Authors
1
Department of Pathology, Collage of Medicine, University of Baghdad, Baghdad, Iraq
2
National Cancer Research Centre, University of Baghdad, Baghdad, Iraq
Abstract
BACKGROUND:
Breast cancer is the most common malignancy affecting the Iraqi population. As many cases are still detected in advanced stages of the disease, regular follow-up of the diagnosed and treated patients is crucial to manage therapy-related complications and limit loco-regional recurrences.
OBJECTIVE:
To report the clinicopathological features, the offered treatment options and the recurrence rates among a sample of Iraqi female patients followed up after diagnoses with breast cancer.
PATIENTS AND METHODS:
A retrospective study design was followed enrolling a sample of 154 female patients diagnosed with breast cancer at a referral center for early detection of cancer in Baghdad, Iraq during a six month period (from January to July 2019). All cases with histopathologically confirmed invasive breast carcinoma were included in the study if they had reliable valid data related to their demographic, clinical, pathological and follow up status (for at least two years).
RESULTS:
The peak age frequency for breast cancer occurred in the fifth decade of life. Family history was observed in 18.2% of patients. The most common histological type was invasive ductal carcinoma (92.9%) while 46.8% of the patients presented in advanced clinical stages (III and IV). ER and PR and HER2 were positive in 66.2%, 63.6% and 36.4% of the cases respectively. Surgery was prescribed in 95.5% of the patients; 83.8% underwent modified radical mastectomy. Chemotherapy, Radiotherapy, Hormonal and Biological therapy were received by 92.2%, 66.9%, 64.9% and 32.4%) of patients respectively. Overall, discontinuation of the treatment was observed in 8.4% while recurrence was recorded among 10.1% of the patients.
CONCLUSION:
Frequent regular follow up of patients diagnosed with breast cancer is crucial to achieve better prognosis. Continuous monitoring of the response to therapy and coordination through multidisciplinary follow-up care are essential recommendations to avoid risks of local and regional recurrences.
- Iraqi Cancer Board (2016). Results of the Iraqi Cancer Registry 2015. Baghdad, Iraqi Cancer Registry Center, Ministry of Health, 2018.
- Annual Statistical Report 2016. Planning Directorate, Ministry of Health/ Environment, Republic of Iraq, 2017. Available from: https://moh.gov.iq/ upload/up le/ar/513.pdf.
- Alwan, N, Kerr D, Al-Okati D, et al. Comparative study on the clinic-pathological profiles of breast cancer among Iraqi and British patients. The Open Public Health Journal. 2018; (11): 177–191
- Alwan NAS, Tawfeeq F, Maallah M et al:The Stage of Breast Cancer at the Time of Diagnosis: Correlation with the Cinicopathological Findings among Iraqi Patients. J Neoplasm, 2017; Vol. 2 (3:22); 1-10.
- Alwan NAS, Mualla F, Naqash M et al: Clinical and Pathological Characteristics of Triple Positive Breast Cancer among Iraqi Patients, Gulf Journal of Oncology, 2017; 25: 6-15.
- Alwan NAS.,Tawfek FN.,Mallah NAC, Demographic and clinical profiles of female Patients diagnosed with breast cancer in Iraq. Journal of Contemporary Medical Science, 2019; 5 (1): 14-19.
- Alwan NAS. Tumor Characteristics of Female Breast Cancer: Pathological review of Mastectomy Specimens Belonging to Iraqi Patients .World Journal of Breast Cancer Research, 2018; 1 (1): 1-3.
- Rosai and Ackerman''s Surgical Pathology, Elsevier, eleventh edition, 2018, chapter36 Breast pp (1434-1527)
- Alwan N: Establishing Guidelines for Early Detection of Breast Cancer in Iraq. Int .J. of Advanced Research. 2015; 3 (12): 539-555
- Sankar R, Alwan N & Denny L: “How Can We Improve Survival from Breast Cancer in Developing Countries?" Future Medicine, Breast Cancer Management, 2013, 2 (3): 179-183.
- Alwan NAS, Kerr D. Cancer Control in War-Torn Iraq, The Lancet Oncology, 2018; 19 (3): 291-292
- Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes dealing with the diversity of breast cancer: Highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011, Ann Oncol. 2011; 22 (8):1747-1736
- Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E,Zackrisson S, Cardoso F. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology. 2015 Sep 1; 26 (suppl_5):v8-30.
- Alwan NAS. Breast Cancer Among Iraqi Women: Preliminary Findings From a Regional Comparative Breast Cancer Research Project. Journal of Global Oncology, 2016; 2 (5): 255-258.
- Alwan NAS and Al-Attar: Evaluating the Effect of an Educational Teaching Model on the Knowledge about Breast Cancer among Female University Students in Iraq., JJ Cancer Sci. Res. 2016, 2 (1): 026.
- Alwan NAS, Alattar W, Mallah N, Hassoun T: Baseline Needs Assessment for Breast Cancer Awareness and Management among Paramedical Health Care Providers in Iraq. International Journal of Science and Research (IJSR), 2017; 6 (7): 1515-1520.
- Alwan NAS, Al-Attar WM, Al Mallah N. Baseline Needs Assessment for Breast Cancer Awareness among Patients in Iraq, International Journal of Science and Research (IJSR), 2017; 6 (1): 2088 – 2093.
- Alwan NAS: Clinical and Pathological Characteristics of Familial Breast Cancer in Iraq, Chronicle Journal of Cancer Science, 2017; 1 (1): 002.
- Alwan NAS. Family History among Iraqi Patents Diagnosed with Breast Cancer, IJSR, 2017; 6 (2): 868-872.
- Majid RA, Mohammed HA, Saeed HM, Safar BM, Rashid RM, Hughson MD. Breast cancer in kurdish women of northern Iraq: incidence, clinical stage, and case control analysis of parity and family risk. BMC women''s health. 2009; 9 (1):33.
- Alwan NAS, Tawfeeq FN, Muallah FH. Breast Cancer Subtypes among Iraqi Patients: Identified By Their ER, PR and HER2 Status. Fac Med Baghdad, 2017; 59 (4): 304-307.
- Alawad AS, ALkathum MA, Alwahed AA. A Retrospective Study of Relapsed Breast Cancer Cases During Follow-Up in Merjan. Medical Journal of Babylon. 2009;6 (1): 130-7.
- Onitilo AA, Engel JM, Greenlee RT, Mukesh BN. Breast cancer subtypes based on ER/PR and Her2 expression: comparison of clinicopathologic features and survival. Clinical Medicine & Research. 2009 Jun 1; 7 (1-2):4-13.
- Anthony FY, Yadav NU, Lung BY, Eaton AA, Thaler HT, Hudis CA, Dang CT, Steingart RM. Trastuzumab interruption and treatment-induced cardiotoxicity in early HER2-positive breast cancer. Breast cancer research and treatment. 2015; 1; 149(2):489-95.
- Talima S, Kassem H, Kassem N. Chemotherapy and targeted therapy for breast cancer patients with hepatitis C virus infection. Breast Cancer. 2019; 15;26 (2):154-63.
- Tlefih AJ. Non-Metastatic Breast Cancer: Clinical Presentation and Patterns of Surgical Treatment. Al-Kindy College Medical Journal. 2009; 5 (1):40-6.
- Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. Journal of the National Cancer Institute. 2002; 3;94 (7):490-6.
- El Saghir N, Khalil MK, Eid T, et al. Trends in epidemiology and management of breast cancer in developing Arab countries: A literature and registry analysis. International Journal of Surgery, 2007; 226-233.
- Lazaraviciute G, Chaturvedi S. Mastectomy—A Critical Review. Open Journal of Clinical Diagnostics, 2017; 7:58-66.
- American Society of Clinical Oncology. The state of cancer care in America. A report by the American Society of Clinical Oncology. J. Oncol. Practice, 2014; 10: 119-142.