|Year : 2018 | Volume
| Issue : 3 | Page : 71-74
Cross-sectional descriptive study on the epidemiology of operated female breast tumor cases in a tertiary hospital of Saudi Arabia
Khlood Mohammed Bosaeed1, Khandaker Abu Talha2, Mohammad Asadullah3, Mohamed Abdul Samie Mitkis3, Reham Yousef Al-Ghamdi1, Abdulelah Saleh Al-Gthami1, Albandari Khalid Al-Thubaiti1, Sara Mohammed Alshahrani1
1 Intern in General Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
2 Department of Neurosurgery, King Faisal Hospital Taif, Taif, Saudi Arabia
3 Department of Surgery, King Faisal Hospital Taif, Taif, Saudi Arabia
|Date of Web Publication||10-Sep-2018|
Dr. Reham Yousef Al-Ghamdi
College of Medicine, Taif University, Taif
Source of Support: None, Conflict of Interest: None
Patient's presentation with breast lump is increasing day by day all over the world. There are different causes of breast lumps. Some of them are benign and others are malignant.
Aim of Study: The aim of the study was to find out the breast tumor patients according to their histological types and age groups.
Methodology: This is a cross-sectional descriptive study on the operated breast lump patients in a tertiary hospital of Saudi Arabia. All the breast lump cases operated and diagnosed as breast tumor were included in the study. Data were collected from the operation room registrar, patient file, and histopathology report of the participants. The study period was 5 years. Total number of cases was 192.
Result: Two-third of the operated cases was benign, and one-third of the cases was malignant. The mean age of presentation of benign cases was 29.52 years, and the same of malignant cases was 47.31 years. The most common histopathological subtype of benign cases was fibroadenoma (100%). The different histopathology of malignant tumors was infiltrating ductal (86%), ductal in situ (9%), and invasive lobular (5%). After comparing the epidemiological variables of this study with those of different parts of the world, it has been revealed that the onset age and histopathological subtypes are different in different geographical locations.
Keywords: Breast cancer, breast lump, fibroadenoma
|How to cite this article:|
Bosaeed KM, Talha KA, Asadullah M, Mitkis MA, Al-Ghamdi RY, Al-Gthami AS, Al-Thubaiti AK, Alshahrani SM. Cross-sectional descriptive study on the epidemiology of operated female breast tumor cases in a tertiary hospital of Saudi Arabia. Saudi Surg J 2018;6:71-4
|How to cite this URL:|
Bosaeed KM, Talha KA, Asadullah M, Mitkis MA, Al-Ghamdi RY, Al-Gthami AS, Al-Thubaiti AK, Alshahrani SM. Cross-sectional descriptive study on the epidemiology of operated female breast tumor cases in a tertiary hospital of Saudi Arabia. Saudi Surg J [serial online] 2018 [cited 2018 Sep 22];6:71-4. Available from: http://www.saudisurgj.org/text.asp?2018/6/3/71/240913
| Introduction|| |
A breast lump is any discrete mass noticed by the patient or physician. Rarely, nonpalpable masses may be detected by screening mammography. The most important risk factors are age of menarche, age of menopause, use of steroid, birth control pills, previous breast surgery, history of trauma to breast, and exposure to radiation.
Clinical presentations of benign breast disease are pain, lumps, or breast discharge. Breast cancer in early stage does not cause pain. When cancer grows, it causes changes in the size or shape of the breast. In advanced cases, the tumor can show signs of ulceration of the skin, and fixation to the chest wall, and in the advanced cases lymphadenopathy and distant metastasis.
Triple testing – a combination of clinical examination, imaging, and nonsurgical biopsy is essential for all women who have a significant clinical finding such as an asymmetrical thickening or a discrete palpable mass.
Breast cancer is the most common female cancer worldwide representing nearly a quarter (25%) of all cancers with an estimated 1.67 million new cancer cases diagnosed in 2012. Women from less-developed regions (883,000 cases) have slightly more number of cases compared to more developed (794,000) regions. According to the latest edition of United States Preventive Services Task Force (USPSTF) biennial screening mammography is recommended for all women aged 50–74 years.
Like any tumors, the breast tumors are classified into benign and malignant. The majority of breast tumors are benign. The common benign breast tumors are fibroadenoma and breast cysts. Most frequently diagnosed breast cancers are ductal carcinoma in situ (85%–90%), lobular carcinoma in situ (about 8%), and infiltrating lobular carcinoma (10%–15%).
This is a cross-sectional descriptive study to find out the epidemiological distribution of the breast tumor cases operated at a tertiary hospital of Saudi Arabia. The aim of the study was to find out the breast tumor patients according to their histological types and age groups. All the breast lump cases operated and diagnosed as breast tumor were included in the study. The study period was 5 years. Total number of cases was 192. Data were collected from the operation room registrar, patient file, and histopathology report of the participants. After identifying the cases, data were collected and documented in Microsoft Excel sheet. Different tables and charts were made according to different parameters.
| Results|| |
[Table 1] shows that the total number of the breast tumors was 192. Nearly one-third (64) of them were malignant, and other 67 cases were malignant in nature. The mean age of the malignant cases was 47.31 years with 11.29 years of standard deviation (SD). On the other hand, the mean age of the benign tumors was 29.52 years with SD of 12.35 years.
|Table 1: Distribution of breast tumors according to types, percentage, mean age, and standard deviation of age (n=192)|
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[Table 2] illustrates that there were three subtypes of malignant breast tumors were operated. The most common malignant tumor was infiltrating ductal (86%) followed by ductal in situ (9%) and invasive lobular (5%), respectively. Infiltrating ductal was nearly one-third of the total operated cases. Benign tumors were two-third (128) of all breast tumor cases.
|Table 2: Distribution of breast tumors according to subtypes and their percentage (n=192)|
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[Table 3] reveals that most (45%) of the fibroadenoma patients were in the 20–29 years age group. The next common (20.3%) was 30–39 years age group followed by below 19 years age group (15%). Only 17 patients represented the 40–49 years age group followed by 4.5% and 1.5%, respectively, in 50–59 years and above 60 years age group.
|Table 3: Distribution of fibroadenoma patients according to the age frequency (n=128)|
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[Table 4] shows that the highest number of malignant patients (29.68%) was in 40–49 years age group. The next common age group was 50–59 years (26.56%) followed by 30–39 (21.87%) age group. Below 19-year and above 60-year group had only three and two cases, respectively.
|Table 4: Distribution of malignant breast tumor patients according to the age frequency (n=64)|
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[Figure 1] demonstrates that the percentages of cases in both groups were nearly equal in 30–39 years group. The percentage of benign tumor was higher in younger age groups. In contrast, the malignant patients were predominant in adult- and middle-age groups. The percentages of above 60 years group showed a similarity [Figure 2] and [Figure 3].
|Figure 1: Comparison of age frequencies between benign and malignant breast tumor cases. Figure 1 demonstrates that the percentages of cases in both groups were nearly equal in 30–39 years group. The percentage of benign tumor was higher in younger age groups. In contrast, the malignant patients were predominant in adult- and middle-age groups. The percentages of above 60 years group showed a similarity|
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| Discussion|| |
Coriaty Nelson et al. performed their cohort study (2000) on breast tumor, and they found almost 90% of the 1507 women who developed fibroadenoma were younger than 45 years of age at diagnosis, while only 2% were 50 years of age or older when diagnosed. In this study, it was found that almost 94% patients who developed fibroadenoma were younger than 50 years, while only 6% were 50 years and older.
The epidemiological study of breast cancer done in Europe and Africa showed the mean ages of presentation were different according to the races. The mean age was 48 years in Africa, and approximately two-third of the cases were premenopausal. On the other hand, the majority of the European women were diagnosed after menopause. The mean age in black women in the UK was similar to African women (46 years), but the mean was 67 years for white women. Compared to this result, the mean age of malignant cases was 47 years.
A retrospective study done in the Central African Republic revealed that the mean age of breast cancer was 45.83 (SD = 13.5) years, 50–54 years group was mostly affected. The most common histopathology of breast cancer was invasive ductal (64.9%). This study showed that the mean age of breast cancer was 47.31 (SD = 11.29) years, 40– 49 years group women were mostly affected, and the most common histopathology of breast cancer was infiltrating ductal carcinoma (86%).
According to the study of Eisemann et al., the highest incidence rate of breast carcinoma was found in the age group of 60–64 years. This study showed the highest incidence rate was in the age group of 40–49 years.
The epidemiological study of breast cancer among Bahraini women reported the percentage of premenopausal women diagnosed was 51.2% while 48.8% were postmenopausal. The median age at diagnosis was 49 years while the average age was 50.9 years. The majority of breast cancer cases were infiltrating ductal carcinoma (76.9%) and Grade 2 differentiated tumors (28.6%) with regional and distant metastasis (35.1%). In this study, the percentage of premenopausal women diagnosed was 70.23% while 29.77% were postmenopausal. The mean age at diagnosis was 47.31, and the most common malignant tumor was infiltrating ductal (86%) followed by ductal in situ (9%) and invasive lobular (5%), respectively. Infiltrating ductal was nearly one-third of the total operated cases.
A retrospective study done in Riyadh showed that the median age of carcinoma breast was 45 year, and the median size is 3.0 cm. They also found that the invasive ductal is higher than lobular carcinoma in young patients. The infiltrating ductal was 98.5% of below 40 years age group patients which was 93.2% in above 40 years age group patients. Compared to this study, it was found that 40.55% of patients were under the age of 40, and 29.68% were premenopause. The most common malignant tumor was infiltrating ductal 86%; however, the invasive lobular was only 5%.
A study about breast cancer trends among young women in the United States from 1975 to 2002 showed that the in situ breast cancer incidence rates increased over time for each decade of age for both the white and black women, and the invasive breast cancer incidence rates decreased over time for each decade of age for both the white and black women. In this study, the most common malignant tumor was infiltrating ductal (86%) followed by ductal in situ (9%) and invasive lobular (5%), respectively. Infiltrating ductal was nearly one-third of the total operated cases.
| Conclusion|| |
Breast lump in women is a very common condition in the world. The epidemiological parameters vary in different races and countries for this disease. After comparing the result of this study with that of international studies, it has been found that the age of onset, mean age, and histopathological findings are not similar in different geographical locations.
We are grateful to Dr. Ali Alzahrani and Dr. Najwa for facilitating our job. Their efforts made our work smooth and comfortable.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Haagensen CD. Physician's role in the detection and diagnosis of breast disease. In: Diseases of the Breast. 2nd
ed. Philadelphia: W.B. Saunders; 1971. p. 99-148.
Figueroa JD, Pfeiffer RM, Brinton LA, Palakal MM, Degnim AC, Radisky D, et al.
Standardized measures of lobular involution and subsequent breast cancer risk among women with benign breast disease: A nested case-control study. Breast Cancer Res Treat 2016;159:163-72.
Schroyen S, Adam S, Jerusalem G, Missotten P. Ageism and its clinical impact in oncogeriatry: State of knowledge and therapeutic leads. Clin Interv Aging 2015;10:117-25.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al.
Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.
Siu AL, U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive services task force recommendation statement. Ann Intern Med 2016;164:279-96.
Børresen-Dale AL. TP53 and breast cancer. Hum Mutat 2003;21:292-300.
Coriaty Nelson Z, Ray RM, Gao DL, Thomas DB. Risk factors for fibroadenoma in a cohort of female textile workers in Shanghai, China. Am J Epidemiol 2002;156:599-605.
Abdulrahman GO Jr., Rahman GA. Epidemiology of breast cancer in Europe and Africa. J Cancer Epidemiol 2012;2012:915610.
Balekouzou A, Yin P, Pamatika CM, Bishwajit G, Nambei SW, Djeintote M, et al.
Epidemiology of breast cancer: Retrospective study in the central African republic. BMC Public Health 2016;16:1230.
Eisemann N, Waldmann A, Katalinic A. Epidemiology of breast cancer – Current figures and trends. Geburtshilfe Frauenheilkd 2013;73:130-5.
Hamadeh RR, Abulfatih NM, Fekri MA, Al-Mehza HE. Epidemiology of breast cancer among Bahraini women: Data from the Bahrain cancer registry. Sultan Qaboos Univ Med J 2014;14:e176-82.
Elkum N, Dermime S, Ajarim D, Al-Zahrani A, Alsayed A, Tulbah A, et al.
Being 40 or younger is an independent risk factor for relapse in operable breast cancer patients: The Saudi Arabia experience. BMC Cancer 2007;7:222.
Tarone RE. Breast cancer trends among young women in the United States. Epidemiology 2006;17:588-90.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]