Breast cancer cases rise among Gulf women as disease develops unique regional features
Story by the University of Sharjah
Photo under creative license
- Breast cancer cases are rising among women in Gulf states
- Research reveals pathological features unique to the region
Breast cancer cases have surged in the Gulf Cooperation Council (GCC) states, with the disease developing its own localised clinical and pathological features, according to a study published in the journal Frontiers in Oncology. These unique characteristics differ from those found in women with breast cancer in Western countries.
The study attributes the increase to hereditary factors, weaning children earlier than expected, the prevalence of hormonal treatment, obesity, and the use of contraceptives.
Led by Humaid O. Al Shamsi, oncology professor at Sharjah University’s College of Medicine, and Ajman University, the research is authored by a panel of nine oncologists from four countries: Kuwait, Saudi Arabia, Qatar and the United Arab Emirates (UAE), which along with Oman and Bahrain comprise the GCC. The available data on disease burden was discussed, as well as breast cancer gene (BRCA) mutations, testing and management practices along with associated challenges specific to the region.
Distinctive breast cancer gene mutations
The study is based on an analysis of the BRCA1 and BRCA2 genes of women living in the GCC who have been diagnosed with breast cancer. Everyone has two inherited copies of these genes, one from each parent, and the proteins they produce help repair damaged DNA.
Oncologists compared their genes with those of women living in the West, finding varieties in DNA, RNA and proteins, the elements that determine the genetic compositions of cells or tissues. They also found variations in the age of breast cancer onset, cancer grade and acid residues regulating cancer cell proliferation. The disparate features they found means the disease requires different diagnoses, therapy and treatment.
“Compared to the Western population, breast cancers have diverse clinical, pathological and molecular features including early onset, higher tumour grade, higher human epidermal growth factor receptor (HER)2 amplification rate, more aggressive subtypes and a lower rate of luminal subtype in the GCC population,” the report says.
The researchers’ statistics show that breast cancer is the most prevalent type of cancer in the GCC, and the main cause of cancer death among women.
The rise in breast cancer cases
Over time, there has been a steady increase of breast cancer among women, the authors note, adding, “Hereditary factors are responsible for around 10% to 30% of breast cancer cases and 16% of these hereditary cases are related to germline mutations in BRCA1 and BRCA2 genes.
“Other factors such as early age menarche [the first menstrual cycle], later age at menopause, shorter breastfeeding periods, use of oral contraceptives or hormonal therapy, dense breasts, and older age are found to be associated with increased risk of breast cancer.”
The high rate of women dying of breast cancer in the GCC is attributed to the late stage at which the disease is identified with evidence suggesting “approximately 46.2% to 54% of breast cancer patients are diagnosed at advanced disease stage; 23.3% to 28% are diagnosed with localised tumours while 2% have in-situ carcinoma.”
One important divergence when comparing women with breast cancer in the GCC with women in Western countries is the age at which they are diagnosed with the disease which is “at least a decade younger in the GCC population compared to the Western population”. The average age in the GCC is 48, while in Western countries it’s 60.
There are also marked differences in survival rates. The five-year overall survival rate for women with stage one breast cancer is reported in the study to be 99%, and stage two at 86%. “The five-year survival rate in the GCC region ranges between 63% and 89%, with the highest five-year survival rate being reported in the UAE and the lowest being reported in Bahrain,” the authors say.
Regarding the cumulative danger of developing breast cancer, the authors note that women at age 70 risked being diagnosed with BRCA1 or BRCA2 carriers. “Identification of BRCA mutation in a woman diagnosed with breast cancer may have an impact on both prognosis and treatment – especially, it influences the extent of surgery such as the choice of breast-conserving surgery (BCS) or contralateral mastectomy, also predicts the effectiveness of platinum-based chemotherapy and poly (ADP-ribose) polymerase (PARP) inhibitors.”
Improving breast cancer screening and treatment
BRCA identification, the authors add, helps oncologists to make the right decision in relation to “region-specific guidelines” and helps healthcare providers to administer effective therapies. The research, the authors said, provides data “on the epidemiology of breast cancer BRCA mutations, practices, and challenges associated with BRCA testing in the GCC region.”
The report’s authors came up with a host of recommendations for how to enhance testing for early-stage breast cancer in the region. Additionally, they also provided recommendations for developing a treatment algorithm for BRCA-mutated early-stage breast cancer.
The authors maintain that despite the advances made in combating breast cancer and the availability of modern treatment methods, the region is still in need of more improvements to reach standards attained by Western countries.
The experts’ key recommendations include making breast conservative surgery accessible for most patients with BRCA-mutated early breast cancer, to ensure good cosmetic outcomes.
Other propositions include postoperative care, prophylactic measures that help oncologists with decisions for the removal of healthy breasts as prevention, as well as making additional therapies accessible to breast cancer patients after they have completed chemotherapy and other primary treatments to lower the chance of the disease returning.
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