Breast cancer in Iran: a survival analysis.
ABSTRACT A prospective study was undertaken to examine survival in Iranian breast cancer patients. One hundred and sixty-seven breast cancer patients diagnosed in 1997 were entered into the study and followed up for five years. The mean age of the patients at diagnosis was 47.2 (SD = 13.5), ranging from 24 to 81 years. A total of 39 patients were lost in the follow-up period, leaving 128 for analysis of data. Of these, 79 were alive and 49 were dead after five years. Most patients (61%) presented with advanced disease. Using life table analysis, the overall relative 5-year survival rate was found to be 62% (SE = 0.04). In addition, after adjustment for age at diagnosis, initial treatment (mastectomy, breast conserving surgery, and neo-adjuvant therapy), and disease stage, using Cox's regression model, it was found that receiving neo-adjuvant therapy as the initial treatment was an independent predictor of poorer survival (Hazard ratio = 4.56, 95% CI 2.20-9.44, P<0.0001). The other variables (older age and late stage disease), although associated with high hazards rates, were not significant. The study findings suggest that overall relative survival rate in Iranian breast cancer patients stands between western and eastern European countries and needs to be improved. It seems that early detection and better management using standard guidelines might contribute considerably to improvement of survival in women experiencing breast cancer.
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ABSTRACT: Background: Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms. Materials and Methods: A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analysed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description. Results: The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labelling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear. Conclusions: This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women’s knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs. Keywords: Breast cancer - socio-cultural - entangled cognitive responses - Iranian womenAsian Pacific journal of cancer prevention: APJCP 10/2014; 15(19):8135-8142. · 1.50 Impact Factor
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ABSTRACT: Background: Breast cancer is the most frequently occurring cancer among Iranian women; however limited studies have been conducted to address survival rates. Objective: The objective was to examine survival rates in Tabriz (Northwest of Iran) and compare with those of data reported from other cities and countries. Methods: Survival rates were calculated for one, three, five, seven and ten years for 271 breast cancer patients referred to one university clinic during 1997-2008. Results: Survival analysis demonstrated a lower survival rate compared to western countries. Conclusions: Survival rates for our patients are similar/better than other cities in Iran, but lower than certain European countries and the US. Further studies with a higher number of patients are now required.Asian Pacific journal of cancer prevention: APJCP 01/2013; 14(1):39-42. · 1.50 Impact Factor
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ABSTRACT: Breast cancer is the most common cancer among women worldwide. Based on the latest Iranian national cancer department report, the total number of women registered with breast cancer was 6976 cases during 2007. Five year survival is one of the indicators used for evaluation of the quality for care to different types of malignancies including breast cancer. The aim of this study was to estimate survival rate of breast cancer in 6147 Iranian patients at a national level in different geographic regions. 6147 cases of breast cancer, which had telephone number and were diagnosed between 2001-2006, were called to obtain information about their life status. Survival estimates were calculated using the Kaplan-Meier method, and the survival probability was calculated for the overall cohort and in different categories of gender, age and pathologic type of tumor. Hazard ratios (HR) according to demographic and risk variables were calculated by Cox's proportional hazard model. The overall 5-year survival rate was 71.0%. The mean survival time was different between men and women, which was statistically significant. The number of men involved with breast cancer was 172 (2.8%) of all cases. The 5-year survival rate for patients in age group 41-50 years was significantly higher than other age groups (P = 0.001). The likelihood of death was higher in patients with 61 years old or more years rather than those below forty years old (HR = 1.31; 95% CI: 1.12-1.55). THE FINDINGS OF THIS STUDY MIGHT HELP IRANIAN HEALTH MANAGERS: 1) to be more conscious about geographical and regional determinants which will affect overall survival rate. 2) To carry preventive activities such as public education particularly in Iranian men. 3) To think about screening and early detection of breast cancer.Iranian Red Crescent medical journal. 12/2012; 14(12):798-804.
Asian Pacific Journal of Cancer Prevention, Vol 5, 2004
Breast Cancer Survival in Iran
Asian Pacific J Cancer Prev, 5, 223-225
Breast cancer remains the most common cancer among
women. Compared with western countries the incidence of
breast cancer in Iran is low but patients are relatively young
and present with advanced disease (Harirchi et al., 2000;
Harirchi et al., 2004). Furthermore despite improvements
in survival for breast cancer patients in many countries
(Taylor et al., 2003; Giordano et al., 2004; Thomson et al.,
2004), it appears that the survival in Iranian breast cancer is
poor. It has been suggested that both earlier diagnosis and
changes in breast cancer treatment have contributed to
improved breast cancer survival (Webb et al., 2004).
However, studies have shown that variations in breast cancer
survival partly depend on several etiological factors (Quinn
et al., 1998; Thomson et al., 2001; Bradley et al., 2002;
Shavers et al., 2003; Henson et al., 2003).
The objective of this study was to determine the 5-year
survival in Iranian breast cancer patients who referred to
the Cancer Institute in Tehran, Iran. It was thought a study
on survival might help to find out factors that contribute to
the present situation in Iran.
Breast Cancer in Iran: a Survival Analysis
Mariam Vahdaninia1, Ali Montazeri1,2*
1. Iranian Institute for Health Sciences Research, Tehran, Iran 2.Iranian Centre for Breast Cancer (ICBC), Tehran, Iran Address for
correspondence: Dr. Ali Montazeri, P.O. Box 13185-1488, Iranian Centre for Breast Cancer, Tehran Iran. Tel: 0098 21 6409786, Fax:
6411575. E-mail: firstname.lastname@example.org
A prospective study was undertaken to examine survival in Iranian breast cancer patients. One hundred and
sixty-seven breast cancer patients diagnosed in 1997 were entered into the study and followed up for five years. The
mean age of thr patients at diagnosis was 47.2 (SD = 13.5), ranging from 24 to 81 years. A total of 39 patients were lost
in the follow-up period, leaving 128 for analysis of data. Of these, 79 were alive and 49 were dead after five years.
Most patients (61%) presented with advanced disease. Using life table analysis, the overall relative 5-year survival
rate was found to be 62% (SE = 0.04). In addition, after adjustment for age at diagnosis, initial treatment (mastectomy,
breast conserving surgery, and neo-adjuvant therapy), and disease stage, using Cox’s regression model, it was found
that receiving neo-adjuvant therapy as the initial treatment was an independent predictor of poorer survival (Hazard
ratio = 4.56, 95% CI 2.20-9.44, P<0.0001). The other variables (older age and late stage disease), although associated
with high hazards rates, were not significant. The study findings suggest that overall relative survival rate in Iranian
breast cancer patients stands between western and eastern European countries and needs to be improved. It seems
that early detection and better management using standard guidelines might contribute considerably to improvement
of survival in women experiencing breast cancer.
Key Words: Breast cancer - Survival - Life table - Kaplan-Meier analysis - Cox Proportional Hazards Model - Iran
Materials and Methods
This was a prospective study to examine survival rate in
Iranian breast cancer patients. One hundred and sixty-seven
breast cancer patients with a confirmed pathological report
diagnosed at 1997 were entered into the study and followed
up for five years. Data were collected on demographic and
available clinical characteristics of the patients and were
analyzed using Life table analysis to estimate the overall
relative survival rate, and by Kaplan-Meier analysis to
indicate survival with reference to the disease stage and
initial treatment, and by the Cox’s proportional hazards
model to investigate the interaction between variables on
Of the 167 patients with breast cancer studied, in all 39
patients were lost in the follow-up period. This led to analysis
of data for the 128 remaining patients. The demographic
and clinical data for the initial and the follow-up samples
are shown in Table 1. The mean age of patients at diagnosis
Mariam Vahdaninia and Ali Montazeri
Asian Pacific Journal of Cancer Prevention, Vol 5, 2004
was 47.2 (SD= 13.5) years, most were married (69%) and
presented with advanced disease (stage III = 33% and stage
IV = 28%). Of these, at five years 79 patients were alive
and 49 patients were dead. The mean survival time was 47.3
(SD = 19.0) months and using the life table analysis the
overall 5-year relative survival rate was found to be 62%
(SE = 0.04).
Performing the Kaplan-Meier analysis the 5-year survival
was found to be lower in patients with advanced disease.
The mean survival time for Stage I, II, III and IV patients
was 56, 51, 46 and 42 months, respectively (Figure 1).
Similar analysis by initial treatment as indicating factor
showed that those who received neo-adjuvant treatment as
their initial management had poorer survival. The mean
survival times for mastectomy, breast conservation and neo-
adjuvant treatment groups were 50, 48 and 25 months
respectively (Figure 2).
Finally performing the Cox regression analysis after
adjustment for age at diagnosis, initial treatment and cancer
stage, it was found that initial treatment was the significant
predictor of survival. The analysis indicated that the patients
who received neo-adjuvant therapy had an increased risk of
death (Hazard ratio = 4.5, 95% CI 2.20-9.44, P <0.0001)
while age at diagnosis and cancer stage did not show
significant results although a higher risk of death was
observed in the expected directions (Table 2).
This was a prospective study of survival in breast cancer
patients in Iran and the overall 5-year relative survival rate
was found to be 62%. Since there is no population-based
cancer registry in Iran the study was carried out based on
Figure 2. The Five-year Survival by Initial Management
Table 2. The Results of the Cox Proportional Hazard
Age at diagnosis
Table 1. Demographic and Clinical Characteristics of the
Breast Cancer Patients
Initial sample Follow-up sample
(n = 167)
(n = 128)
Age group (years)
Less than 30
More than 70
* Non-surgical treatment in advanced breast cancer patients.
Figure 1. The Five-year Survival by Disease Stage
70 6050 4030 20 100
706050 40 3020100
Asian Pacific Journal of Cancer Prevention, Vol 5, 2004
Breast Cancer Survival in Iran
data collected from a single institution and therefore the
findings could not be generalized. However, the findings
indicated that the overall relative survival in Iranian breast
cancer patients was higher than some Asian and eastern
European countries and was lower than the U.S and western
European countries (Gajalakshmi et al., 1997; Jemal et al.,
2004). A recent publication from a neighboring country also
has reported similar results where the five-year survival was
found to be 62% for breast cancer patients (Al-Moundhri et
The findings indicated that patients who received neo-
adjuvant therapy as their initial management had poorer
survival compared to those who received mastectomy or
conservative surgery. This might be a true reflection of
patients’ clinical status where mostly presented with
advanced disease (stage III = 33% and stage IV = 28%).
Neo-adjuvant therapy is being used increasingly in the
treatment of patients with large and locally advanced breast
cancer to reduce the size of the primary tumor. It is argued
that neo-adjuvant therapy in this group of patients can result
in satisfactory local control and overall survival rates (Eltahir
et al., 1998). However, it has been shown that patients with
extensive nodal involvement after neo-adjuvant therapy have
a very poor outcome (Pierga et al., 2000). Although we did
not had information on nodal involvement, there is evidence
that 70% of breast cancers in Iran present with lymph node
involvement (Harirchi et al., 2004).
The findings did not show significant association
between survival and age and disease stage. Almost all
studies of survival in breast cancer indicate that age and
stage are predictors of survival (Quinn et al., 1998;
Grosclaude et al., 2001; Ugnat et al., 2004). We suspect that
the power of the present study was low and thus it was not
possible to detect the significant results between survival,
age and disease stage. However, a higher hazard rate was
observed for breast cancer patients with older age and
advanced disease (Table 2). In addition the information on
clinical status of the study sample was limited and therefore
one might argue that if there were enough clinical
information on histological grade or nodal involvement it
was possible to arrive at different results. Furthermore
evidence suggests that even specialist or non-specialist care
might influence survival in breast cancer patients
(Kingsmore et al., 2004). Unfortunately such information
was not available for the present study.
In conclusion, the findings of the study suggest that
overall relative survival rate in Iranian breast cancer patients
stands between western and eastern European countries and
needs to be improved. It seems that expansion of current
preventive programs on breast cancer with more attention
on public awareness; early detection and using standard
treatment protocols might improve survival in Iranian breast
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