Breast cancer is one of the most frequent malignancies among Iranian women, however; the epidemiological aspects of breast cancer among Iranian patients are uncertain. A literature review of the published articles from January 1998 to December 2005 was conducted using different search engines: MEDLINE, Scientific information data base of Academic Center for Education, Culture and Research, and over 2000 issues of 94 Persian medical journals. The headings "Breast Cancer,""Breast Tumor,""Breast Malignancy," and "Breast Carcinoma" were combined with the word "Iran" to execute the search. In all, 85 full papers were reviewed. These findings showed that participants ranged from 15 to 84 years old, with those 40-49 being the most prevalent. The incidence of breast cancer in women was 22 per 100,000. The prevalence in this same population was 120 per 100,000. Stage I was diagnosed in 18%, stage II in 57% and stage III in 25% of the cases. About 72% of the patients were diagnosed with a tumor over 2 cm. Sixty-three percent of the patients had lymph node involvement at the diagnostic time. Infiltrative ductal carcinoma was found to be the most common at 77% and lobular carcinoma the least at 5%. This review indicates that the epidemiological aspects of breast cancer in Iran are relatively well-studied. Shortcomings in study of its clinical aspects are evident and need to be a central part of upcoming investigations.

Breast cancer in Iran: an epidemiological review.

This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages I and II, only 20%-50% patients in the majority of low- and middle-income countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existent in these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.

Challenges to the early diagnosis and treatment of breast cancer in developing countries.

Breast cancer is the most common cancer in women in both developed and developing countries and the second most common cancer in the world. Developing countries are increasingly adopting a Western lifestyle, such as changes in diet and delayed first childbirth, lower parity, and shorter periods of breastfeeding, which are important determinants of a higher incidence of breast cancer among those regions. Low- and middle-income countries (LMICs) represent most of the countries with the highest mortality rates, ranging from 40% to 60%. Furthermore, developing countries account for scarce survival data, and the few data available coincide with the observed incidence and mortality differences. Five-year survival rates for breast cancer are much worse for LMICs countries such as Brazil, India, and Algeria in comparison with the United States and Sweden. Paucity of early detection programs explain these poor survival rates, which results in a high proportion of women presenting with late-stage disease, along with lack of adequate diagnosis and treatment facilities. Emphasis is urgently needed on health education, to promote early diagnosis of breast cancer, highlighting the importance of creating more public facilities that provide treatment, which are key components for the improvement in breast cancer care in developing countries.

https://journals.sagepub.com/doi/pdf/10.1177/1178223417752677

Delays in Breast Cancer Detection and Treatment in Developing Countries

Background.
Breast cancer incidence is increasing in low- and middle-income countries (LMICs). Mortality/incidence ratios in LMICs are higher than in high-income countries, likely at least in part because of delayed diagnoses leading to advanced-stage presentations. In the present study, we investigated the magnitude, impact of, and risk factors for, patient and system delays in breast cancer diagnosis in Rwanda.

Delays in Breast Cancer Presentation and Diagnosis at Two Rural Cancer Referral Centers in Rwanda

Background. Within the developing world, many personal, sociocultural, and economic factors cause delayed patient presentation, a prolonged interval from initial symptom discovery to provider presentation. Understanding these barriers to care is crucial to optimizing interventions that pre-empt patient delay. Methods. A systematic review was conducted querying: PubMed, Embase, Web of Science, CINAHL, Cochrane Library, J East, CAB, African Index Medicus, and LiLACS. Of 763 unique abstracts, 122 were extracted for full review and 13 included in final analysis. Results. Studies posed variable risks of bias and produced mixed results. There is strong evidence that lower education level and lesser income status contribute to patient delay. There is weaker and, sometimes, contradictory evidence that other factors may also contribute. Discussion. Poverty emerges as the underlying common denominator preventing earlier presentation in these settings. The evidence for sociocultural variables is less strong, but may reflect current paucity of high-quality research. Conflicting results may be due to heterogeneity of the developing world itself. Conclusion. Future research is required that includes patients with and without delay, utilizes a validated questionnaire, and controls for potential confounders. Current evidence suggests that interventions should primarily increase proximal and affordable healthcare access and secondarily enhance breast cancer awareness, to productively reduce patient delay.

/pdf/a-systematic-review-of-barriers-to-breast-cancer-care-in-1dfzmxgg19.pdf

R. Moghimi

Papers

Patient delay in women presenting with advanced breast cancer: an Iranian study