Breast cancer risk factors among women (aged years) in Saudi Arabia

Transcription

1 Breast cancer risk factors among women (aged years) in Saudi Arabia Sulafa T AlQutub, MD, ABCM, MPH In Health policy Public health Department at Jeddah Directorate

2 Introduction Saudi Arabia is considered as High income country and rankedrelatively high- at 34 th_ in Human development index. Between over all Age adjusted incidence rate for BC in KSA= /100,000 respectively, similar incidence was observed in Mecca region which = / The region ranked the second in incidence after the eastern region. Breast cancer ranked the first among Saudi Women aged In 2008 IARC estimated that the age-standardized incidence rate for breast cancer at 22.4 per 100,000 women. Knowledge on risk factors is important for risk assessment, disease cost reduction and for efficient screening and control strategies.

3 Fig. 1 Estimated age-standardised incidence rates of female breast cancer by country, Data taken from GLOBOCAN <ce:cross-ref refid="bib0155"> [31]</ce:cross-ref>. Rates were age-standardised to the WHO World Standard population and expressed per Danny R. Youlden, Susanna M. Cramb, Nathan A.M. Dunn, Jennifer M. Muller, Christopher M. Pyke, Peter D. Baade The descriptive epidemiology of female breast cancer: An international comparison of screening, incidence, survival and mortality Cancer Epidemiology, Volume 36, Issue 3, 2012,

4 Introduction Our case-control study, captured the risk factors among Saudi women at their third decade all the way up to the 5 th decade in Jeddah City. Risk factors assessment were mainly retrieved from Gail model ; the model included age at menarche, age at first live birth (or null parity), family history of breast cancer in first-degree relatives, history of breast biopsy, and history of breast biopsy with a typical hyperplasia. Breast cancer susceptibility genes BRCAI and BRCAII are beyond the scope of this study.

5 Jeddah City within Mecca Region

6 Population and Methods N= cases 134controls 151 cases 166 controls N=315

7 Population and Methods Breast cancer confirmed Cases by histopathology over the last two years were recruited from three different cancer management centers in Jeddah. To minimize the selection bias, we selected both hospital and community controls. Data collection through interview; consisted of an interviewer asking questions to an interviewee.

8 Results Early age at menarche (<12 years), monthly income of at least SR ($ 5333), use of exogenous estrogen and progesterone, and previous breast biopsies or surgeries irrespective of the diagnosis. All were significantly associated with breast cancer. Our study did not conclude any significant relations between body weight and height and premenopausal breast cancer.

9 Disease association to parity, lifetime breastfeeding, and family history Factor Cases Controls OR[95% CI] P-value Total no. of pregnancy < 4 > 4 No response [ ] 0.30 Life time breast feeding Yes No No response [ ] 0.01 Affected family member Yes No [ ] 0.13

10 % Reported regular exercise frequency Reported as yes Reported as yes 0 Cases Controls Reported frequency of exercise (>2 h/week for more than 4 months / year)

11 % Reported regular exercise frequency Odds for exercise frequency among the cases and controls was 1.45 (95% CI ). NS However, the culturally rare exposure to exercise among Saudi women made it difficult to conclude the significantly protective effect of exercise.

12 Frequency of Clinical Breast Examination 70.00% 60.90% 60.00% 50.00% 34.30% 40.00% 30.00% 20.00% 10.00% 0.00% Cases Controls

13 Reported Frequency of screening mammography 65.80% 70.00% 60.00% 50.00% 40.00% 30.00% 22.20% 20.00% 10.00% 0.00% Cases Controls This raise concerns about over diagnosis phenomenon which usually appear more Among women at years.

14 How are we different from Europe and North America regarding the risk factors? Mean Age at the Diagnosis Positive Family History Mean Age at menarche Mean BMI among cases Our study Other s studies ± 40Y 38Y-49Y 4.6% 15-20% 12.4Y 13 and/14y Kg/m 2 <25 kg/m 2 ± Menarche, menopause, and breast cancer risk: individual participant meta-analysis, including women with breast cancer from 117 epidemiological studies, Lancet Oncology, 13 (2012) doi: /s (12)

15 Cost per year of life saved through annual mammography screening Cost/year saved Cost/year saved * cost of $84 for a conventional film-screen mammogram in 1994 US dollars Calculations Based on Rosenquist and Lindfors estimates

16 Recommendation to bridge the gap Epidemiological studies To conduct Survival studies on breast cancer to evaluate the control efforts and to compare them within gulf cities and countries. To Conduct similar studies at different gulf cities and countries! Policy development Implement Regulations on Exogenous estrogen/progesterone prescription and to be prescribed at lowest possible doses and for short periods. Cost and harm assessment for various screening strategies (CBE/screening Mammography) to reduce the burden of the disease. Increase Insurance coverage and access to screening and preventive services.

17 Recommendation to bridge the gap Behavioral interventions Implementing proper breast feeding education programs and programs for healthy life style.

18 Acknowledgment To the chairwoman of Sheikh Mohammed Bin Hussien Al-Amoudi Center of Excellence in Breast Cancer for funding and logistics.

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