Iran does not have a breast cancer screening program. The aim is to survey the trend in the incidence rate of different stages of the disease to help establishing a related health policy.
We evaluated the records of the patients with breast carcinoma have been referred to the all public and private oncologic centers of Mashhad University of Medical Sciences during a 33-year period from 1980 to 2012. All the pathological records were reevaluated and whenever possible the tumors were staged based on the last American Joint Committee on Cancer 2010.
Four-thousand records related to women with breast cancers were evaluated. Patients were classified into three consecutive time periods including 1980 to 1990 (521 cases), 1991 to 2002 (1178 cases) and 2001 to 2012 (2302 cases).The mean tumor size was 4.2 cm (0.5-15), 4.2 cm (0.4-15) and 3.8 cm (0.1-17) over the periods respectively, showing a significant change at the third periode (p < 0.000).The incidence rates increased from 0% to 0.9% for carcinoma in-situ (p = 0.001), from 6.9% to 8% for stage I (p = 0.2), and from 32.2% to 47.1% for stage II (p < 0.000) through the periods of the study. While the number of patients with stage IV decreased significantly from 18.9% to 9.7% (p = 0.003). The incidence rate of T4 tumors declined from 19.4% in the first period to 10% in the third period (p < 0.000) and the rate of tumors at T2 and T3 stages significantly increased (p = 0.001).The rate of lymph node involvement significantly decreased during these periods so that the rate of node positives decreased from 73% to 66% within the third period (p < 0.001).
In absence of a screening program the earlier stages of disease have increased significantly. We think detecting these changes is based on overall improvement of health level especially in rural regions that is the consequences of increasing the rates of medical staff, availability of more facilities and increasing the health knowledge of population.
Clinical trial identification
All authors have declared no conflicts of interest.