Epidemiology and clinical profile of breast cancer in central Nepal
In this study, our objective was to determine the epidemiological and clinical profile of breast cancers. Different Literatures have highlighted the correlation between stage and age at diagnosis, size and age at diagnosis, correlations of different hormone receptor status with different age group etc. but precise documentation is lacking in Nepal. Methods and Materials: The study was conducted at department of medical oncology, Nepal cancer hospital and research center from Dec 2014 to June 2016 and 183 patients diagnosed with breast cancer were enrolled. A retrospective cross sectional study was conducted. Results: Prevalence of breast cancer was 5.59 Newar was the most affected ethnic group. The most frequent age group was 40 to 49. The most common symptom was mass in 80 of patients. Stage II (49.1 was the most common stage at diagnosis. 83% patients had a tumor size of 2 5 cm with average size of 3.25 cm at presentation. Younger women with cancer had a strong correlation with ER ve/PR ve and Her 2/Neu+ve receptor status with P<0.05. Triple Negative receptor status was 32.87 Her2/neu +ve receptor status cancer was 39.72% Conclusion: Majority of patients presented with Stage IIa and IIIa disease breast cancer. Disease is more aggressive and diagnosed at a more advanced stage in younger women. Younger women had a strong correlation with ER ve/PR ve and her 2/neu +ve receptor. Recommendation for the Her 2/Neu receptor test should be done in every case of breast cancer. Triple negative status was lower in comparison to the previous studies which is favorable for hormonal antibody treatment implementation. ABBREVIATIONS ER: Estrogen Receptor; PR: Progesterone Receptor; Her 2/ Neu: Human Epidermal Growth Factor Receptor; TNM: Tumor Node Metastasis; AJCC: American Joint Committee on Cancer INTRODUCTION Cancer is a group of disease that causes cells in the body to change and grow out of control [1] These are neoplastic disorders caused due to excessive proliferation of cells. Cancer is one of the most dreaded non communicable diseases that have made them most important contributor to the global burden of disease [2] Since, Cancer is a multi cellular disease that causes excessive proliferation of cells; continual future research on cancer trends is warranted to study the actual cancer scenario. Background Worldwide scenario: Breast cancer ranks as the fifth cause of death from cancer overall (522,000 deaths) and while it is the most frequent cause of cancer death in women in less developed regions (324,000 deaths, 14.3% of total) it is now the second cause of cancer death in more developed regions (198,000 deaths, 15.4% after lung cancer. The incidence of breast cancer varies markedly from country to country being highest in United States and Northern Europe and lowest in Asia. In developed countries the incidence of breast cancer is more than 1000 per million, whereas in developing countries, it is less than 200 per million women. However, cancer mortality is higher in developing countries than in the developed countries [3] The mortality rates are less than that for incidence because of the more favorable survival of breast cancer in (highincidence) developed regions, with rates ranging from 6 per 100,000 in East Asia to 20 per 100,000 in Western Africa [4] In Western Europe also, breast cancer incidence has reached more than 90 new cases per 100,000 women annually, compared with 30 per 100,000 in East Africa. In contrast, breast cancer mortality rates in these two regions are almost identical, at about 15 per 100,000, which clearly points to a later diagnosis and much poorer survival in eastern Africa. An urgent need in cancer control today is to develop effective and affordable approaches to the early detection, diagnosis, and treatment of breast cancer Central Bringing Excellence in Open Access Shrestha et al. (2016) Email: Ann Breast Cancer Res 1(1) 1005 (2016) 2/5 among women living in less developed countries," explains Dr Christopher Wild, Director of IARC. "It is critical to bring morbidity and mortality in line with progress made in recent years in more developed parts of the world [5] In developing countries, patients have limited access to screening, or any effective awareness programs and consequently advanced disease. Thus, the growing incidence of breast cancer worldwide stresses the greater need for a study of its rise and the need for awareness about it in developing nations. Scenario in Nepal: According World Health Organization (2008) breast cancer accounts for 6% of all cancers in Nepal. The commonest age group of women with breast cancer in Nepal is 40 50 years. This is a remarkable difference in higher incidence of younger than 50 years age [6] Latest data of WHO data published in 2011, breast cancer death in Nepal has reached 1,248 or 0.84% of total deaths. The age adjusted death rate is 12.92 per 100,000of population. Nepal ranks number 142 in the world [7] According to Singh YP, Sayami P in management of cancer in Nepal, cancer education, screening and early detection are the key elements to influence the diagnosis, treatment and prognosis of breast cancer also it can be cured in the majority of the cases, if diagnosed early stages [3] but the Hospital record shows that Nepali women reach to get medical help when the disease is already in an advanced stage [8] In our study; we attempted to make epidemiological observation of breast cancer patients in one of the major tertiary care hospital for cancer treatment in the central region of Nepal. The distribution of breast cancer based on the basis of ethnicity, age, duration, sex and clinical profile was recorded. Few studies have been done signifying the importance of hormonal receptor status in breast cancer worldwide, including Nepal [12] but here we focused to understand the association between ER/PR/ HeR 2 receptor status with age, aggressiveness (stage and size) of disease with age, prevalence of triple negative status, Her2/receptor status, ER/PR status for the better implication of hormonal treatment and screening in appropriate group. MATERIALS AND METHODS A retrospective cross sectional study was conducted. Study site The study was conducted at the Nepal Cancer Hospital and Research Center. The collection of data was done by the inpatient medical record files of breast cancer patients who were registered at the hospital from December 2014 to June 2016. Data collection A modified data collection form was used to collect the information. Operation Modality The in patient record files were obtained from the hospital and the specified fields in the form were filled. The data collection was performed by all the members of the research group and was cross checked with one another for any missed information. 183 diagnosed cases of breast cancer attending the oncology outpatient department were consecutively enrolled. Patients with an inconclusive diagnosis were excluded. Detailed history, clinical examination and necessary investigation reports was recorded. Histological features including receptor status were recorded. Tumor Node Metastasis (TNM) staging system was as per American Joint Committee on Cancer (AJCC) sixth edition [9] There was no any direct patient contact or interview during the research. Data was entered into the Excel and later test of significance was applied as required. Analysis was done in SPSS [13] Sample Size 183 diagnosed cases of breast cancer were registered.