BREAST CANCER AMONG WOMEN IN BASRAH, IRAQ: A DESCRIPTIVE STUDY IN BIRAD 1 & 2 SCREENED CASES

Introduction reast cancer is one of the most in growing health issues that threats female globally and especially in the developing countries because of the poor facilities and low socioeconomic status. Basically the detection of breast cancer relies on the primary healthcare centers and specialized clinics for early detection of breast cancer1,2 . A new research stated that about 1.7 million new cases of breast cancers reported globally each year and 60% deaths of breast cancer or its complications happened in the developing countries3 . These countries depend on their national healthcare system in the screening process and early detection, which are poorly equipped, and need more training and experience4 . The most common risk factors of breast cancer are; nulliparity, using oral contraceptives, hormonal replacement therapy, low physical activity and family history5 . In addition, many studies show no difference in the incidence of breast cancer in rural and urban areas6 . An increased risk of breast cancer in women with a family history of breast cancer has been demonstrated by many studies using a variety of study designs. However, this depends mainly on the type of relative relationship, if more than one BBreast cancer among women in Basrah Hayder H Abdulsamad, Mazin H Al-Hawwaz & Rajaa A Mahmoud Bas J Surg,June, 27, 2021 52 relative were affected, in addition to the age of getting the cancer7 . World Health Organization along with nation cancer control centers advice and encourage the screening program for detection of the breast cancer in early stage using mammography8,9 . The mammogram is an imaging technique used to understand the breast health, although it gives no definitive diagnosis of malignancy, but the radiologist can help by describing the findings for the surgeons that may help in taking the decision for each patient10 . The extension of screening mammography has resulted in a decreased number of patients who dies from breast cancer, because mammography is sensitive for the detection of clinically occult breast cancer11,12 . Mammography is a highly sensitive screening test for breast cancer screening, with a positive predictive value (PPV) of 15%–30% for malignancy detection among non-palpable lesions13,14 . Breast Imaging Reporting And Data System (BIRADS) is commonly used by American College of Radiology14, and most commonly as a numerical scale15: Category 0: indicates an incomplete test (non-conclusive study), Category 1: indicates normal breast tissue , Category 2: benign finding, Category 3: probably benign (carry 2%) risk of malignancy, Category 4: subdivided into; A, carry (2- 9) % risk of malignancy, B, carry (10-49) % risk of malignancy, C, carry (50-95) % risk of malignancy. Category 5: indicates high suspicion of cancer (> 95% risk of malignancy), Category 6: malignancy proved with biopsy, used to compare mammography finding and the respond to treatment (surgical, chemotherapy, radiation). Although BIRADS 1 and 2, both denote an essentially zero chance of malignancy, BIRADS 1 is used in situations where the breast is completely unremarkable, and BIRADS 2 is used when the radiologist wants to remark on a benign finding16-19 . This study aimed to determine the general socio-demographic characteristics of breast cancer screened cases among women above 35 years in Basrah and to detect malignant cases among BIRAD 1 & 2 categorized cases who underwent mammography screening in Basrah during the period 2014-2020. This is a retrospective database descriptive study using mammographic medical records of women attended to Basrah Cancer Screening Center in Basrah Teaching Hospital. The lesions at the screening center are classified according BIRADS grading methodology. Patients and methods A total of 448 female patients who had a histopathological result indicating breast cancer and classified according to mammogram Breast Imaging Reporting And Data System (BI-RADS) grading methodology in Basra from 2014-2020. Inclusion criteria of the study sample: Symptomatic or asymptomatic visiting Basrah Cancer Screening Center, All cases who had FNA and or biopsy taken and proved malignant. Exclusion criteria: Any file missing the mammographic or FNA or histopatholgical report. The patient's medical files at the cancer screening centers that have been used during the study were usually written by radiologists and surgeons that considered as a part from the government program for early detection of breast cancer. Socio-demographic data of patients were sourced from the patient’s medical files. Cases with BIRAD 1 & 2 (which are considered to be normal and benign respectively), were investigated histopathologically for being malignant taking in consideration the patient age, parity and family history of CA breast. Statistical analysis of the data included in the study was done by using SPSS version 20 and Microsoft Excel sheets version 2010. To validate malignancy detection, the following statistical Breast cancer among women in Basrah Hayder H Abdulsamad, Mazin H Al-Hawwaz & Rajaa A Mahmoud Bas J Surg,June, 27, 2021 53 measures were used: Sensitivity and specificity of breast cancer malignancy detection. Positive predictive value (PPV) & Negative predictive value (NPV) of breast cancer malignancy detection among screened cases. The study was approved by the Clinical & Ethical Committee at Basrah Directorate of Health. Study limitations: Pandemic COVID-19 interrupted the study work especially after converting the study location to include only COVID-19’s patients with closure of all other departments, missing information registered in the patient's medical records especially for the variables: education, use of hormone therapy, use of oral contraceptives, age at first pregnancy, age of menarche and breastfeeding history.