Assessment of Predictive Confounders for the Prevalence of Breast Cancer among Iraqi Population: A Retrospective Study from Baghdad, Iraq
Although breast cancer prevalence continues to increase, mortality has been decreasing as a result of early detection and improvement in adjuvant systemic therapy. Nevertheless, this disease required further efforts to understand and identify the associated potential risk factors that could play a role in the prevalence of this malignancy among Iraqi women. The objective of this study was to assess the perception of certain predictive risk factors on the prevalence of breast cancer types among a sample of Iraqi women diagnosed with breast cancer. This was a retrospective observational study carried out at National Cancer Research Center in College of Medicine, Baghdad University from November 2017 to January 2018. Data of 100 patients with breast cancer whose biopsies examined in the National Cancer Research Center were included in this study. Data were collected to structure a detailed assessment regarding the patients’ demographic, medical and cancer records. The majority of study participants (94%) suffered from ductal breast cancer with mean age 49.57 years. Among those women, 48.9% were obese with body mass index (BMI) 35 kg/m2. 68.1% of them had positive family history of breast cancer and 66% had low parity. 40.4% had stage II ductal breast cancer followed by 25.5% with stage III. It was found that 59.6% and 68.1% had positive oestrogen receptor sensitivity and positive human epidermal growth factor (HER2/neu) receptor sensitivity respectively. In regard to the impact of prediction of certain variables on the incidence of ductal breast cancer, positive family history of breast cancer (P < 0.0001), low parity (P< 0.0001), stage I and II breast cancer (P = 0.02) and positive HER2/neu status (P < 0.0001) were significant predictive factors among the study participants. The results from this study provide relevant evidence for a significant positive and potential association between certain risk factors and the prevalence of breast cancer among Iraqi women.
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 J. Cuzick, I. Sestak, B. Bonanni, JP. Costantino, S. Cummings, A. DeCensi, et al., ‘‘Selective oestrogen receptor modulators in prevention of breast cancer: an updated meta-analysis of individual participant data,’’ Lancet; vol. 381, no.9880, pp.1827-34, 2013.
 CE. DeSantis, CC. Lin, AB. Mariotto, RL. Siegel, KD. Stein, JL. Kramer, et al., ‘‘Cancer treatment and survivorship statistics, 2014,’’ CA Cancer J Clin., vol. 64, pp. 252–71, 2014.
 DA. Berry, KA. Cronin, SK. Plevritis, DG. Fryback, L. Clarke, M. Zelen , et al., ‘‘Effect of screening and adjuvant therapy on mortality from breast cancer,’’ N Engl J Med., vol. 353,pp. 1784–92, 2005.
 S. Sharma, ‘‘Tumor markers in clinical practice: General principles and guidelines,’’ Indian J Med Paediatr Oncol, vol.30, no. 1, pp. 1–8, 2009.
 FH. Schröder, J. Hugosson, MJ. Roobol, TL. Tammela , S. Ciatto , V. Nelen , et al., ‘‘Screening and prostate-cancer mortality in a randomized European study, ’’N Engl J Med., vol. 360, no. 13, pp. 1320-8, 2009.
 SS. Buys, E. Partridge, A. Black, CC. Johnson , L. Lamerato , C. Isaacs , et al, ‘‘Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial,’’ JAMA, vol. 305, no.22, pp. 2295–303, 2011.
 DW. Cramer, RC Jr. Bast, CD. Berg, EP. Diamandis , AK. Godwin , P. Hartge, et al.,‘‘Ovarian cancer biomarker performance in prostate, lung, colorectal, and ovarian cancer screening trial specimens,’’. Cancer Prev Res (Phila), vol. 4, no. 3, pp. 365-74, 2011.
 C. Biesheuvel, S. Weigel, W. Heindel, ‘‘Mammography Screening: Evidence, History and Current Practice in Germany and Other European Countries, ’’ Breast care (Brasel, Switzerland), vol. 6, no. 2, pp.104–109, 2011.
 P. Lal, LK. Tan, B. Chen, ‘‘Correlation of HER-2 Status with Estrogen and Progesterone Receptors and Histologic Features in 3,655 Invasive Breast Carcinomas,’’ Am J Clin Pathol. vol. 123, no. 4, pp. 541-6, 2005.
 DJ. Slamon, GM. Clark, SG. Wong, WJ. Levin, A. Ullrich, WL. McGuire, ‘‘Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene’’ Science, vol. 235, no.4785, pp. 177-82, 1987.
 MP. DiGiovanna, P. Chu, TL. Davison, CL. Howe, D. Carter, EB. Claus et al., ‘‘Active signaling by HER-2/neu in a subpopulation of HER-2/neu-overexpressing ductal carcinoma in situ: clinicopathological correlates, ’’ Cancer Res., Vol. 62, no. 22, p. 6667-73, 2002.
 T. Petit, P. Dufour, I Tannock, ‘‘A critical evaluation of the role of aromatase inhibitors as adjuvant therapy for postmenopausal women with breast cancer,’’ Endocr. Relat Cancer, vol. 18, no.3, pp. R79–89, 2011.
 Pich, E. Margaria E, L. Chiusa, ‘‘Oncogenes and male breast carcinoma: c-erbB-2 and p53 coexpression predicts a poor survival’’ J Clin Oncol. , vol. 18, no. 16, pp. 2948–56, 2000.
 M. Veljković, S. Veljković , ‘‘The risk of breast cervical, endometrial and ovarian cancer in oral contraceptive users’’ Med pregl., vol. 63, no. (9–10), pp. 657–61, 2010.
 WN. Hait, ‘‘The Prognostic and Predictive Values of ECD-HER-2, ’’ Clin Cancer Res. vol. 7, no. 9, pp. 2601-4, 2001.
 IL. Andrulis, SB. Bull, ME. Blackstein, D. Sutherland, C. Mak, S. Sidlofsky, et al., ‘‘neu/erbB-2 amplification identifies a poor-prognosis group of women with node-negative breast cancer’’. J Clin Oncol. , vol. 16, no. 4, pp. 1340 –9, 1998.
 Hamilton, M. Piccar, ‘‘The contribution of molecular markers to the prediction of response in the treatment of breast cancer: a review of the literature on HER-2, p53 and BCL-2, ’’ Ann Oncol, vol. 11, no. 6, p. 647-663, 2011.
 Iraqi Cancer Board Results of the Iraqi Cancer Registry 2012. Baghdad, Iraq: Iraqi Cancer Registry Center, Ministry of Health; 2015.
 JL. Kelsey, MD. Gammon, EM. John, ‘‘Reproductive factors and breast cancer,’’ Epidemiol Rev., vol. 15 pp.36-47, 1993.
 L. Bernstein, ‘‘Epidemiology of endocrine-related risk factors for breast cancer,’’ J Mammary Gland Biol Neoplasia, vol.7, pp.3-15, 2002.
 CI. Li, BO. Anderson, JR. Daling, RE. Moe, ‘‘Trends in incidence rates of invasive lobular and ductal breast carcinoma,’’ JAMA, vol.289, pp.1421-1424, 2003.
 CI. Li, KE. Malone, PL. Porter, NS. Weiss, MT. Tang, JR. Daling, ‘‘Reproductive and anthropometric factors in relation to the risk of lobular and ductal breast carcinoma among women 65–79 years of age,’’ Int J Cancer, vol.107, pp.647–51, 2003.
 GK. Reeves, K. Pirie, J. Green, D. Bull, V. Beral, ‘‘Reproductive factors and specific histological types of breast cancer: prospective study and meta-analysis,’’ Br J Cancer, vol. 100, pp.538–44, 2009.
 F. Levi, VC. Te, L. Randimbison, C. La Vecchia, ‘‘Increase in lobular breast cancer incidence in Switzerland,’’ Int J Cancer, vol.107, pp.164–5, 2003.
 HM. Verkooijen, G. Fioretta, G. Vlastos, A. Morabia, H. Schubert, AP. Sappino , et al, ‘‘Important increase of invasive lobular breast cancer incidence in Geneva, Switzerland,’’ Int J Cancer., vol.104,pp.778–81, 2003.
 K. Reinier, P. Vacek, B. Geller, ‘‘Risk factors for breast carcinoma in situ versus invasive breast cancer in a prospective study of pre- and post-menopausal women,’’ Breast Cancer Res Treat., vol. 103, pp.343–348, 2007.
 JA. Stewart, RS. Foster, ‘‘Breast cancer and aging,’’ Semen Oncol., vol.16, pp.41-50, 1989.
 A. Jemal, F. Bray, MM. Center, J. Ferlay, E. Ward, D. Forman, ‘‘Global cancer statistics,’’ CA Cancer J Clin., vol. 61, pp. 69–90, 2011.
 C. DeSantis, R. Siegel, P. Bandi, A. Jemal, ‘‘Breast cancer statistics, 2011’’, CA Cancer J Clin, vol. 61, no.6, pp.409-18, 2011.
 World Cancer Research Fund (WCRF). Continuous Update Project: 2016. London, UK: WCRF International; 2016.
 M. Picon‐Ruiz, C. Pan, K. Drews‐Elger K, K. Jang, AH. Besser, D. Zhao, et al, ‘‘Interactions between adipocytes and breast cancer cells stimulate cytokine production and drive Src/Sox2/miR‐302b mediated malignant progression,’’ Cancer Res., vol.76, pp.491‐504, 2016.
 B. Dirat, L. Bochet, M. Dabek, D. Daviaud, S. Dauvillier, B. Majed B, et al, ‘‘Cancer‐associated adipocytes exhibit an activated phenotype and contribute to breast cancer invasion,’’ Cancer Res., vol. 71, pp.2455‐2465, 2011.
 A. Engin, ‘‘Obesity-associated Breast Cancer: Analysis of risk factors,’’ Adv Exp Med Biol., vol. 960, pp. 571-606, 2017.
 JA. Buxton, JL. Bottorff, LG. Balneaves, C. Richardson, M. McCullum, PA. Ratner, et al, ‘‘ Women’s perceptions of breast cancer risk: are the accurate?,’’ Can J Public Health., vol. 94, pp.422–426, 2003.
 M. Barnard, C. Boeke, R. Tamimi, ‘‘Established breast cancer risk factors and risk of intrinsic tumor subtypes,’’ Biochim Biophys Acta Rev Cancer, vol. 1856, pp.73–85, 2015.
 K. Hemminki, C. Granstrom, K. Czene, ‘‘Attributable risks for familial breast cancer by proband status and morphology: a nationwide epidemiologic study from Sweden,’’ Int J Cancer, vol. 100, pp. 214–219, 2002.
 Collaborative Group on Hormonal Factors in Breast Cancer Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58 209 women with breast cancer and 101 986 women without the disease, Lancet, vol. 358, pp.1389–1399, 2001.
 AI. Phipps, CI. Li, K. Kerlikowske, WE. Barlow, DS. Buist, ‘‘Risk factors for ductal, lobular, and mixed ductal-lobular breast cancer in a screening population,’’ Cancer Epidemiol Biomarkers Prev., vol.19, no.6, pp.1643-54, 2010.
 G. Haber, NU. Ahmed, V. Pekovic, ‘‘Family history of cancer and its association with breast cancer risk perception and repeat mammography,’’ Am J Public Health., vol. 102, pp. 2322-9, 2012.
 EJ. Kantelhardt, G. Muluken, G. Sefonias, A. Wondimu, HC. Gebert, S. Unverzagt S, et al., ‘‘A review on breast cancer care in Africa,’’ Breast Care (Basel), vol.10, pp. 364–70, 2015.
 A. Nkondjock, P. Ghadirian P, ‘‘Facteurs de risque du cancer du sein, M/S,’’ Med Sci (Paris), vol. 21, pp. 175–80, 2005.
 S. Masood, ‘‘Estrogen and progesterone receptors in cytology: a comprehensive review,’’ Diagn. Cytopathol., vol.8,pp. 475-491, 1992.
 S. Mohibi, S. Mizra, H. Band, V. Band, ‘‘Mouse models of estrogen receptor-positive breast cancer,’’ J. Carcinog., vol. 10, pp. 35, 2011.
 MP. Navolanic, SL. Steelman, AJ. McCubrey, ‘‘EGFR family signaling and its association with breast cancer development and resistance to chemotherapy,’’ Int. J. Oncol., vol. 22, pp. 237-252, 2003.