Teaching Hospital FIVE YEAR SURVIVAL IN PATIENTS WITH BREAST CANCER A STUDY CARRIED AT THE ONCOLOGY CENTER OF BASRAH

Objectives: The aim of this work was to determine the five years survival of patients with breast cancer attending the Oncology Center of Basrah between October 1999 and December 2001. Methods: Three hundred eight patients attending the Oncology Center for registration and treatment during the years 19992001 were studied and the status of each whether alive or dead was ascertained after one year and five years. Result: Among 308 patients, 5 were males, 68.16% were in advanced stage (i.e. stage 2-4) and 5 years survival was (25.24 %). Conclusion: Five years survival of breast cancer in Basrah is low. This needs the adoption of wide scale screening program to help early detection and to review the care and modalities of treatment to improve the outcome. INTRODUCTION reast cancer is the most common cancer in woman in United States and is the most common cause of death from cancer in woman worldwide. Its incidence rate is high in the more developed and industrialized countries, but less in African and Asian countries. The incidence rate in Western countries is >100/100000 and in Asian countries the incidence rate is between 10-15/100000. In Basrah, breast cancer constitutes one third of all cancers in woman with incidence rate of 13.1/100000 women. The annual mortality rate of breast cancer in Basrah in 2005 is 3.2 per 100000, whereas in Mosul, the incidence rate of breast cancer is 12.5 /100000 and the death rate is 6/1ooooo. The above result of incidence rate looks low when compared to the incidence rate of Western countries. This is attributed in part to improper registration and the lower risk profile in Basrah. The life time risk for female breast cancer in USA, ranges between 1:252 at the age of 30-45 years and 1: 8 at the age of 110 years. Premenapausal breast cancer rates are similar in Asian and western countries. A number of factors are known to increase the risk of breast cancer such as: female sex, increasing age, early menarche, late menopause, obesity, postmenapausal hormonal therapy, benign proliferative breast disease, ionizing radiation, lastly germ line mutation such as BRCA1, BRCA2, P35 and PTEN. [7,8] METHODS Medical records of patients with breast cancer registered and treated in Oncology Center of Basrah during the years 1999, 2000 and 2001 were retrospectively studied and followed for five years. Data including patients age, sex, stage of disease and modality of treatment were observed investigated. Deaths were ascertained through either direct follow up, or from death registration office.


INTRODUCTION
reast cancer is the most common cancer in woman in United States and is the most common cause of death from cancer in woman worldwide.Its incidence rate is high in the more developed and industrialized countries, but less in African and Asian countries.The incidence rate in Western countries is >100/100000 and in Asian countries the incidence rate is between 10-15/100000. [1]n Basrah, breast cancer constitutes one third of all cancers in woman with incidence rate of 13.1/100000 women. [2]The annual mortality rate of breast cancer in Basrah in 2005 is 3.2 per 100000, [3] whereas in Mosul, the incidence rate of breast cancer is 12.5 /100000 and the death rate is 6/1ooooo. [4]The above result of incidence rate looks low when compared to the incidence rate of Western countries.This is attributed in part to improper registration and the lower risk profile in Basrah.The life time risk for female breast cancer in USA, ranges between 1:252 at the age of 30-45 years and 1: 8 at the age of 110 years. [5]Premenapausal breast cancer rates are similar in Asian and western countries. [6]A number of factors are known to increase the risk of breast cancer such as: female sex, increasing age, early menarche, late menopause, obesity, postmenapausal hormonal therapy, benign proliferative breast disease, ionizing radiation, lastly germ line mutation such as BRCA1, BRCA2, P35 and PTEN. [7,8]ETHODS Medical records of patients with breast cancer registered and treated in Oncology Center of Basrah during the years 1999, 2000 and 2001 were retrospectively studied and followed for five years.Data including patients age, sex, stage of disease and modality of treatment were observed investigated.Deaths were ascertained through either direct follow up, or from death registration office.

DISCUSSION
This study reveals that the incidence of breast cancer in Basrah is low under the age of 25 years (ie: 0.32%).In some European studies no cases recorded below that age. [9]Peak incidence was at the age of 45-54 years 113 cases were recorded, but the number decreases with the advancing of age.Six cases were recorded at the age 75-84 years.This decrease may not be real because it is not population adjusted.In some European statistics, the peak incidence is at the age of 50-54 years so that the peak incidence in this study is lower than western countries, but this point needs to be confirmed by extending the duration of the study, so increasing the number of patients.The survival rate was low regardless the stage of the disease, hormone receptor status and treatment modality.One year survival rate was 52.5 and five years survival was 25.24, if we consider those who defaulted are all alive after five years, then the five years survival rate will be 31.04.It is known that increasing size of the primary tumor is inversely related to the disease free survival, and overall survival rates. [10]Five years survival for those with tumor size more than 5 cm is 55%, the number of axillary lymph node involvement is another predictor to adverse prognosis and five years survival.In negative node patients is (78-92%), and (32-57%) in patients with more than 4 lymph nodes involvement. [11,12]glandular breast tissue is identical in male and female.
Male breast cancer in this study was (1.6%).In some of statistics, it is accounting for (0.2%) of all male cancer and about (1%) of all new recorded breast cancer. [13,14]Overall low survival rate in this study can be attributed to many factors, of these unavailability or insufficient chemotherapy or radiotherapy, and interrupted courses because of social, political and economic instability.In addition, more than half of the patients (68.16%) are in advanced stage (stage 2-4) when first seen.Another finding is that 18 patients (5.8% of total) stop attending the center (defaulter) probably due to social and personal difficulties.All these factors may contribute to the low five years survival rate of our patients.

Table 1 . Sex distribution of breast cancer (1999- 2001)
rate was 44.04, and those who survives five years 22 patients, with a five year survival rate of 26.19.Those who discontinue attendance were 8(9.5) patients, while patients who survive less than one year were 17.In the year of 2000 one year survival rate was 59.13 and five years survival rate was 19.13.In 2001 total registered cases were 109, one year survival rate was 51.37, and five years survival rate 31.19.Whereas defaulters were 5(4.5).The total number of patients remained alive after one year were 161.one year survival rate was 52.5, and who remained alive after five years were 78 with a five years survival rate was 25.24.while those defaulted were 18(5.8).
years) only 6 (1.9%) were recorded.Whereas (Table-3) revealed.Total number of registered cases during 1999 were 84.Those who remained alive after one year were 37 patients B and their survival

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The study shows low incidence rate of breast cancer which is comparable to the incidence in Asian countries.The low incidence may be partially due to defective registration.Considerablenumber of patients are defaulters which might affect the number of survivals and mortality rate.Noscreening program is in work (clinical or laboratory), so high percentage of patients are in advanced stage when first seen. Staging of breast cancer improved successfully in the years 1999, 2000, 2001.