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Breast Cancer Survival in Sultanate of Oman
– Reported, June 06, 2013
Breast cancer is the leading cause of cancer-related mortality in women worldwide. Almost half of annually diagnosed females with breast cancer belong to developing countries, where they present at a younger age with advanced-stage disease. These women also have poor overall outcomes compared to women in developed countries. The advanced stage of presentation of breast cancer in developing countries was attributed to a lack of mass education and screening programs, poverty, poor access to health care facilities, lack of expertise, and poor country infrastructure .
It is an established fact that ethnic disparities affect breast cancer outcome. Despite correction of well-known factors associated with breast cancer-related outcome, such as tumor size, lymph node status, hormone receptor expression, Her2/neu gene expression, stage, and age at presentation, racial differences were prominent as prognostic factors and have been associated with genetic differences between races. Investigators have proposed multiple reasons to explain these differences between races.
The Sultanate of Oman is a developing Asian country in the Gulf Region with a developing health care system. Like women worldwide, Omani women also share major burden of breast cancer incidence and associated mortality. One out of five Omani women is diagnosed with breast cancer in her lifetime, and the age-standardized incidence rate is 15.6 per 100,000. In our last reported study, we found that age at diagnosis is younger in Oman than in the western world, and the majority of patients present at advanced stages of disease (III and IV).
The risk factors associated with poor outcome of breast cancer such as young age at presentation, advanced stage, and negative hormone receptor status have been well recognized. In addition to these well-established risk factors, quality of provided care, health awareness, access to the health care system, and sociocultural beliefs are also closely linked to the ultimate outcome of disease.
NA chemotherapy administered to patients for locally advanced breast cancer is generally accepted as the treatment of choice. This type of treatment is the reason for the increasing number of breast-conserving surgeries (BCSs) and is also associated with better OS. However, data from various papers regarding the treatment of breast cancer in developing countries clearly demonstrates the underutilization of BCS. Furthermore, most patients undergo unwarranted surgeries early in the course of the disease at peripheral hospitals or have an advanced stage of tumor growth. Similar to our previous published paper, the use of NA therapy was underutilized.
Presentation at an advanced stage is common among patients with breast cancer in undeveloped countries. Socioeconomic issues, cultural barriers, and low literacy rates have been reported as the factors responsible for advanced stage of presentation, in addition to lack of screening programs and poor access to health care facilities.
Comparisons between this and the previous study reveal that Omani breast cancer patients still present with advanced disease, poor tumor differentiation, at a young age, and have a low percentage of hormone-positive tumors, all of which are known factors associated with poor overall disease outcome. Mass education programs, health awareness measures, and establishing screening programs are basic ways to decrease the disease burden and enable diagnosis at earlier stages of disease.
CREDITS.
Shiyam Kumar, Ikram A. Burney, Adel Al-Ajmi, and Mansour S. Al-Moundhri
http://www.ncbi.nlm.nih.gov/
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