Breast Cancer Stage at the Time of Presentation: Clinicopathological Correlations

Background: Breast cancer is the most frequently diagnosed malignancy and the second leading cause of mortality among women in Iraq forming 23% of cancer related deaths. The low survival from the disease is a direct consequence to the advanced stages at diagnoses.

Aim: To document the composite stage of breast cancer among Iraqi patients at the time of diagnosis; correlating the observed findings with other clinical and pathological parameters at presentation.

Patients and Methods: A retrospective study enrolling the clinical and pathological characteristics of 448 Iraqi female patients diagnosed with breast cancer. The composite stage of breast cancer was determined according to UICC TNM Classification System of Breast Cancer and the American Joint Committee on Cancer Staging. The studied parameters comprised age of the patient, stage of the disease, marital and educational status, history of lactation and hormonal intake (for a minimum period of 6 months), family history of breast or any other cancer, the effected breast side, hormone (Estrogen and Progesterone) receptor (ER, PR) and Her2 contents of the primary cancer. Statistical analysis was performed to correlate the recorded composite stages at diagnosis with the corresponding clinical and pathological data utilizing SPSS version 16.0 statistical program.

Results: Out of 448 patients, four (0.9%) had ductal carcinoma in situ (Stage 0). Stages I, II and III were documented in 7.6%, 46.9% and 39.3% respectively; while only 5.4% presented in Stage IV. No correlation was elicited between the stage of breast cancer and the age of the patients or the history of lactation. A significant association was demonstrated with the marital and educational status, history of hormonal intake, contralateral breast involvement and familial cancer. The ER+PR+Her2+ (Triple Positive/Luminal B), ER-PR-Her2- (Triple Negative), ER+PR+Her2- (Luminal A) and ER-PR-Her2+ (Her2) subtypes were detected in 13.4%, 11.8%, 48.2% and 9.8% respectively. When correlating the composite stage with the corresponding breast cancer subtypes, categorized according to the immunohistochemical staining, the relationship was highly significant at p < 0.01.

Conclusions and Recommendations: The regression in Stage IV breast cancer at the time of presentation among Iraqi patients represents one of the fruitful outputs of initiating the National Program for Early Detection of Breast Cancer. Further professional efforts, endorsed by practical policy decisions, are recommended to down stage breast cancer through promoting evidence based protocol guidelines and adopting comprehensive well designed diagnostic, screening and cancer control strategies.