Hamze Mohamed, Alawa Jude, Alahdab Fares, Al-Shemali Alaa, Alhussein Ahmed Najeb, Arab Nour Muhammed Ali, Galal Bayan, Debel Jamil, Jemo Ayham, Khalil Molham, Chagpar Anees, Atassi Bassel, Khoshnood Kaveh, Abbara Aula
Department of Research, Syrian American Medical Society, Washington DC, United States.
School of Medicine, Stanford University, Stanford, California, United States.
Avicenna J Med. 2025 May 19;15(1):9-16. doi: 10.1055/s-0045-1802585. eCollection 2025 Jan.
Breast cancer remains a significant public health challenge in conflict-affected regions. This study aims to investigate the impact of armed conflict on the burden of breast cancer in female patients in northwest Syria, focusing on clinical presentations, management, diagnosis, access to care, and treatment outcomes. We conducted a retrospective analysis of breast cancer patients diagnosed at the Idlib Oncology Center between March 2017 and January 2022. Data were extracted from clinical files and analyzed in R. The study was conducted at the Idlib Oncology Center, the main referral center for cancer care in northwest Syria, serving a population of 4.6 million. A total of 192 patients were included, with a median age of 45.5 years (interquartile range [IQR]: 40-56). Of 108 patients, 56.5% were internally displaced. Most patients were diagnosed with invasive ductal carcinoma (81.3%), and the majority presented at stages II and III (34.8 and 59%, respectively). Among 192 patients, 95.8% underwent surgery, with 96.6% having a mastectomy and 90.7% receiving chemotherapy. The median interval from symptom onset to diagnosis was 100.5 days, that from diagnosis to surgery was 14.5 days, and that from surgery to radiotherapy was 229 days. No significant effect was observed for chemical weapon exposure or family loss on survival. Displacement was associated with significantly lower predicted survival ( = 0.0038; 95% confidence interval [CI]: 0.05064-0.2570). This study highlights a high prevalence of late-stage breast cancer, a high rate of mastectomies, delayed access to radiotherapy, and long delays between diagnosis and treatment in northwest Syria. Displacement negatively affects survival rates. Additionally, the substantial lack of radiotherapy in patients needing it and prolonged intervals between treatments contribute to poorer outcomes. Establishing localized oncology services and increasing funding for cancer medications and radiotherapy would improve access to necessary oncology care in this region.
在受冲突影响地区，乳腺癌仍然是一项重大的公共卫生挑战。本研究旨在调查武装冲突对叙利亚西北部女性乳腺癌患者负担的影响，重点关注临床表现、管理、诊断、获得医疗服务的情况以及治疗结果。
我们对2017年3月至2022年1月期间在伊德利卜肿瘤中心确诊的乳腺癌患者进行了回顾性分析。数据从临床档案中提取，并在R软件中进行分析。该研究在伊德利卜肿瘤中心开展，该中心是叙利亚西北部癌症护理的主要转诊中心，服务人口达460万。
共纳入192例患者，中位年龄为45.5岁（四分位间距[IQR]：40 - 56岁）。在108例患者中，56.5%为境内流离失所者。大多数患者被诊断为浸润性导管癌（81.3%），且大多数患者在II期和III期就诊（分别为34.8%和59%）。在192例患者中，95.8%接受了手术，其中96.6%进行了乳房切除术，90.7%接受了化疗。从症状出现到诊断的中位间隔时间为100.5天，从诊断到手术为14.5天，从手术到放疗为229天。未观察到化学武器暴露或家庭丧失对生存有显著影响。流离失所与预测生存率显著降低相关（P = 0.0038；95%置信区间[CI]：0.05064 - 0.2570）。
本研究凸显了叙利亚西北部晚期乳腺癌的高患病率、乳房切除术的高比例、放疗延迟以及诊断与治疗之间的长时间延误。流离失所对生存率有负面影响。此外，急需放疗的患者严重缺乏放疗服务以及治疗间隔时间延长导致了更差的治疗结果。建立本地化的肿瘤学服务并增加对癌症药物和放疗的资金投入将改善该地区获得必要肿瘤护理的情况。
