Cardiac conduction disturbance necessitating pacemaker implantation is common among elderly patients. However, patients often have comorbidities and increased frailty which may result in limited life prognosis and a high rate of procedure-related complications. We evaluated pacemaker implantation in older patients by comparing life prognosis and complication rate in patients aged ≥ and < 85 years.

METHODS

We retrospectively enrolled 262 consecutive patients who underwent initial pacemaker implantation for bradycardia (age, 77 ± 10 years old; male, 132 (50%); dual chamber pacemaker, 222 (85%) patients). Acute and long-term outcomes were compared between patients aged ≥ 85 and < 85 years. Primary outcome was a composite of all-cause death and severe procedure-related complications.

RESULTS

Seven (14%) patients aged ≥ 85 years (n = 50; 19%) were non-ambulatory. During 2-year follow-up, primary outcome (death or severe complication) occurred in 47 (18%). Freedom from primary outcome was similar between age groups (81.6% versus 80.8%; p = 0.98). Freedom from all-cause death and from severe complication in the study period were also similar (all-cause death, 91.6% versus 88.7%, p = 0.70; severe complication, 89.7% versus 91.5%, p = 0.75). On multivariate analysis, sick sinus syndrome (hazard ratio (HR) 2.7, 95% confidence interval (CI) 1.1-6.4, p = 0.03), immunosuppressant use (HR 21 (95% CI 3.3-134), p < 0.01), and high C-reactive protein (HR 1.5 (95% CI 1.2-1.9), p < 0.01) were independent predictors of primary outcome.

CONCLUSIONS

Life prognosis and severe complication rates after pacemaker implantation were similar between patients aged ≥ and < 85 years.

Incidence trend of breast Cancer in women of eastern Mediterranean region countries from 1998 to 2019: A systematic review and meta-analysis

BACKGROUND

This study was conducted to provide evidence on the current status of breast cancer and its incidence trend in Eastern Mediterranean Region during 1998-2019. Also, this study aimed to investigate the association between the incidence of breast cancer and Human Development Index and some factors related to this index, including total fertility rate, and obesity, using a meta-analysis.

METHOD

Data on incidence of breast cancer were collected from various sources, including PubMed, Embase, Web of Science, and WHO, from 1998 to 2019 using systematic review and meta-analysis. Pooled age standardized rate was calculated based on study duration and quality of data using a subgroup analysis and random effect meta-analysis.

RESULTS

A total of 80 studies (545 data points) were analyzed. Pooled age standardized rate of breast cancer for Eastern Mediterranean Region was 37.1 per 100,000 person-year (95% confidence interval [CI], 34.5, 39.8) during 2011-2019. age standardized rate of breast cancer had an upward trend in Eastern Mediterranean Region from 2005 to 2019. However, the increasing trend was found to be slightly different in various regions based on quality of data. Moreover, pooled age standardized rate had a significant association with Human Development Index [- 89.2 (95% CI, - 119.8, - 58.7)] and obesity [1.2 (95% CI, 0.9, 1.5)].

CONCLUSION

Pooled age standardized rate of breast cancer in Eastern Mediterranean Region was lower than the global average. Also, the age standardized rate value and its incremental trend have been higher in countries with high-quality data than in other countries of this region in recent years. Data quality or physiological factors, such as increase in obesity rates, could be the reasons for this incremental trend.

Risk factors assessment of breast cancer among Iraqi Kurdish women: Case-control study

BACKGROUND

To our knowledge, there is no international publication on risk factors of breast cancer among Kurdish women. There are several risk factors of breast cancer may differ in different geographical cultures. The aims of this study are to assess the established and probable risk factors of breast cancer among Iraqi Kurdish women as well as to investigate the effect of some Mediterranean food items on this issue.

MATERIALS AND METHODS

This retrospective case-control study was constructed in Sulaimanyah governorate-Iraq. Data were collected regarding socio-demographic characters, established risk factors, and dietary habits of 338 cases that were registered in Sulaimanyah Breast Center during January 2015-February 2019 with collection of same items for 338 age-matched controls.

RESULTS

The marriage was appeared to be a protective factor with (OR = 0.596, CI: 0.364-0.974, P = 0.039). Age at menarche ≥14 years has a protective effect with (OR: 0.326, P = 0.027) and 152 cases (45.0%) had menarche at ≤12 years compared to 56 controls (16.6%) with (P = 0.000). Numbers of children ≥ 3, regular exercise, and breastfeeding for >48 months duration have protective role. Consumption of fast foods and some Mediterranean foods weekly >2 times are risk factors, while taking stewed meat weekly one time, fish weekly ≥1 time, fruit daily>1 time and vegetables daily≥1 time, and black tea daily >3 cups have preventative effect on breast cancer.

CONCLUSION

Among Kurdish women, some items of Mediterranean food have the same causative effect as fast food items. Marriages, consumption of stewed meat, fish, fruit, vegetables, and black tea may have preventative effect.

Epidemiology and treatment patterns of rheumatoid arthritis in a large cohort of Arab patients

OBJECTIVES

There is limited information on the epidemiology and treatment patterns of rheumatoid arthritis (RA) across the Arab region. We aim in this study to describe the demographic characteristics, clinical profile, and treatment patterns of patients of Arab ancestry with RA.

METHODS

This is a cross sectional study of 895 patients with established rheumatoid arthritis enrolled from five sites (Jordan, Lebanon, Qatar, Kingdom of Saudi Arabia (KSA), and United Arab Emirates). Demographic characteristics, clinical profile, and treatment patterns are compared between the five countries.

RESULTS

The majority of our patients are women, have an average disease duration of 10 years, are married and non-smokers, with completed secondary education. We report a high (>80%) ever-use of methotrexate (MTX) and steroids among our RA population, while the ever-use of disease modifying anti-rheumatic drugs (DMARDs) and TNF-inhibitors average around 67% and 33%, respectively. There are variations in RA treatment use between the five country sites. Highest utilization of steroids is identified in Jordan and KSA (p-value < 0.001), while the highest ever-use of TNF-inhibitors is reported in KSA (p-value < 0.001).

CONCLUSION

Disparities in usage of RA treatments among Arab patients are noted across the five countries. National gross domestic product (GDP), as well as some other unique features in each country likely affect these. Developing treatment guidelines specific to this region could contribute in delivering standardized therapies to RA patients.

Metformin Reshapes the Methylation Profile in Breast and Colorectal Cancer Cells

With no sharp cure, breast cancer still be the major and the most serious life-threatening disease worldwide. Colorectal is the third most commonly occurring cancer in men and the second most commonly occurring cancer in women. In the present investigation, colon cancer cells (CaCo-2) and breast cancer cells (MCF-7) were treated with elevated doses of metformin (MET) for 48h. Cell count was assessed using trypan blue test, and the cytotoxicity was evaluated using MTT assay. Methylation-specific PCR was performed on the bisulfite-treated DNA against two tumor suppressor genes; RASSF1A and RB. Results indicated that: in breast cancer, the cell count was decreased significantly (P>0.005) after being treated with 5, 10, 20, 50, and 100 mM of MET. The elevated concentration had increased reduction percentages on the MCF-7 cells, as 5 mM and 100 mM have yielded 35% and 93.3% reduction in cell viability, respectively. Colon cancer cells have responded to the doses of MET differently, as for the 5 mM and the 100 mM, it gave 88% and 60% reduction in cells viability, respectively. Cytotoxicity assay revealed that 5 mM and 100 mM of MET caused breast cancer cells to loss 61.53% and 85.16% of its viability, respectively, whereas colon cancer cells have responded to the 5 mM and 100 mM of MET by reducing the cells viability with 96.91% and 96.24%, respectively. No RB promoter methylation was detected in colon cells, while RASSF1A was partially methylated. In the MCF-7 breast cancer cells, both RASSF1A and RB were partially methylated.

Assessment of breast cancer early detection program in Iraq-Sulaimania: Measuring the cancer detection rate

Background

Low- and middle-income countries require to specify early detection programs and intervention models for breast cancer. The aim of this study was to assess the performance efficacy of an Iraqi early detection model in terms of cancer detection rate (CDR) and the method of participation in this program.

Materials and Methods

Data from June 2007 to August 2016 was collected from the Breast Disease Treatment Center in the Sulaimani province in Iraq. A total of 40,491 women had registered at the center during that period for breast cancer screening, and cancer was detected in 793 women.

Results

The CDR of the Iraqi program was 8.2 per 1000 screened women, and that of the mammograms was 42.02 per 1000 mammograms. Women mostly participated in the program by the self-referral method (77.54%).

Conclusion

The performance of the Iraqi early detection model was effective with a high CDR, and most women participated by self-referral. This program could, therefore, be effective in low- and middle-income countries.

Recent incidence and descriptive epidemiological survey of breast cancer in Saudi Arabia

Objectives:

To review and analyze the pattern of breast cancer (BC) in the Kingdom of Saudi Arabia (KSA).

Methods:

A retrospective descriptive epidemiological review of BC of all diagnosed Saudi female cases from January 1990 to December 2014 was conducted at the Faculty of Sciences, Department of Biology, University of Tabuk, Tabuk, KSA. This report contains information obtained from the Saudi Cancer Registry and from King Faisal Specialist Hospital and Research Center.

Results:

The number of women with BC increased steadily from 1990-2010. On the basis of the number of cases, the percentage distribution of BC appears to be increasing. There were 1152 female BC cases in 2008 in comparison with 1308 in 2009, and 1473 in 2010. Breast cancer ranked first among females accounting for 27.4% of all newly diagnosed female cancers (5378) in the year 2010. The average age at the diagnosis of BC was 48; weighted average was 49.8, and range 43-52.

Conclusion:

Among Saudi patients, there was a significant increase in the number of cases of BC, which occurs at an earlier age than in Western countries. Continued vigilance, mammographic screening, and patient education are needed to establish early diagnosis and perform optimal treatment.