Abstract
In the Kingdom of Saudi Arabia (KSA), hospital and population based statistics have shown that breast cancer has the highest crude frequency rate among Saudi women. The scarcity of reports about the disease in the KSA has been the impetus to this analysis about breast cancer in the eastem province of KSA. Data on female patients with invasive breast carcinoma seen at King Fahd Hospital of the University in the eastern province of KSA, were retrospectively reviewed. The analysis intended to examine the pattern of the disease and the outcome for patients. Between 1985 and 1995, 292 patients were identified. Their median age±SD (standard deviation) was 42±10.5 years. Most patients were younger than 50 years (78%) and were predominantly premenopausals (79%). Only 25 (9%) of patients had stage I cancer, whilst 130 (44%), 90 (30%), and 47 (16%) had stage II, III, and IV, respectively. Among patients with known axillary nodal status (242 patients), only 37% were node-negative whilst 32% and 31% had 1–3, and ≥4 positive nodes, respectively. Adjuvant chemotherapy and tamoxifen were commonly offered; nonetheless, other adjuvant modalities were rarely utilised. The median follow-up ±SD of all patients was 62.3±8.9 months: 152 patients (52%) were alive with no evidence of disease, 25 (9%) were alive with evidence of disease, and 115 (39%) were dead from breast cancer or its related complications. The median survival of the entire group was not obtained, but the 10-year projected survival was 55%. For stage I and II patients, 118 (76%) were alive with a projected 10-year actuarial survival of 64%. On the other hand, only 51 (57%) of patients with stage III disease were alive with a median survival of 41.5 months (95% Confidence interval (CI), 18.9 to 51.3). Patients with stage IV disease demonstrated a poor outcome with a median survival of 23.5 (95%, CI 12.2 to 31.4). Multivariate analyses were performed to explore the influence of independent variables on overall survival (OS) for patients with non-metastatic disease. Besides the expected adverse effect of disease progression, the favourable influence of adjuvant chemotherapy and tamoxifen prevailed. The amount of benefit gained from tamoxifen, however, was small. Similar analyses were undertaken to determine the influence of independent variables on progression-free survival (PFS). These analyses ascertained the adverse effects of advanced stage and the favourable impact of adjuvant chemotherapy. Breast cancer in the KSA has features that are distinctive from those of industrialised countries. Survival data, however, were comparable. The favourable influence of adjuvant chemotherapy was evident on both OS and PFS. Adjuvant tamoxifen, however, had little effect. Due to its infrequent use, the role of other adjuvant modalities could not be asserted.
Similar content being viewed by others
References
Parker SL, Tong T, Bolden S, Wingo PA. Cancer statistics 1996.Ca-A Cancer J Clin 1996;46: 5–27.
Parkin DMet al (Eds).Cancer Incidence in Five Continents. IARC: Lyon, 1992, vol 6, Scientific Publication 120.
Mahboubi E.Epidemiology of cancer in Saudi Arabia, 1975–1985.Ann Saudi Med 1987;7: 265–276.
Ezzat Aet al. An overview of breast cancer.Ann Saudi Med 1997;17: 10–15.
Al-Tamimi Tet al. Cancer in the Eastern Region of Saudi Arabia: a population-based study (1987–1988).Ann Saudi Med 1997;17: 53–66.
Omer YT, Gjorgov AN, Ismail AS, Tabik MA. Cancer trends in Kuwait (1974–1982). In: M. Khogali, YT Omer, A Gjorgov, AS Ismail (eds).Cancer Prevention in Developing Countries Pergamon: London, 1986, p 25–34.
Ibrahim EM. Pattern and prognosis of breast cancer at a referral center in Saudi Arabia.Breast Dis 1990;3: 187–198.
Ibrahim EM. Pattern and prognosis of breast cancer: data from the Eastern Province of Saudi Arabia.Saudi Med J 1991;12: 227–231.
Harmanek P, Sobin LH.TNM Classification of Malignant Tumors. UICC International Union Against Cancer Springer-Verlag: Berlin, 1987.
American Joint Committee on Cancer.Manual for Staging of Cancer, 4th edn. Lippincott: Philadelphia, 1992, pp 149–154.
Haagensen CD, Stout AP. Carcinoma of the breast: Criteria of inoperability.Ann Surg 1943;118: 859–870.
World Health Organization.Handbook for Reporting Results of Cancer Treatment WHO: Switzerland, 1979, no. 48, 16–21.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations.J Am Stat Ass 1958;53: 457–481.
Brookmeyer R, Crowley J. A confidence interval for the median survival time.Biometrics 1982;38: 29–41.
Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration.Cancer Chemother Rep 1966;50: 163–170.
Cox DR, Oakes D. Regression models and life tables (with discussion).J Roy Stat Soc 1972;B34: 187–220.
Kalbfleisch JD, Prentice RL.The Statistical Analysis of Failure Time Data. Wiley: New York, 1980.
Kay R. Proportional hazard regression models and the analysis of censored survival data.Appl Stat 1977;26: 227–237.
Dixon WJ, Brown MB, Engelman L, Jennrich RI.BMDP Statistical Software Manual. University of California Press: Berkeley, 1990.
Brufman Get al. Neoadjuvant chemotherapy (cyclophosphamide, adriamycin, and 5FU) for clinical Stage III breast cancer. Fourth International Congress on Anticancer Chemotherapy. 2–5 February 1993, Paris, p 58.
Early Breast Cancer Trialists' Collaborative Group. Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy. 133 randomized trials involving 31,000 recurrences and 24,000 deaths among 75,000 women.Lancet 1992;339: 1–15.
Early Breast Cancer Trialists' Collaborative Group. Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy. 133 randomized trials involving 31,000 recurrences and 24,000 deaths among 75,000 women.Lancet 1992;339: 71–85.
Early Breast Cancer Trialists' Collaborative Group. Effects of radiotherapy and surgery in early breast cancer.N Engl J Med 1995;333: 1444–1455.
Early Breast Cancer Trialists' Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomized trials.Lancet 1998;351: 1451–1466.
Saarto T, Blomqvist C, Grohen P, Rissanen P, Elomaa I. The prognosis of stage III breast cancer treated with postoperative radiotherapy and adriamycin-based chemotherapy with and without tamoxifen. Eight year follow-up results of a randomized trial.Eur J Surg Oncol 1995;21: 146–150.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ibrahim, E.M., Al-Mulhim, F.A., Al-Amri, A. et al. Breast cancer in the eastern province of Saudi Arabia. Med Oncol 15, 241–247 (1998). https://doi.org/10.1007/BF02787207
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF02787207