Acta Medica Mediterranea, 2016, 32: 1521

THE PREVALENCE OF BREAST CANCER IN THE EAST OF PROVINCE IN 2012- 2013

ALI MAHADAVI*, TAHOORA MOUSAVI**, FATEMEH DEHKHODA***, JAMSHID YAZDANI CHARATI****, RAVANBAKHSH ESMAEILI***** *MSc. in Nursing, Mazandaran University of Medical Sciences, , - **MSc. in Psychology, Mazandaran University of Medical Sciences, Sari, Iran. - ***MSc. in Microbiology, Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran - ****Associate Professor, Department of Biostatistics, Mazandaran University of Medical Sciences, Sari, Iran - *****Assistant Professor, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran

ABSTRACT

Introduction: Breast Cancer is one of the most common cancer and cause of death in Iranian women, so that 32% of women suffer this disease. Due to high incidence of this disease and its consequences in the society, this study aimed to determine the preva- lence of breast cancer in the east of in 2010 to 2013. Methodology: This is a correlational study. Samples were selected by simple random sampling and through discovering 103224 file of patients in Imam Khomeini Hospital from 2010-2013. Then, data were analysed by descriptive statistical test and SPSS 20 statistical software. Findings: by studying the patients file, it was founded that 159 cases (0.001%) suffered all kinds of Cancer in which 46 cases (28.9%) was related to Breast Cancer. The people who suffered cancer included 4 male (8.7%) and 42 female (91.3%) in the age group 34-83 years old and average age of 11.06 ± 55.77. Conclusion: The results of the study showed that the average age of Breast Cancer is lower in Iran compared to foreign stati- stic. The incidence of Breast Cancer in most of western countries was below 40 years old.

Key words: Breast Cancer, Prevalence, East of Mazandaran Province.

Received June 30, 2015; Accepted January 02, 2016

Introduction Findings show that the incidence of this dis- ease has reached from 19.3 per 100,000 people in Iran after cardiovascular disease and acci- East Africa to 89.9 per 100,000 people in West dents. Breast cancer is the most common cancer in Europe in 2008(5). Different variables including eco- the countries and caused to the death of 8 million nomic changes, lifestyle, radiation, X-ray, body people within 1990 to 2010(1). Also in 2012, 1.7 mil- weight gain after menopause, lack of exercise, alco- lion people have been suffered this disease world- hol and , increased estrogen, HRT (hormone wide(2). This disease comprised 32% of breast can- therapy in which postmenopausal women receive cer in women. The incidence of this disease in alternative hormone) influence the incidence of Iranian women is between 35 to 55 years old and is breast cancer in the developed and developing the second cause of death after lung cancer in countries(6). The incidence of the disease is more in women(3). Breast cancer is not common in men and developed countries, but mortality is more in less less than one percent of all breast cancers are in developed countries(7). The incidence of breast can- men which also depend on family history(4). cer is varied greatly among different nations. 1522 Ali Mahadavi, Tahoora Mousavi et Al

Across countries; , Kuwait and Then, data were analyzed using descriptive Qatar have the highest incidence of breast cancer, statistical test and SPSS software (version 20). while Arabic Emirates, Saudi Arabia, Oman had lower incidence of the disease(8). Findings In general, the lowest incidence (1%) has been observed in Asian countries such as Iran. Examining 103224 of patients files showed has high incidence rate of death due to breast can- that 159 cases (0.001 %) are suffering from cancer cer, so that 34.6% of people are suffering the dis- in which 46 cases (28.9%) are related to breast can- ease(9). Breast cancer is considered as a major prob- cer. Of these, 4 patients (8.7%) were men and 42 lem in South America. The incidence of the disease patients (91.3%) were female. According to the chi- in countries of South America was (69.14 per square test, the difference was statistically signifi- 100,000) more than tropics regions (39.07 per cant (P=0.0001). 100,000)(10). Other factor that is involved in the In terms of age distribution of breast cancer, development of breast cancer is old age of individu- patients were in the age range of 34-83 years old als(11). So that, the incidence of breast cancer have with a mean age of 11.06 ± 55.77 years. Chi-square been reported in 50% of women over 65 years old test didn’t show statistically significant differences and in 30% of women over 70 years old(12). From in age distribution between the sexes. (P=0.038) 1992, in some Arabic countries, the average age The findings also showed that the average hospital- was 30-64 years old depending on the educational ization times and hospitalization days in these status and breast self-examination. It seems the patients were respectively 7 times and each time prevalence of breast cancer in Iran is occurred at average of 4 days (Table 1). younger age(7). The present study was conducted in East of Discussion Mazandaran province, Behshahr city to extract the breast cancer prevalence in the region as a sample Breast cancer is the most common cancer in of Mazandaran province. Since information about developed and developing countries(13) and its value breast cancer and the age and sex distribution in the have been reported 3-4%(14). In the present study, the North East of Mazandaran, Behshahr city is not incidence of breast cancer in Behshahr Imam available; therefore the necessity of this study was Khomeini Hospital in 2010-2013 was investigated. observed to obtain a better understanding on this The study findings showed the highest number of hos- issue. pitalizations among the types of cancer with 46 cases (28.9%) was related to Breast cancer which is ranked Methodology first among the women (91.3%) and sixth among men (8.7%) respectively. The majority of patients (69.6%) This is a correlational study. Samples were were over 49 years old and only 5 patients (10.9%) selected by simple random sampling and through were under 40 years old which is higher than the glob- discovering 103224 files of patients in Behshahr al statistics. According to the studies in Arabic coun- Imam Khomeini Hospital from 2010-2013. tries like Bahrain, the risk of breast cancer is increased Inclusion criteria for the study are diagnosis of when the age is increased and this rate is estimated at breast cancer in the hospital, the availability of doc- 65-69 years old. Also, according to a survey conduct- uments in the archives, hospitalized with breast ed in Kuwait and Pakistan, the age of people with this cancer or its complications. Exclusion criteria for disease are estimated 65-69 years old and over 40 the study are cancer patients attending the emer- years old respectively(8,16) On the other hand, in a study gency, lack of admissions file, hospitalization due conducted in showed that 50% of patients were to other diseases such as an accident, injury, poison- older than 50 years old(17). ing and surgery unrelated to the breast cancer. In Fasihi et al conducted a study and showed the this study, demographic information such as age women are suffered this disease in 35-44 years old(18). and sex ... and the questionnaire for recording neo- On the other hand, in a survey conducted by Haghighe plastic diseases in various cancers including breast et al in Birjand, the average age was reported 8.56 ± cancer were used to gather data in order to evaluate 44.48(19). In this study, the age range is 34 to 83 years the prevalence of breast cancer. old and a mean age of 11.06 ± 55.77, which is consis- tent with other studies. The prevalence ofbreast cancer in the east of Mazandaran province in 2012-2013 1523

Average hosp. Average hospi. days Age average Over 49 years old 40-49 years old Lower 40 years old Breast cancer times Variable Gender Percent Number Percent Number Percent Number Percent Number

12.50% 4 0 0 0 0 8/7% 4 Men 4 7 55/77 ±11/6 87.50% 28 19/6% 9 10/9% 5 91/3% 42 Women

0.38 0.0001 P-value

Table 1: Distribution of age and gender and the hospitalization times and hospitalization days in the patients with breast cancer. The average age of breast cancer in this study is tion, lifestyle changes and improve quality of life and higher compared to other regions in Iran. The age examine its effect on the admission of these people. range for breast cancer is lower compared to the glob- al statistic in which the average age is 62 years old(20). In international statistics, only 6% of cases of breast cancer have been reported below 40 years old. Studies show that improvement in patients under 35 years old is more difficult compared to the patients with older age and the elderly live longer compared to young people(21). References In the other hand, reports show that breast cancer is uncommon in men and only one percent of all 1) Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, breast cancers are in men. For example, in a study in Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 1999 in Cancer Institute of Imam Khomeini hospital 2010: a systematic analysis for the Global Burdenof (20) in , breast cancer was observed in men 3% . Disease Study 2010. Lancet 2012; 380(9859): 2095- But in this study, 7.8% of cancers in men were related 2128. to breast cancer which indicates the high incidence of 2) Naderimagham Sh, Alipour S, Djalalinia Sh, Kasaeian cancer in East of Mazandaran. Therefore, it is suggest- A, Noori A, Rahimzadeh Sh, Modirian M, Khosravi A, Etemad K, Jamshidi HR, Farzadfar F. National and ed to examine this issue perfectly. Given that environ- Sub-national Burden of Breast Cancer in Iran; 1990- mental factors and genetic factors can be the main fac- 2013. Arch Iran Med 2014; 17(12): 794-799. tor causing cancer(22). It is recommended to examine 3) Almasinokiani F, Akbari H, , Izadi B, Emami Ale Agha genetic factors, environment, nutrition and climate and M. Incidence of Breast Cancer in Breast Sample Pathology Reports in Iran (Kermanshah) 2001-2004. their impact on the prevalence of cancer in this area The Iranian Journal of Obstetrics, Gynecology and concisely. Infertility 2005; 8(2): 23-28. (Persian) 4) Bouchardya CH, Rapitia E, Fiorettaa G, Schuberta H, Conclusion Chappuis P, Vlastosd G, Benhamou S. Impact of family history of breast cancer on tumour characteristics, treatment, risk of second cancer and survival among According to the study, it can be seen that the men with breast cancer. Swiss Med Wkly 2013; 143 average age of breast cancer is lower in comparison to w13879. doi: 10.4414/smw.2013.13879. foreign reports, (55 years old versus 62 years old) and 5) Ferlay J, Shin HR, Bray F, Forman D, Mathers C, also breast cancer prevalence under 40 years old has Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; been more in Western figures, (10.9% vs. 6%). It is 127(12): 2893-917. doi: 10.1002/ijc.25516. recommended to manager to pay more attention to 6) Hoover RN, Hyer M, Pfeiffer RM, Adam E, Bond B, early diagnosis and treatment of this disease, holding Cheville AL, et al. Adverse health outcomes in women public education program on self-breast examination exposed in utero to diethylstilbestrol. N Engl J Med and screening mammography after 35 years old by 2011; 365(14): 1304-1314. 7) Hortobagyi GN, de la Garza SJ, Pritchard K, Amadori health centers which provide healthy for urban and D, Haidinger R, Hudis CA, Khaled H, Liu MC, Martin rural societies. These programs reduce the risk of dis- M, Namer M, O’Shaughnessy JA, Shen ZZ, Albain KS. ease. In one hand, lack of adequate information and The global breast cancer burden: variations in epi- self-care on the disease can be a major cause of hospi- demiology and survival. Clin Breast Cancer 2005; 6(5): 391-401. tal admission for patients and imposed a high econom- 8) Randah R. Hamadeh, Najat M. Abulfatih, Majeda A. ic burden on the family. Therefore, it is suggested to Fekri, Hala E, et al. Epidemiology of Breast Cancer implement some interventions such as self-care educa- among Bahraini Women Data from the Bahrain Cancer 1524 Ali Mahadavi, Tahoora Mousavi et Al

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