伊拉克北部库尔德族妇女的乳腺癌：发病率、临床分期，以及产次和家族风险的病例对照分析。
Breast cancer in Kurdish women of northern Iraq: incidence, clinical stage, and case control analysis of parity and family risk.
机构信息
Department of Pathology, Shorsh General Hospital, Sulaimaniyah, Iraq.
出版信息
BMC Womens Health. 2009 Dec 11;9:33. doi: 10.1186/1472-6874-9-33.
BACKGROUND
Breast cancer in the Middle-East occurs in relatively young women and frequently presents as advanced disease. A protective effect of multiparity is not apparent, and high familial risk is reported in some countries. This study investigates breast cancer rates and clinical stage related to age in the Kurdish region of Iraq and evaluates risk associated with parity and family history. Findings are compared with nearby countries and the West.
METHODS
Sulaimaniyah Directorate of Health records identified 539 women diagnosed with breast cancer during 2006-2008. Clinical survey forms were completed on 296 patients and on 254 age-matched controls. Age specific incidence rates were calculated from Directorate of Health population estimates.
RESULTS
Average patient age was 47.4 +/- 11 years and 59.5% were pre-menopausal. Diagnosis was at clinical stage 1 for 4.1%, stage 2 for 43.5%, stage 3 for 26.0%, and stage 4 for 8.1% of patients. For 18.2%, stage was unknown. Annual breast cancer incidence rates per 100,000 women peaked at 168.9 at age 55 to 59 and declined to 57.3 at 60 and above. Patients had an average of 5.0 +/- 3.3 children compared to 5.4 +/- 3.5 for controls, P = 0.16. A first degree family member had breast cancer among 11.1% of patients and 2.1% of controls (P < 0.001) with > 50% of these patients and controls being > or =50 years old. No statistically significant relationship was found between tumor stage and age, P = 0.59.
CONCLUSIONS
In Kurdish Iraq, breast cancer is predominantly a disease of pre-menopausal women having multiple pregnancies. For younger patients, breast cancer incidence was similar to the West and possibly higher than many Middle-Eastern countries, but unlike the West, the estimated rates declined markedly in the elderly. The familial breast cancer risk for both older and younger women was within the general population risk of Western countries. Clinical stages were advanced and indicated delays in diagnosis that were unrelated to patient age.
背景
中东地区的乳腺癌发生在相对年轻的女性中，且常表现为晚期疾病。多胎妊娠似乎没有保护作用，并且一些国家报告存在高家族风险。本研究调查了伊拉克库尔德地区与年龄相关的乳腺癌发病率和临床分期，并评估了与生育次数和家族史相关的风险。研究结果与附近国家和西方国家进行了比较。
方法
苏莱曼尼亚卫生局的记录确定了 2006 年至 2008 年间诊断出的 539 名乳腺癌女性患者。对 296 名患者和 254 名年龄匹配的对照者进行了临床调查。从卫生局的人口估计中计算出特定年龄的发病率。
结果
患者的平均年龄为 47.4 +/- 11 岁，59.5%为绝经前。诊断为临床 1 期的患者占 4.1%，2 期占 43.5%，3 期占 26.0%，4 期占 8.1%。18.2%的患者分期未知。每 100,000 名妇女中，年龄在 55 至 59 岁的乳腺癌发病率最高，为 168.9，而 60 岁及以上的发病率则下降至 57.3。患者平均有 5.0 +/- 3.3 个孩子，而对照组为 5.4 +/- 3.5，P = 0.16。11.1%的患者和 2.1%的对照组有一级亲属患有乳腺癌（P < 0.001），其中> 50%的患者和对照组年龄> =50 岁。肿瘤分期与年龄之间无统计学显著关系，P = 0.59。
结论
在伊拉克库尔德地区，乳腺癌主要是绝经前多胎妊娠女性的疾病。对于年轻患者，乳腺癌的发病率与西方国家相似，且可能高于许多中东国家，但与西方国家不同的是，在老年患者中，发病率明显下降。无论是老年还是年轻女性，家族性乳腺癌风险均处于西方国家的一般人群风险范围内。临床分期较晚，表明诊断存在延迟，但与患者年龄无关。
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