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      Pattern of Presentation of Patients With Breast Cancer in Iraq in 2018: A Cross-Sectional Study

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          Abstract

          PURPOSE

          This study aims to describe the pattern of presentation of Iraqi female patients with breast cancer by assessing the grades and stages of their cancers at the time of presentation, to identify patients’ main complaints, and to discover whether there is any difference in presentation between patients in Iraq and those in other countries.

          PATIENTS AND METHODS

          This is a retrospective cross-sectional study that was performed in the National Center of Cancer in 2018. The target population was female patients with breast cancer who came to the Center for treatment and follow-up. A sample of 171 patients was drawn from this population. Self-evaluation forms were used in interviews with the patients to collect personal and sociodemographic data; clinical and histologic characteristics of the patients’ tumors were obtained from their medical records. Ethical approval was obtained.

          RESULTS

          Forty-five percent of the patients were younger than age 50 years, and 25% were younger than age 45 years. In all, 42.9% of the patients were diagnosed with stage III and 25% with stage IV cancer, and metastasis was diagnosed in 24.1%. In our study population, 53.4% of the tumors were found in the right breast, and 3.9% of patients had bilateral breast tumors. The most common histopathologic type was invasive ductal carcinoma (81.4%) followed by invasive lobular carcinoma (6.9%) and tubular carcinoma (5.9%). The patients’ most common complaints were breast lump (71.3%) and pain (18.9%). No correlation was found between tumor stage and breast self-examination, family history, education, occupation, histopathology, or grade.

          CONCLUSION

          Most of the patients are diagnosed at a late stage when treatment is less effective.

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          Most cited references15

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          Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis

          Highlights • A minority of women with breast cancer experience substantial diagnostic delays. • Our findings suggest that around 1 in 6 women had symptoms other than breast lump. • On average, women experienced longer patient intervals than primary care intervals. • Women with ‘non-lump’ or ‘both lump and non-lump’ symptoms delayed seeking help. • Symptom awareness campaigns should further emphasise non-lump breast symptoms.
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            Factors influencing diagnosis delay of advanced breast cancer in Moroccan women

            Background Delay in the diagnosis of breast cancer in symptomatic women of 3 months or more is associated with advanced stage and low survival. We conducted this study to learn more about the extent and reasons behind diagnosis delay of advanced breast cancer in Moroccan women. Methods A group of patients with advanced breast cancer were interviewed at the National Institute of Oncology in Rabat during the period from February to December 2014. Diagnosis delay was devised into patient delay and system delay. Patient delay was defined as time from first symptoms until first medical consultation. System delay was defined as time from first presentation to a health care provider until definite diagnosis or treatment. Prospective information and clinical data were collected on a form during an interview with each patient and from medical records. Results In all, 137 patients were interviewed. The mean age of women was 48.3 ± 10.4 years. The median of consultation time was 6[4,12] months and the median of diagnosis time was 1[1,3] months. Diagnosis delay was associated to a personal reason in 96 (70.1 %) patients and to a medical reason in 19 (13.9 %) patients. A number of factors predicted diagnosis delay: symptoms were not considered serious in 66 (55.9 %) patients; traditional therapy was applied in 15 (12.7 %) patients and fear of cancer diagnosis and/or treatment in 14 (11.9 %) patients. A use of traditional methods was significantly associated with rural residence and far away from basic health center (p = 0.000). Paradoxically, a family history of breast cancer was significantly higher in who report a fear of cancer diagnosis and/or treatment to diagnosis delay (p < 0.001). Also, a significantly higher risk of more than 6 months delay was found among rural women (P = 0.035) and women who live far away from specialized care center (P = 0.001). Conclusions Diagnosis delay is very serious problem in Morocco. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer information in our populations and training of general practitioners to reduce advanced breast cancer by promoting early detection. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2394-y) contains supplementary material, which is available to authorized users.
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              Breast cancer in young women: special considerations in multidisciplinary care

              Breast cancer is one of the most prevalent cancers in females, and 5%–7% of breast cancer cases occur in women under 40 years of age. Breast cancer in the young has gained increased attention with an attempt to improve diagnosis and prognosis. Young patients tend to have different epidemiology, presenting with later stages and more aggressive phenotypes. Diagnostic imaging is also more difficult in this age group. Multidisciplinary care generally encompasses surgeons, medical oncologists, radiation oncologists, radiologists, and social workers. Other special considerations include reconstruction options, fertility, genetics, and psychosocial issues. These concerns enlarge the already diverse multidisciplinary team to incorporate new expertise, such as reproductive specialists and genetic counselors. This review encompasses an overview of the current multimodal treatment regimens and the unique challenges in treating this special population. Integration of diagnosis, treatment, and quality of life issues should be addressed and understood by each member in the interdisciplinary team in order to optimize outcomes.
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                Author and article information

                Journal
                J Glob Oncol
                J Glob Oncol
                jgo
                jgo
                JGO
                Journal of Global Oncology
                American Society of Clinical Oncology
                2378-9506
                2019
                13 November 2019
                : 5
                : JGO.19.00041
                Affiliations
                [ 1 ]College of Medicine, University of Baghdad, Baghdad, Iraq
                Author notes
                Mohammed Tareq Mutar, College of Medicine, University of Baghdad Surgical Dept, Bab Almouadam Campus, Filastin St District 510, House 37, Baghdad 10064, Iraq; e-mail muhammed.tariq64@ 123456gmail.com .
                Article
                1900041
                10.1200/JGO.19.00041
                6882514
                31721627
                64e7ffbf-b32d-4c89-afd8-89c158a8a135
                © 2019 by American Society of Clinical Oncology

                Licensed under the Creative Commons Attribution 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                : 12 September 2019
                Page count
                Figures: 1, Tables: 6, Equations: 0, References: 28, Pages: 6
                Categories
                , Breast Cancer
                , Epidemiology
                Original Reports
                Custom metadata
                v1

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