Increasing prevalence of breast cancer among Saudi patients attending a tertiary referral hospital: a retrospective epidemiologic study.
ABSTRACT To determine the pattern of breast diseases among Saudi patients who underwent breast biopsy, with special emphasis on breast carcinoma.
A retrospective review was made of all breast biopsy reports of a mass or lump from male and female patients seen between January 2001 and December 2010 at the King Khalid University Hospital, Riyadh, Saudi Arabia.
Of 1035 breast tissues reviewed, 939 specimens (90.7%) were from female patients. There were 690 benign (65.8%) and 345 (34.2%) malignant cases. In women, 603 (64.2%) specimens were benign and 336 (35.8%) were malignant. In men, 87 specimens (90.6%) were benign and 9 (9.4%) were malignant. All malignant cases from male patients belonged to invasive ductal carcinoma and the majority of malignant cases from female patients belonged to invasive/infiltrating ductal carcinoma. The proportion of malignancy was 18% in patients younger than 40 years and 63.2% in patients older than 60 years. The mean age of onset for malignancy was 48.6 years. The annual percentage incidence of malignant breast cancer steadily increased by 4.8%, from an annual rate of 23.5% in 2000 to 47.2% in 2007.
Among Saudi patients, there is a significant increase in the incidence of breast cancer, which occurs at an earlier age than in western countries. Continued vigilance, mammographic screening, and patient education are needed to establish early diagnosis and perform optimal treatment.
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ABSTRACT: Marine microorganisms are considered to be an important source of bioactive molecules against various diseases and have great potential to increase the number of lead molecules in clinical trials. Progress in novel microbial culturing techniques as well as greater accessibility to unique oceanic habitats has placed the marine environment as a new frontier in the field of natural product drug discovery. A total of 24 microbial extracts from deep-sea brine pools in the Red Sea have been evaluated for their anticancer potential against three human cancer cell lines. Downstream analysis of these six most potent extracts was done using various biological assays, such as Caspase-3/7 activity, mitochondrial membrane potential (MMP), PARP-1 cleavage and expression of gammaH2Ax, Caspase-8 and -9 using western blotting. In general, most of the microbial extracts were found to be cytotoxic against one or more cancer cell lines with cell line specific activities. Out of the 13 most active microbial extracts, six extracts were able to induce significantly higher apoptosis (>70%) in cancer cells. Mechanism level studies revealed that extracts from Chromohalobacter salexigens (P3-86A and P3-86B(2)) followed the sequence of events of apoptotic pathway involving MMP disruption, caspase-3/7 activity, caspase-8 cleavage, PARP-1 cleavage and Phosphatidylserine (PS) exposure, whereas another Chromohalobacter salexigens extract (K30) induced caspase-9 mediated apoptosis. The extracts from Halomonas meridiana (P3-37B), Chromohalobacter israelensis (K18) and Idiomarina loihiensis (P3-37C) were unable to induce any change in MMP in HeLa cancer cells, and thus suggested mitochondria-independent apoptosis induction. However, further detection of a PARP-1 cleavage product, and the observed changes in caspase-8 and -9 suggested the involvement of caspase-mediated apoptotic pathways. Altogether, the study offers novel findings regarding the anticancer potential of several halophilic bacterial species inhabiting the Red Sea (at the depth of 1500--2500 m), which constitute valuable candidates for further isolation and characterization of bioactive molecules.BMC Complementary and Alternative Medicine 12/2013; 13(1):344. · 2.08 Impact Factor
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ABSTRACT: Cancer registration provides a firm basis for cancer control efforts and research into changing patterns of incidence, mortality, survival and prevalence is of obvious importance. Most of the countries of Asia have already published relevant data although the level of coverage and accuracy do vary a great deal both between and within countries. The present review concerns the relevant literature for the period 2008-2013, focusing on the types of research conducted and the conclusions that can be drawn with regard to what should be done in the future to translate the information available into effective intervention efforts to reduce the burden of disease. A major emphasis has been on determining variation in incidence and mortality/survival on the basis of ethnicity and socioeconomic as well as geographical background, as well as trends over time, either for cancer in general or specific organ sites. In addition a small number of papers focused on methodological, quality and cancer control issues, very pertinent to the future development of cancer registry based research.Asian Pacific journal of cancer prevention: APJCP 01/2013; 14(8):4461-4484. · 1.50 Impact Factor
Aim To determine the pattern of breast diseases among
Saudi patients who underwent breast biopsy, with special
emphasis on breast carcinoma.
Methods A retrospective review was made of all breast bi-
opsy reports of a mass or lump from male and female pa-
tients seen between January 2001 and December 2010 at
the King Khalid University Hospital, Riyadh, Saudi Arabia.
Results Of 1035 breast tissues reviewed, 939 specimens
(90.7%) were from female patients. There were 690 benign
(65.8%) and 345 (34.2%) malignant cases. In women, 603
(64.2%) specimens were benign and 336 (35.8%) were ma-
lignant. In men, 87 specimens (90.6%) were benign and 9
(9.4%) were malignant. All malignant cases from male pa-
tients belonged to invasive ductal carcinoma and the ma-
jority of malignant cases from female patients belonged
to invasive/infiltrating ductal carcinoma. The proportion
of malignancy was 18% in patients younger than 40 years
and 63.2% in patients older than 60 years. The mean age
of onset for malignancy was 48.6 years. The annual per-
centage incidence of malignant breast cancer steadily in-
creased by 4.8%, from an annual rate of 23.5% in 2000 to
47.2% in 2007.
Conclusion Among Saudi patients, there is a significant
increase in the incidence of breast cancer, which occurs at
an earlier age than in western countries. Continued vigi-
lance, mammographic screening, and patient education
are needed to establish early diagnosis and perform op-
Ammar Al-Rikabi, Sufia
Department of Pathology, College
of Medicine, King Saud University,
Riyadh, Saudi Arabia
Received: August 1, 2011
Accepted: March 30, 2012
Ammar Cherkess Al-Rikabi
Department of Pathology
King Saud University, Faculty of
Medicine and King Khalid University
P.O. Box 2925
Kingdom of Saudi Arabia
Increasing prevalence of breast
cancer among Saudi patients
attending a tertiary referral
hospital: a retrospective
Croat Med J. 2012;53:239-43
Increased awareness and efficient breast cancer informa-
tion-dissemination campaign led to an increased num-
ber of diagnosed cases of breast cancer. According to
the American Cancer Society, about 1.3 million Ameri-
can women annually are diagnosed with breast cancer
and about 465 000 die from the disease (1). The number
of deaths has decreased since 1990, probably due to an
earlier detection and advances in treatment. According to
2000-2004 Saudi National Cancer Registry data, there were
127.8 per 100 000 women with breast cancer and mortality
rate was 25.5 per 100 000 (2).
Most palpable breast masses are benign; less than 30% of
women with palpable masses have a diagnosis of cancer
(3-5). Approximately 4% of breast cancers present with
a palpable mass without mammographic or ultrasono-
graphic evidence of the disease (6). Therefore, evaluation
of a breast mass should be done by taking into consider-
ation patient’s history, physical examination, imaging, and
biopsy. Definitive diagnosis in nearly all cases is established
by needle biopsy. Because of the low specificity of mam-
mography, many women undergo unnecessary breast
biopsy. As many as 65%-85% of breast biopsies are per-
formed on benign lesions (7), which subjects the patients
to avoidable emotional and physical burden.
Similarly to other countries, breast cancer in Saudi Arabia is
the most common cancer in women (7). The Saudi Nation-
al Cancer Registry reported a rising proportion of breast
cancer among women of all ages, from 10.2% in 2000 to
24.3% in 2005 (8). A significant majority of these breast
cancers (almost 80%) were of the infiltrating ductal type.
The average age at presentation of breast cancer in Arab
countries is 48 years, which is a decade earlier than in west-
ern countries (9). The median age of onset of breast cancer
among Saudi women is 46 years (8). Due to the increasing
incidence, several articles have been published on screen-
ing for breast cancer and on public awareness programs
initiated by the Saudi Arabian government and non-gov-
ernmental sectors (10-13). This study aims to describe the
epidemiological characteristics of breast mass lesions of
patients examined at the King Khalid University Hospital,
Riyadh, Saudi Arabia from 2001 to 2010.
MAteRiAlS And MetHodS
This retrospective study included histopathological re-
ports of all patients (including male patients) who had
undergone biopsy of breast masses or lesions between
January 2001 and December 2010 at the King Khalid
University Hospital, which is a large (1000 beds) tertiary re-
ferral hospital with a large patients catchment area cover-
ing the northern part of Riyadh. Data were extracted from
the hospital computer database and entered into an Excel
sheet. Demographic data included age at diagnosis and
sex. Histomorphological features were classified as benign
or malignant based on the 2003 World Health Organiza-
tion classification of tumors of the breast (14). Data were
analyzed using Predictive Analytical Software, version 18
(IBM, SPSS Inc., Chicago, IL, USA) and expressed as mean,
standard deviation, and percentages. Validation was per-
formed by random re-examination by the two authors of
15% of the histopathology slides representing the various
A total of 1035 breast tissue specimens were examined
between January 2001 and December 2010 at the Pathol-
ogy Department of the King Khalid University Hospital.
There were 939 specimens (90.7%) from female and 96
(9.3%) from male patients. Histopathology revealed 681
(65.8%) benign and 354 (34.2%) malignant cases. The av-
erage age at diagnosis of all patients with malignancy was
48.6 ± 11.6 years.
Among men, benign breast lesions mostly occurred in
patients younger than 40 years, while malignant lesions
occurred in patients aged 40 and older (Table 1). Among
women, benign breast lesions also mostly occurred in pa-
tients younger than 40 years and the majority of those
cases (more than 50%) were fibroadenomas. The medi-
an age of onset of breast cancer in our population was
48.0 years (range, 20-91 years). However, the proportion of
malignancy progressively increased from 18% in the age
group 20-39 years to 53.3% in the age group 40-59 years,
tAble 1. breast lesions detected in male patients with age
Age groups in years, n (%)
benign (n = 87):
Malignant (n = 9):
18 (90.0) 53 (88.3) 5 (50)
1 (5.0) 3 (5)
1 (5.0) 4 (6.7)
1 (16.7) 1 (1.0)
--4 (40) 5 (83.3) 9 (9.4)
Al Rikabi and Husain: Breast lesions among Saudi patients
and as much as 63.2% of patients were more than 60 years
old (Table 2).
The yearly percentage incidence of malignant breast neo-
plasms (in terms of percentage distribution) showed a
steady rise over the years, as compared to benign breast
lesions. In 2000, 76.5% of the tissues submitted for histo-
pathology were benign and only 23.5% were malignant.
From 2000 to 2007, there was a steady rise by a mean of
4.8% in the annual incidence of malignant breast lesions,
with the exception of 2003, when there was a slight de-
crease. The annual rate of a malignant breast lesions con-
firmed by histopathological examination ranged from
23.5% in 2000 to 47.2% in 2007. In contrast, after 2007,
there was a shift of the trend toward more benign cases
(Figure 1). There was, however, an overall increase in the
percentage of people diagnosed with breast cancer from
23.5% in 2000 to 34.5% in 2010.
In this study, the majority of breast lesions sent for histo-
pathology were fibroadenomas, constituting 423 of 1035
(40.9%) breast specimens received in our laboratory. This
finding is similar to other reports (1,2). Such patients were
predominantly young, with age range from 18 to 78 years
in women. Although fibroadenomas are not cancerous or
life-threatening lesions they can still be a source of signifi-
cant anxiety and concern to the patient.
Our study found a malignancy rate of 33.3% (ie, 345 out
of 1035 cases were malignant). It is a high rate, compared
to the rate reported in the literature that was lower than
30% (3-5). Furthermore, our incidence rate was significant-
ly higher than the incidence rate of 24.3% reported by the
Saudi National Cancer Registry in 2005 (8). This difference
may be explained by an increase in the use of mammog-
raphy, effectiveness of breast cancer awareness program
tAble 2. breast lesions seen in female breasts with age distribution
Age groups in years, n (%)
<2020-3940-5960 and abovetotal
benign (n = 603):
epidermal inclusion cyst
benign phyllodes tumor
Malignant (n = 336):
invasive ductal carcinoma
malignant phyllodes tumor
medullary breast cancer
mucinous colloid carcinoma
FiguRe 1. Annual percentage and distribution of benign vs
malignant cases of breast lesions over a period of ten years.
Rhomb – benign; square – malignant.
Croat Med J. 2012;53:239-43
that has been initiated by the government, the effective
campaign organized by various health authorities in order
to educate the public on early detection of breast cancer
through self breast examination, or sample bias (10-13). In
our study, infiltrating/invasive ductal carcinoma was the
most common malignant type of breast cancer (96.2%),
with a slightly higher rate than that reported by the Saudi
National Cancer Registry (8). Patients diagnosed with breast
cancer were in the age groups ranging from 28 to 78 years;
however most of the women were in the age group 40-59
years (97.3%) (8). The age of onset of breast cancer in our
patients was similar to that previously reported (9) but was
slightly higher than that reported by the Saudi National
Cancer Registry (8).
Although our findings did not substantially differ from
those in previous studies in terms of the age of presen-
tation of breast cancer, histopathological types, or even
the ratio of benign to malignant cases, we believe that it
is necessary to point out the steady rise in the incidence of
breast cancer since 2000, with a mean annual increase of
4.8%. This rate is higher than the reported annual increase
in the proportion of breast cancer of 2% in the UK (15) and
higher than the annual average increase of 0.4% in the
USA (16). This trend can be explained either by an effec-
tive awareness program and efficient patient education on
breast self-examination or by sample bias as our patients
came from only one referral center. It is also important to
emphasize that breast cancer remains the leading cause of
death among the Saudi women.
Furthermore, we noticed a changing pattern in the pro-
portion of breast cancer cases in the last 3 years (2007 to
2010). Before 2007, most of the breast specimens were be-
nign cases, with an increasing annual incidence of malig-
nant cases. However, after 2007, the trend shifted toward
benign cases. In our opinion, this is a reflection of an ef-
fective campaign of breast diseases awareness programs.
Nevertheless, this trend should not be a reason for com-
placency, since some of these benign cases, though not
cancerous, may indicate an increased risk toward the de-
velopment of pre-malignant conditions such as fibroad-
enomas (17). Another point of paramount importance,
highlighted in this and other studies (9,15), is that among
Saudi patients breast carcinoma occurs in relatively
younger age groups than is the case in Western patients.
This could be due to the demography of the Saudi pop-
ulation, which is characterized by a predominance of a
younger population (more than 60% of the population
is under 18 years) (8).
An important limitation of this study is its retrospective na-
ture and, although our study covered a large catchment
area, all the data were from one tertiary referral hospital,
which is why they might not be representative of the entire
country. There is a need for a larger study involving various
medical centers that would also examine other environ-
mental, genetic, and dietary factors that may contribute to
the incidence of breast diseases in this part of the world.
Acknowledgment The authors would like thank Miss Roxanne Alamares for
her excellent secretarial help and computer skills during the typing of this
ethical approval Not required.
declaration of authorship AA-R is the owner of the original idea and par-
ticipated in the discussion. SH participated in the discussion.
competing interests All authors have completed the Unified Competing
Interest form at www.icmje.org/coi_disclosure.pdf (available on request
from the corresponding author) and declare: no support from any organi-
zation for the submitted work; no financial relationships with any organiza-
tions that might have an interest in the submitted work in the previous 3
years; no other relationships or activities that could appear to have influ-
enced the submitted work.
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