32Background: 33 Breast cancer is the most prevalent cancer among females worldwide including Sudan. The aim of 34 this study was to determine the spatial distribution of breast cancer in Sudan.
35Materials and methods: 36 A facility based cross-sectional study was implemented in eighteen histopathology laboratories 37 distributed in the three localities of Khartoum State on a sample of 4630 Breast Cancer cases 38 diagnosed during the period 2010-2016. A master database was developed through Epi Info TM 39 7.1.5.2 for computerizing the data collected: the facility name, type (public or private), and its geo-40 location (latitude and longitude). Personal data on patients were extracted from their respective 41 medical records (name, age, marital status, ethnic group, State, locality, administrative unit, 42 permanent address and phone number, histopathology diagnosis). The data was summarized 43 through SPSS to generate frequency tables for estimating prevalence and the geographical 44 information system (ArcGIS 10.3) was used to generate the epidemiological distribution maps. 45 ArcGIS 10.3 spatial analysis features were used to develop risk maps based on the kriging method.46 Results: 47 Breast cancer prevalence was 3.9 cases per 100,000 female populations. Of the 4423 cases of 48 breast cancer, invasive breast carcinoma of no special type (NST) was the most frequent (79.5%, 49 3517/4423) histopathological diagnosis. The spatial analysis indicated as high risk areas for breast 50 cancer in Sudan the States of Nile River, Northern, Red Sea, White Nile, Northern and Southern 51 Kordofan. 52 Conclusions: 53 The attempt to develop a predictive map of breast cancer in Sudan revealed three levels of risk 54 areas (risk, intermediate and high risk areas); regardless the risk level, appropriate preventive and 55 curative health interventions with full support from decision makers are urgently needed.56 Introduction 61 Breast cancer (BC) is a heterogeneous group of diseases characterized by different pathologies, 62 biological characteristics and clinical behaviors. It is the leading cancer among females worldwide 63 with 641,000 cases reported in 1980 and 1,643,000 cases in 2010; the annual incidence increased 64 between the two years was 3.1% [1]. In the year 2012, globally, BC represented 25% of all cancers 65 and 15% of the cancer deaths among females [2]; in 2015, WHO reported 571000 deaths [3] while 66 by 2020, 1.7 million new cases are expected mostly in the developing countries [4]. The recent shift 67 in its burden in the developing world is revealed by a high mortality rate and a poorer overall 68 survival [2, 4]. The geographical distribution of BC in Africa revealed a marked variation in 69 incidence within the continent with a high incidence rate of 130 cases/100,000 populations in 70 Northern African countries and a lowest rate of 95 cases/100,000 populations recorded in the 71 Western part of the African continent [5]. The highest standardized mortality rate worldwide 72 according to WHO six regio...