Skip to main content Skip to main navigation menu Skip to site footer
Articles
Published: 2023-12-15

A study of risk factors for breast cancer in Al-Anbar province: a case- control study

Department of Family and Community Medicine, College of Medicine, Anbar University, Anbar, Iraq
Department of Obstetrics and Gynecology, College of Medicine, University of Anbar, Anbar, Iraq

Abstract

Background: Globally, breast cancer is a widespread malignancy among women, ranking as the second leading cause of female mortality. This study investigates risk factors for breast cancer in AL-Anbar province, Iraq, emphasizing their significance in disease development. 

Methods: An investigation was carried out at Al-Anbar Cancer Center in Al-Anbar province, Iraq, employing a case-control design. The study comprised 60 confirmed breast cancer cases and 120 controls without breast issues. Data was collected through direct interviews using a semi-structured questionnaire, and subsequent analyses included descriptive, bivariate, and multivariate approaches.

Results: About 48.0% aged 41-49, and 25% aged 50-59. Case and control groups were matched in age, but varied in marital, education, occupation, menopausal status. Women with benign breast diseases have a 1.7 times higher breast cancer risk (OR=1.7, CI=0.063-4.53). Positive family history triples the risk (OR=3, CI=1.21-7.80, P=0.002), and the sedentary lifestyle exhibits 5 times higher risk of breast cancer (OR=5.67, CI=2.89-4.13, P < 0.001). Menstrual age, parity, and reproductive factors influence breast cancer risk. Menarche at ≤12 years triples the risk (OR=3.05, CI=1.82-5.05, P<0.001), while menarche at ≥16 decreases it (OR=0.89, CI=0.06-5.12, P<0.001). Nulliparity increases risk 2.1 times (OR=2.1, CI=0.8-4.89, P=0.002), and more live births provide significant protection. Preterm delivery before the eighth month triples the risk (OR=2.9, CI=1.32-6.53, P=0.002). Multiple children prevent breast cancer, while mother's age at first full birth ≥30 raises the risk 3.5 times (OR=3.4, CI=1.45-7.88, P=0.014). Women who never breastfed had a significant twofold higher risk of breast cancer (OR=2, CI=0.8-4.38, P=0.003). Postmenopausal women at ≥50 years faced a threefold higher risk than their counterparts (OR=3.25, CI=1-1.11, P=0.004). Hormonal use showed a marginal risk increase (OR=1.2, CI=0.5-1.8, P<0.001).

Conclusion: Breast cancer susceptibility arises from diverse factors like genetics, nutrition, environment, and lifestyle. Effectively managing and preventing breast cancer involves implementing strategic control measures.

 



Downloads

Download data is not yet available.

References

  1. Chhikara BS, Parang K. Global Cancer Statistics 2022: the trends projection analysis. Chemical Biology Letters 2022; 10(1): 451.
  2. Romero Y, Trapani D, Johnson S, Tittenbrun Z, Given L, Hohman K, Stevens L, Torode JS, Boniol M, Ilbawi AM. National cancer control plans: a global analysis. Lancet Oncol. 2018 Oct;19(10): e546-e555. doi: 10.1016/S1470-2045(18)30681-8.
  3. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424. doi: 10.3322/caac.21492.
  4. Grimm LJ, Avery CS, Hendrick E, Baker JA. Benefits and Risks of Mammography Screening in Women Ages 40 to 49 Years. J Prim Care Community Health. 2022 Jan-Dec; 13:21501327211058322. doi: 10.1177/21501327211058322.
  5. Thamer Yahyaa B, Ali Altaha M, Abdulhadi Al-Rawi R, Ali Mustafa Al-Samarrai M, Ali Jadoo SA. knowledge and attitude of Iraqi women in reproductive age group about risk factors in pregnancy. Journal of Ideas in Health 2022; 5(2):673-8. Doi: 10.47108/jidhealth.vol5.iss2.223.
  6. Khalaf H, Mohammed A, Shukur S, Alhalabi N, Almothafar B, Hassan M, Abu A. Breast cancer: age incidence, hormone receptor status and family history in Najaf, Iraq. J Med Life. 2022 Oct; 15(10): 1318–1321.
  7. Kashyap D, Pal D, Sharma R, Garg VK, Goel N, Koundal D, Zaguia A, Koundal S, and Belay A. Global Increase in Breast Cancer Incidence: Risk Factors and Preventive Measures. BioMed Research International. 2022. Article D 9605439 | https://doi.org/10.1155/2022/9605439.
  8. Feng Y, Spezia M, Huang S, Yuan C, Zeng Z, Zhang L, Ji X, Liu W, Huang B, Luo W, Liu B, Lei Y, Du S, Vuppalapati A, Luu HH, Haydon RC, He TC, Ren G. Breast cancer development and progression: Risk factors, cancer stem cells, signaling pathways, genomics, and molecular pathogenesis. Genes Dis. 2018 May 12;5(2):77-106. doi: 10.1016/j.gendis.2018.05.001.
  9. American Cancer Society, Guidelines for the Early Detection of Cancer. Available from: https://www.cancer.org/cancer/screening/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html [Accessed on 15th August 2023].
  10. Koo MM, von Wagner C, Abel GA, McPhail S, Rubin GP, Lyratzopoulos G. Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis. Cancer Epidemiol. 2017 Jun; 48:140-146. doi: 10.1016/j.canep.2017.04.010.
  11. Arnold M, Morgan E, Rumgay H, Allini Mafra A, Singh D, Laversanne M, Vignat J, Gralow JR, Cardoso F, Siesling S, Soerjomatarama I. Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast. 2022 Dec; 66: 15–23.
  12. Pace LE, Shulman LN. Breast Cancer in Sub-Saharan Africa: Challenges and Opportunities to Reduce Mortality. Oncologist. 2016 Jun;21(6):739-44. doi: 10.1634/theoncologist.2015-0429.
  13. Leong SP, Shen ZZ, Liu TJ, Agarwal G, Tajima T, Paik NS, Sandelin K, Derossis A, Cody H, Foulkes WD. Is breast cancer the same disease in Asian and Western countries? World J Surg. 2010 Oct;34(10):2308-24. doi: 10.1007/s00268-010-0683-1.
  14. Al-Hashimi MMY. Trends in Breast Cancer Incidence in Iraq During the Period 2000-2019. Asian Pac J Cancer Prev. 2021 Dec 1;22(12):3889-3896. doi: 10.31557/APJCP.2021.22.12.3889.
  15. Alwan NAS. Breast cancer: demographic characteristics and clinico-pathological presentation of patients in Iraq. Eastern Mediterranean Health Journal2010; 16(11):1159-1164.
  16. Iraqi Cancer Board. Results of the Iraqi Cancer Registry 2004. Baghdad, Iraqi Cancer Registry Center, Ministry of Health, 2007. Available from: https://old.moh.gov.iq/upload/upfile/ar/1642009%20cancer%20registery.pdf.
  17. World Health Organization, Cancer Iraq 2020 country profile. WHO. 1 January 2020. Technical document. Available from: https://www.who.int/publications/m/item/cancer-irq-2020 [Accessed on 21 August 2023].
  18. World Health Organization. 2020. Iraq - Source: Globocan 2020. Retrieved July 05, 2023, from https://gco.iarc.fr/today/data/factsheets/populations/368-iraq-fact-sheets.pdf.
  19. M-Amen K, Abdullah OS, Amin AMS, Mohamed ZA, Hasan B, Shekha M, et al. Cancer Incidence in the Kurdistan Region of Iraq: Results of a Seven-Year Cancer Registration in Erbil and Duhok Governorates. Asian Pac J Cancer Prev. 2022 Feb 1;23(2):601-615. doi: 10.31557/APJCP.2022.23.2.601.
  20. Abood RA. Breast Cancer in Basra Oncology Center: A Clinico- Epidemiological Analysis. Asian Pac J Cancer Prev. 2018 Oct 26;19(10):2943-2946. doi: 10.22034/APJCP.2018.19.10.2943.
  21. Hamed E, Alemrayat B, Syed MA, Daher-Nashif S, Rasheed HMA, Kane T. Breast Cancer Knowledge, Attitudes and Practices amongst Women in Qatar. Int J Environ Res Public Health. 2022 Mar 28;19(7):3995. doi: 10.3390/ijerph19073995.
  22. Dafni U, Tsourti Z, Alatsathianos I. Breast Cancer Statistics in the European Union: Incidence and Survival across European Countries. Breast Care (Basel). 2019 Dec;14(6):344-353. doi: 10.1159/000503219.
  23. Haddou Rahou B, El Rhazi K, Ouasmani F, Nejjari C, Bekkali R, Montazeri A, Mesfioui A. Quality of life in Arab women with breast cancer: a review of the literature. Health Qual Life Outcomes. 2016 Apr 27; 14:64. doi: 10.1186/s12955-016-0468-9.
  24. Dong JY, Qin LQ. Education level and breast cancer incidence: a meta-analysis of cohort studies. Menopause. 2020 Jan;27(1):113-118. doi: 10.1097/GME.0000000000001425.
  25. Liu L, Hao X, Song Z, Zhi X, Zhang S, Zhang J. Correlation between family history and characteristics of breast cancer. Sci Rep. 2021 Mar 18;11(1):6360. doi: 10.1038/s41598-021-85899-8.
  26. Mukama T, Fallah M, Brenner H, Xu X, Sundquist K, Sundquist J, Kharazmi E. Risk of invasive breast cancer in relatives of patients with breast carcinoma in situ: a prospective cohort study. BMC Med. 2020 Nov 5;18(1):295. doi: 10.1186/s12916-020-01772-x.
  27. Kim EY, Chang Y, Ahn J, Yun JS, Park YL, Park CH, Shin H, Ryu S. Mammographic breast density, its changes, and breast cancer risk in premenopausal and postmenopausal women. Cancer. 2020 Nov 1;126(21):4687-4696. doi: 10.1002/cncr.33138.
  28. Abdel hakiem NH, El-Sawy, WH, Almoghraby SMA, Elsayed RHE. Outcome of the locally advanced breast cancer patients in Zagazig University Hospital (Experience of Zagazig University Hospital). Zagazig University Medical Journal 2021;27(4): 759-766. doi: 10.21608/zumj.2019.17825.1574.
  29. Johansson A, Christakou AE, Iftimi A, Eriksson M, Tapia J, Skoog L, Benz CC, Rodriguez-Wallberg KA, Hall P, Czene K, Lindström LS. Characterization of Benign Breast Diseases and Association With Age, Hormonal Factors, and Family History of Breast Cancer Among Women in Sweden. JAMA Netw Open. 2021 Jun 1;4(6):e2114716. doi: 10.1001/jamanetworkopen.2021.14716.
  30. Mukama T, Kharazmi E, Sundquist K, Sundquist J, Brenner H, Fallah M. Familial risk of breast cancer by dynamic, accumulative, and static definitions of family history. Cancer. 2020 Jun 15;126(12):2837-2848. doi: 10.1002/cncr.32815.
  31. Chen X, Wang Q, Zhang Y, Xie Q, Tan X. Physical Activity and Risk of Breast Cancer: A Meta-Analysis of 38 Cohort Studies in 45 Study Reports. Value Health. 2019 Jan;22(1):104-128. doi: 10.1016/j.jval.2018.06.020.
  32. Nounu A, Kar SP, Relton CL, Richmond RC. Sex steroid hormones and risk of breast cancer: a two-sample Mendelian randomization study. Breast Cancer Res. 2022 Oct 8;24(1):66. doi: 10.1186/s13058-022-01553-9.
  33. Latif S, Perveen S, Iqbal M, Ahmed T, Moula Bux K, Jafri SNA. Epidemiology of Carcinoma Breast in Young Adolescence Women. Cureus. 2022 Mar 31;14(3):e23683. doi: 10.7759/cureus.23683.
  34. Maxwell CV, Al-Sehli H, Parrish J, D'Souza R. Breast Cancer in Pregnancy: A Retrospective Cohort Study. Gynecol Obstet Invest. 2019;84(1):79-85. doi: 10.1159/000493128.
  35. El Sharif N, Khatib I. Reproductive factors and breast cancer risk in Palestine: A case control study. Cancer Epidemiol. 2021 Oct;74:102019. doi: 10.1016/j.canep.2021.102019.
  36. Ebrahimi M, Vahdaninia M, Montazeri A. Risk factors for breast cancer in Iran: a case-control study. Breast Cancer Res. 2002;4(5):R10. doi: 10.1186/bcr454.
  37. Khushalani JS, Qin J, Ekwueme DU, White A. Awareness of breast cancer risk related to a positive family history and alcohol consumption among women aged 15-44 years in United States. Prev Med Rep. 2019 Dec 9;17:101029. doi: 10.1016/j.pmedr.2019.101029.
  38. Hill DA, Prossnitz ER, Royce M, Nibbe A. Temporal trends in breast cancer survival by race and ethnicity: A population-based cohort study. PLoS One. 2019 Oct 24;14(10):e0224064. doi: 10.1371/journal.pone.0224064.
  39. Drummond AE, Swain CTV, Brown KA, Dixon-Suen SC, Boing L, van Roekel EH, et al. Linking Physical Activity to Breast Cancer via Sex Steroid Hormones, Part 2: The Effect of Sex Steroid Hormones on Breast Cancer Risk. Cancer Epidemiol Biomarkers Prev. 2022 Jan;31(1):28-37. doi: 10.1158/1055-9965.EPI-21-0438.
  40. Slepicka PF, Cyrill SL, Dos Santos CO. Pregnancy and Breast Cancer: Pathways to Understand Risk and Prevention. Trends Mol Med. 2019 Oct;25(10):866-881. doi: 10.1016/j.molmed.2019.06.003.
  41. Kensler KH, Eliassen AH, Rosner BA, Hankinson SE, Brown M, Tamimi RM. Pre-diagnostic sex hormone levels and survival among breast cancer patients. Breast Cancer Res Treat. 2019 Apr;174(3):749-758. doi: 10.1007/s10549-018-05121-8.
  42. Ginsburg O, Yip CH, Brooks A, Cabanes A, Caleffi M, Dunstan Yataco JA, et al. Breast cancer early detection: A phased approach to implementation. Cancer. 2020 May 15;126 Suppl 10(Suppl 10):2379-2393. doi: 10.1002/cncr.32887.
  43. Al-Samarrai MAM, Al-Rawi RA, Yaseen SM, Ali Jadoo SA. Knowledge, attitude, and practice of mothers about complementary feeding for infants aged 6-12 months in Anbar Province, Iraq. Journal of Ideas in Health 2020;3(1):125-9. Doi: 10.47108/jidhealth.vol3.iss1.17.
  44. Rositch AF, Unger-Saldaña K, DeBoer RJ, Ng'ang'a A, Weiner BJ. The role of dissemination and implementation science in global breast cancer control programs: Frameworks, methods, and examples. Cancer. 2020 May 15;126 Suppl 10:2394-2404. doi: 10.1002/cncr.32877.
  45. Wild CP, Weiderpass E, Stewart BW, editors (2020). World Cancer Report: Cancer Research for Cancer Prevention. Lyon, France: International Agency for Research on Cancer. Available from: http://publications.iarc.fr/586. [Accessed on 17th July 2023].
  46. American Cancer Society, Cancer Facts & Figures 2023. Available from: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/2023-cancer-facts-figures.html [Accessed on 19th July 2023].
  47. Fitzpatrick D, Pirie K, Reeves G, Green J, Beral V. Combined and progestagen-only hormonal contraceptives and breast cancer risk: A UK nested case-control study and meta-analysis. PLoS Med. 2023 Mar 21;20(3):e1004188. doi: 10.1371/journal.pmed.1004188.


How to Cite

1.
Sarhan Y, Bardan R. A study of risk factors for breast cancer in Al-Anbar province: a case- control study. jidhealth [Internet]. 2023 Dec. 15 [cited 2024 Feb. 23];6(4):982-9. Available from: https://jidhealth.com/index.php/jidhealth/article/view/311