A population-based study of Kurdish breast cancer in northern Iraq: Hormone receptor and HER2 status. A comparison with Arabic women and United States SEER data

Abstract

BackgroundHormone receptor (HR) and HER2 expression predict the therapeutic response and prognosis of breast cancer. In the Middle-East, breast cancer is diagnosed at a young age, and Arabic women are reported to have a low frequency of HR positive tumors. This study investigates HR and HER2 expression among Kurdish and Arabic women.MethodsDuring 2008–2010, the Sulaimaniyah Directorate of Health records identified 514 Sulaimaniyah Kurdish women, 227 Kurdish women of other Governates, and 83 Arabic women with a first diagnosis of breast cancer. The breast cancers of 432 women had immunohistochemistry (IHC) performed for estrogen and progesterone receptors (ER and PR) and HER2. Age specific and age standardized incidence rates were calculated for Sulaimaniyah Kurds. Results were compared with Egypt and with United States (US) SEER data.ResultsThe median patient age was 46 years and 60.4% were < 50 years old. Tumors of 65.2% of women were ER+/HER2- with the rate increasing to 78.3% in patients ≥ 60 years old in proportions similar to US whites. The total annual age standardized incidence for breast cancer among Sulaimaniyah Kurds was 40.5/100,000 women, a rate similar to Egypt but much lower than the US. By HR/HER2 subtype, the highest age specific incidence rates were 16.4 and 45.4/100,000 for ER+/PR+/HER2- tumors in women < 50 or ≥ 50 years old, respectively (US whites: 37.7 and 226.1/100,000). Tumors of 20.4% of Sulaimaniyah women were HER2+ with annual incidence rates for ER-/PR-/HER2+ tumors of women <50 or ≥ 50 years old being 4.0 and 6.3/100,000 (US whites: 3.2 and 14.4/100,000). No significant differences in ER or HER2 status were found between Kurdish and Arabic patients.ConclusionsCompared to the US, low age standardized and age specific breast cancer incidence rates were found in Kurdish women; nevertheless, the proportional expression of HR and HER2 for both Kurds and Arabs was comparable to that of US white women. The great majority of the breast cancer was ER+/HER2- and should respond to anti-estrogen therapy.

First report on molecular breast cancer subtypes and their clinico-pathological characteristics in Eastern Morocco: series of 2260 cases

“…This result is similar to those reported in other North African countries, Iraq, Sub-Saharan Africa, Korea, China, and Taiwan [18, 24–32]. However, in Western countries and other Arab and Asian countries breast cancer occurs at an older age [26, 27, 33–36]. The age at diagnosis represents an important prognostic factor since tumors diagnosed at younger ages are generally more aggressive and/or less responsive to treatment [37–39].…”

“…Lobular invasive carcinoma was the second most common histological type accounting for 15.3% of all cases. This level of lobular invasive carcinoma in our study is higher compared to what has been reported in Fez (Morocco) (4%), Egypt (9%), Saudi Arabia (3%) and Iraq (3.9%) [18, 26, 36, 48]. …”

Breast cancer in Iraq is associated with a unimodally distributed predominance of luminal type B over luminal type A surrogates from young to old age

“…In the developing world, a flattening and then a decline occur about 10–15 years after the menopause. In developed countries, the age specific incidence accelerates after the menopause, and at age 70 and above doubles that seen at 45–49 years old [3–5]. The life-style changes contributing to increased post-menopausal breast cancer are largely premenopausal and include obesity, low rates of childbirth, infrequent or no lactation, early menarche, and late menopause [2].…”

The impact of uterine leiomyomas: a national survey of affected women

“…A recently conducted international survey confined its assessment to only bleeding and pain symptomology. 6 In addition to the physical symptoms, validated quality of life measures indicate that uterine leiomyomas impact women emotionally, including increased fears about their health along with additional considerations with regard to relationships, sexual function, body image, loss of control, and hopelessness. 7 Further, the economic impact of this disease is probably underestimated given the limited amount of information on its impact on women’s work.…”