JOURNAL BROWSE
Search
Advanced SearchSearch Tips
Determinants of Advanced Stage at Initial Diagnosis of Breast Cancer in Pakistan: Adverse Tumor Biology vs Delay in Diagnosis
facebook(new window)  Pirnt(new window) E-mail(new window) Excel Download
 Title & Authors
Determinants of Advanced Stage at Initial Diagnosis of Breast Cancer in Pakistan: Adverse Tumor Biology vs Delay in Diagnosis
Khokher, Samina; Qureshi, Muhammad Usman; Mahmood, Saqib; Sadiq, Sadia;
  PDF(new window)
 Abstract
Background: Breast cancer is the most frequent cancer of women in Pakistan with the majority presenting with stage III or IV lesionsat initial diagnosis. Patient and health system related factors are well known determinants of delay in presentation and diagnosis. Additionally, breast cancer being a heterogeneous disease, the various molecular subtypes featuring different aggressiveness also need to be considered. The present study evaluated the association of stage at initial diagnosis of breast cancer with these two factors in local women at a tertiary level health care facility in Lahore, Pakistan. Materials and Methods: Patient and tumor features were recorded separately during diagnostic workup in Breast Clinics at INMOL and at Services Hospital, Lahore. Data were entered in MS Excel and analyzed by descriptive statistics and Chi-Square test. Results: Among the 261 patients, 64% were staged as late breast cancer (LBC), the mean age was 46.8 with standard deviation of 13 years. Some 92% had invasive ductal carcinoma (IDC), 61% had luminal types (LT) of non-aggressive tumor while 39% had the non-luminal types (NLT) of of HER2-enriched or basal aggressive tumors. While 70% of patients presented within one year of symptomatic disease (early report group "ERG"), 30% reported after a mean delay of 4 years with a standard deviation of 3.75 years. The stage distribution among ERG patients was not statistically different from those reporting late (P
 Keywords
Breast cancer;Pakistan;delayed diagnosis;mortality;advanced breast cancer;molecular types;
 Language
English
 Cited by
 References
1.
Agarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS (2007). Spectrum of breast cancer in Asian women. World J Surg, 31, 1031-40. crossref(new window)

2.
Akhtar M, Akulwar V, Chandak K, Gandhi D (2011). Is locally advanced breast cancer a neglected disease? Indian J Cancer, 48, 403-5. crossref(new window)

3.
Asif HM, Sultana S, Akhtar N, Rehman JU, Rehman RU (2014). Prevalence, risk factors and disease knowledge of breast cancer in Pakistan. Asian Pac J Cancer Prev, 15, 4411-6 crossref(new window)

4.
Aziz Z (2008). Across generations: cancer treatment in developing countries. J Clin Oncol, 26, 4990-1. crossref(new window)

5.
Aziz Z, Iqbal J, Akram M (2008). Effect of social class disparities on disease stage, quality of treatment and survival outcomes in breast cancer patients from developing countries. Breast, 14, 372-5. crossref(new window)

6.
Badar F, Faruqui ZS, Uddin N, Trevan EA (2011). Management of breast lesions by breast physicians in a heavily populated south asian developing country. Asian Pac J Cancer Prev, 12, 827-32.

7.
Bhikoo R, Srinivasa S, Yu T Moss D, Hill AG (2011). Systematic review of breast cancer biology in developing countries (Part 2): Asian subcontinent and South East Asia. Cancer, 3, 2382-401. crossref(new window)

8.
Bhurgri Y, Bhurgri A, Nishter S, et al (2006). Pakistan - country profile of cancer and cancer control 1995-2004. J Pak Med Assoc, 56, 124-30.

9.
Boyle P, Levin B. World Cancer Report (2008). Lyon, france:international agency for research on cancer; 2008.

10.
Bradley CJ, Given CW, Roberts C. (2001) Disparities in cancer diagnosis and survival. Cancer, 91, 178-88. crossref(new window)

11.
Carey LA, Perou CM, Livasy CA, et al (2006). Race, breast cancer subtypes and survival in the carolina breast cancer study. JAMA, 295, 2492-502. crossref(new window)

12.
Carvalho FM, Bacchi LM, Pincerato KM, Rijn MVD, Bacchi CE (2014). Geographic differences in the distribution of molecular subtypes of breast cancer in Brazil. BMC Women's Health, 14, 102. crossref(new window)

13.
Cianfrocca MO, and Gradishar W (2009). New molecular classifications of breast cancer. CA Cancer J Clin, 59, 303-13. crossref(new window)

14.
Echeverria SE, Borrell LN, Brown D, Rhodes G (2009). A local area analysis of racial, ethnic and neighbourhood disparities in breast cancer staging. Cancer Epidemiol Biomarkers Prev, 18, 3024-9. crossref(new window)

15.
Ghoncheh M, Hafshejani AM,Salehiniya H (2015). Incidence and mortality of breast cancer and their relationship to development in Asia. Asian Pac J Cancer Prev, 16, 6081-7. crossref(new window)

16.
Gilani GM, Kamal S, Akhter AS (2003). A differential study of breast cancer patients in Punjab, Pakistan J Pak Med Assoc, 53, 478-80.

17.
Goldhirsch A, Wood WC, Coates AS, et al (2011). 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, 22, 1736-47. crossref(new window)

18.
Gorin SS, Heck JE, Cheng B, Smith SJ (2006). Delays in breast cancer diagnosis and treatment by racial/ethnic group. Arch Intern Med, 166, 2244-52. crossref(new window)

19.
Groot MT, Baltussen R, Groot CAU, Anderson BO, Hortobagyi GN (2006). Costs and health effects of breast cancer interventions in epidemiologically different regions of Africa, North America and Asia. Breast, 12, 81-90. crossref(new window)

20.
Igene H (2008). Global health inequalities and breast cancer: an impending public health problem for developing countries. Breast, 14, 428-34. crossref(new window)

21.
Ishikawa T, Hamaguchi Y, Ichikawa Y, et al (2002). Locally advanced mucinous carcinoma of the breast with sudden growth acceleration: a case report. Jpn J Clin Oncol, 32, 64-7. crossref(new window)

22.
Kakarala M, Rozek L, Cote M, Liyanage S, Brenner DE (2010). Breast cancer histology and receptor status characterization in Asian Indian and Pakistani women in the U.S. a SEER analysis. BMC Cancer, 10, 191. crossref(new window)

23.
Khan TM, Leong JPY, Ming LC, Khan AH (2015). Association of knowledge and cultural perception of Malaysian women with delay in diagnosis and treatment of breast cancer: a systematic review. Asian Pac J Cancer Prev, 16, 5349-57. crossref(new window)

24.
Khokher S, Mahmood S, Khan SA (2010). Response to Neoadjuvant chemotherapy in patients with advanced breast cancer: A local hospital experience. Asian Pac J Cancer Prev, 11, 303-8.

25.
Khokher S, Qureshi W, Mahmood S, Saleem A, Mahmud S (2011). Knowledge attitude and preventive practices of women towards breast cancer in educational institutions of Lahore, Pakistan. Asian Pac J Cancer Prev, 12, 2419-24.

26.
Khokher S, Qureshi MU, Riaz M, Akhtar N, Saleem A (2012). Clinicopathologic profile of breast cancer patients in Pakistan: Ten years data of a local cancer hospital. Asian Pac J Cancer Prev, 13, 693-8 crossref(new window)

27.
Leong SPL, Shen ZZ, Liu TJ, Agarwal G, et al (2010). Is breast cancer the same disease in Asian and Western countries? World J Surg, 34, 2308-24. crossref(new window)

28.
Li CI, Daling JR, Malone KE, Bernstein L, et al (2006). Relationship between established breast cancer risk factors and risk of seven different histologic types of invasive breast cancer. Cancer Epidemiol Biomarkers Prev, 15, 946-54. crossref(new window)

29.
Malik AM, Pathan R, Shaikh NA, Qureshi JN, Talpur KA (2010). Pattern of presentation and management of Ca Breast in developing countries. There is a lot to do. J Pak Med Assoc, 60, 718-721.

30.
Merkin SS, Stevenson L, Powe N (2002). Geographic socioeconomic status, race and advanced stage breast cancer in New York city. Am J Pub Health, 92, 64-70. crossref(new window)

31.
Moore MA, AriyaratneY, Badar F, et al (2009). Cancer epidemiology in South Asia- Past, present and future. Asian Pac J Cancer Prev, 10, 49-67.

32.
Newman LA (2015) Disparities in breast cancer and African ancestory: Global perspective. Breast, 21, 133-9. crossref(new window)

33.
Parkin DM (2004). International variation. Oncogene, 23, 6329-40. crossref(new window)

34.
Perou CM, Sorlie T, Eison MB, et al (2000). Molecular portraits of human breast tumors. Nature, 406, 747-52 crossref(new window)

35.
Phipps AI, Buist DS, Malone KE, et al (2011). Reproductive history and risk of three breast cancer subtypes defined by three biomarkers. Cancer Causes Control, 22, 399-405. crossref(new window)

36.
Sariego J (2009). Pattern of breast cancer in United States: Does geography matter? Am Surg, 75, 545-50.

37.
Siegel RL, Miller KD, Jemal A (2015). Cancer statistics 2015. CA Cancer J Clin, 65, 5-29. crossref(new window)

38.
Singh M, Ding Y, Zhang LY, et al (2014). Distinct breast cancer subtypes in women with early-onset disease across races. Am J Cancer Res, 4, 337-52.

39.
Singletary SE, Connolly JL (2006). Breast cancer staging: working with the sixth edition of the AJCC cancer staging manual. CA Cancer J Clin, 56, 37-47. crossref(new window)

40.
Talpur AA, Srahio AR, Ansari A, Ghumro AA (2011). Late Presentation of breast cancer: a Dilemma. JPMA, 61, 662-6.

41.
Yersal O and Barutca S (2014). Biological subtypes of breast cancer: Prognostic and therapeutic implications. World J Clin Oncol, 5, 412-24. crossref(new window)