الفهرس 
EPIDEMIOLOGY AND ETIOLOGICAL FACTORSOnly 14 pages are availabe for public view
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Abstract
B
reast cancer is the most common cancer among females worldwide, and the second most common cause of cancer related death after lung cancer, which makes its global burden substantial. However, the burden is not evenly distributed worldwide: with large variations between different countries, regions, and within specific regions (Hortobagyi et al., 2005).
The development of breast cancer has been associated with numerous risk factors, including genetic, environmental, hormonal influences yet 75%of women with this cancer have no readily identifiable risk factors (Jardines et al., 2014).
Breast cancer is presented by a variety of symptoms and signs of which a lump constitutes the most common presentation. Nipple discharge, skin changes (peau d’orange), axillary lymphadenopathy, nipple retraction, paget’s disease and inflammatory breast cancer are among other manifestations (Pegram et al., 2012).
Distant metastasis could be the first presenting symptom in breast cancer. Common sites are bone, liver, lung and brain. Almost 5% of breast cancer cases in the developing countries present by distant or metastatic stage (stage IV) (Lawrence et al., 2010).
The diagnosis of breast cancer is based on history and clinical examination of the breasts and locoregional lymph nodes in combination with imaging including bilateral mammography and ultrasound or MRI if needed and imaging for detecting metastasis and finally confirmed by pathological assessment (Saslow et al., 2004)
It is of utmost importance to be able to distinguish prognostic and predictive factors for every patient. Prognostic factors are key elements for oncologists to select those patients who are candidates for adjuvant treatment based on their risk of tumor relapse. While, predictive factors drive the decision of which type(s) of treatment should be given (Biganzoli, 2009).
Prognostic factors that are considered to be independent variables include lymph node status, tumor size, grade, presence of lymphovascular invasion, age and tumor proliferation markers. Certain biologic factors, including ER, PR and HER2 neu, are both prognostic and predictive factors (Cianfrocca et al., 2004).
Breast cancer management has become increasingly complex, it has become more evident that a multidisciplinary team approach that involves a spectrum of breast experts is necessary to provide optimal care to patients. This team includes medical and radiation oncologists, pathologists, surgical breast specialists, geneticists, and primary care physicians. A multidisciplinary focus that entails prevention, diagnosis, and treatment has led significantly to reduction of breast cancer incidence and mortality (Pruthi et al., 2007).
This study is a retrospective analysis of clinico-epidemiological features among breast cancer patients at the Clinical Oncology Department, Ain Shams University through the years 2010-2014. In the current study, many of the parameters addressed were almost similar to worldwide incidences with little variations. Mean age at diagnosis was 51.9 with postmenopausal being more common. The most common presenting symptom was breast lump, in the left UOQ. Stage III was the most prevalent stage, IDC was the most common pathological subtype, and the hormone receptor positive, Her2 negative breast cancer were the most common molecular subtype.
There was no statistically significant correlation between age at presentation and stage or molecular subtypes; neither was found between menopausal status and molecular subtypes. Although family history was more common in younger patients, yet there was no statistical significance as well.
On the other hand, menopausal status was correlated with stage and found that premenopausal patients tended to present at earlier stages than postmenopausal with statistically significant results. Also histological subtype when correlated to age was found to have a significant difference between IDC and ILC where the latter’s incidence tended to increase with advancing age.
Tumor size was positively correlated with both nodal status and metastatic incidence, where it was found that along with increasing tumor size, there was an upstaging to nodal stage together with increasing incidence of distant metastasis. Results were highly statistically significant in both correlations (P value < 0.001)
Nodal involvement was also correlated with metastatic incidence and it was found that with increasing nodal stage, the incidence of metastasis almost doubled with each nodal stage from N0 to N3, the results were highly statistically significant (P value < 0.001).
To sum up, breast cancer is one of the most important worldwide encountered disease burdens to which many international guidelines for diagnosis and management have been recommended. Yet, as previously pointed out, this burden is not evenly distributed and each region should be able to identify its own magnitude of the problem in order to be able to solve it. Hopefully this study is the first step in this process and soon we will be able to tailor our own guidelines for the sake of the best patients’ benefit.