Urban-rural differences in breast cancer incidence in Egypt (1999-2006)

Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109, USA.
Breast (Edinburgh, Scotland) (Impact Factor: 2.38). 05/2010; 19(5):417-23. DOI: 10.1016/j.breast.2010.04.005
Source: PubMed


To describe urban-rural differences in breast cancer incidence in Gharbiah, Egypt and to investigate if these differences could be explained by known risk factors of breast cancer.
We used data from the population-based cancer registry of Gharbiah, Egypt to assess breast cancer incidence from 1999 through 2006. The Egyptian census provided data on district-specific population, age, and urban-rural classification. Incidence patterns of breast cancer by district and age-specific urban-rural differences were analyzed.
Overall, incidence rate of breast cancer was three to four times higher in urban areas than in rural areas (60.9/10(5)-year for urban areas versus 17.8/10(5)-year for rural areas; IRR=3.73, 95% CI=3.30, 4.22). Urban areas had consistently higher incidence of breast cancer across all age-groups for all years. Higher incidence of breast cancer was also seen in the more developed districts of Tanta and El-Mehalla.
Higher incidence of breast cancer in urban and more developed populations might be related to higher exposure to xenoestrogens, as well as other endocrine disruptors and genotoxic substances.

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Available from: Subhojit Dey, Oct 01, 2015
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    • "We previously proposed a breast cancer screening program based on clinical breast examination with selective use of mammography, and we rationaled our proposal on the decreased accuracy of mammography at young ages.16 The data in the current study and other recent reports from Egyptian databases indicate a trend towards an age distribution shift from the midfifties to the early sixties.7,17 This changing trend in age at diagnosis emphasizes the importance of implementing screening mammography in our community and advises against the reticence of many practitioners to recommend mammography for routine screening. "
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    ABSTRACT: Breast cancer is the most common cancer among Egyptian women. The disease is often advanced at diagnosis. Since molecular profiling is not feasible in routine practice, we sought to examine the association of age distribution with hormone receptor profile, disease stage and outcome among Egyptian women. We conducted a retrospective review of breast cancer patients treated at Mansoura University Cancer Center in the Nile Delta from 2006 through 2011. Age groups were examined in relation to hormone receptors status and tumor clinicopathological criteria. Additionally, the effect of receptor status on disease relapse and disease-free survival was examined with logistic regression and Kaplan-Meier analysis. A total of 263 patients were included in the current analysis. About 66.9% (n = 176) of patients were hormone receptor positive, 14.1% (n = 37) were Her2/neu positive, and 19.0% (n = 50) were triple negative. Median age of the patients was 52 years and was equal across all receptor status types. Triple negative status correlated with increased risk of disease relapse (odds ratio = 1.8, P = 0.03) and with shortened disease-free survival (hazards ratio = 2.6, P < 0.01). The age distribution and receptor status pattern in the Nile Delta region does not explain the aggressive behavior of the disease. The age of the patients at diagnosis is older than patients in earlier studies from Egypt emphasizing the importance of implementing mammographic screening programs.
    Breast cancer 06/2013; 7:51-7. DOI:10.4137/BCBCR.S12214
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    • "Exposure to endocrine disruptors varies within populations based on age, race, and sociodemographic factors [3,26]. Epidemiological studies conducted in Egypt also report geographical variance in disease incidence, highlighting the importance in evaluating the contribution of environmental exposures to these trends [27-29]. Developing countries, where there are major discrepancies in social and behavioral practices between urban and rural populations, offer a unique setting in which to study potential toxicant-disease interactions. "
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    ABSTRACT: Exposure to endocrine active compounds, including bisphenol A (BPA), remains poorly characterized in developing countries despite the fact that behavioral practices related to westernization have the potential to influence exposure. BPA is a high production volume chemical that has been associated with metabolic dysfunction as well as behavioral and developmental effects in people, including children. In this pilot study, we evaluate BPA exposure and assess likely pathways of exposure among girls from urban and rural Egypt. We measured urinary concentrations of total (free plus conjugated) species of BPA in spot samples in urban (N = 30) and rural (N = 30) Egyptian girls, and compared these concentrations to preexisting data from age-matched American girls (N = 47) from the U.S. National Health and Nutrition Examination Survey (NHANES). We also collected anthropometric and questionnaire data regarding food storage behaviors to assess potential routes of exposure. Urban and rural Egyptian girls exhibited similar concentrations of urinary total BPA, with median unadjusted values of 1.00 and 0.60 ng/mL, respectively. Concentrations of urinary BPA in this group of Egyptian girls (median unadjusted: 0.70 ng/mL) were significantly lower compared to age-matched American girls (median unadjusted: 2.60 ng/mL) according to NHANES 2009-2010 data. Reported storage of food in plastic containers was a significant predictor of increasing concentrations of urinary BPA. Despite the relatively low urinary BPA concentrations within this Egyptian cohort, the significant association between food storage behaviors and increasing urinary BPA concentration highlights the need to understand food and consumer product patterns that may be closing the gap between urban and rural lifestyles.
    Environmental Health 04/2012; 11(1):20. DOI:10.1186/1476-069X-11-20 · 3.37 Impact Factor
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    • "The age-standardized rate (ASR) for breast cancer incidence in Egypt is 37.3 compared to 76 in the United States. Although incidence remains significantly lower than in highly developed countries, rates are steadily increasing [2,3]. Mortality rates in Egypt are worse (20.1 per 100 000) then they are in the United States (14.7 per 100 000), and is the leading cause of cancer-related deaths. "
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    ABSTRACT: Prognostic markers and molecular breast cancer subtypes reflect underlying biological tumor behavior and are important for patient management. Compared to Western countries, women in North Africa are less likely to be prognosticated and treated based on well-characterized markers such as the estrogen receptor (ER), progesterone receptor (PR) and Her2. We conducted this study to determine the prevalence of breast cancer molecular subtypes in the North African country of Egypt as a measure of underlying biological characteristics driving tumor manifestations. To determine molecular subtypes we characterized over 200 tumor specimens obtained from Egypt by performing ER, PR, Her2, CK5/6, EGFR and Ki67 immunohistochemistry. Our study demonstrated that the Luminal A subtype, associated with favorable prognosis, was found in nearly 45% of cases examined. However, the basal-like subtype, associated with poor prognosis, was found in 11% of cases. These findings are in sharp contrast to other parts of Africa in which the basal-like subtype is over-represented. Egyptians appear to have favorable underlying biology, albeit having advanced disease at diagnosis. These data suggest that Egyptians would largely profit from early detection of their disease. Intervention at the public health level, including education on the benefits of early detection is necessary and would likely have tremendous impact on breast cancer outcome in Egypt.
    BMC Women's Health 09/2011; 11(1):44. DOI:10.1186/1472-6874-11-44 · 1.50 Impact Factor
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