Outcome of Breast Cancer Management Comparative Cross Sectional Study in Sudan and Greece

Abstract

Introduction: Prognosis of breast cancer depends mainly on early detection of the disease it is also well known the stage at diagnosis is inversely associated with the five-year survival rate nodal involvement is main prognostic factor. Other factors are associated with the prognosis of breast cancer like the molecular subtype of the tumor, socioeconomic status of the patient, and the modalities of treatment received. The management of the patient is going to be planned according to stage at diagnosis, aggressiveness of the breast cancer disease; of course, the timing of investigation and treatment is influenced by the socioeconomic status of the patient. We have recorded invasive or non- invasive breast cancer at the time of diagnosis, site of the disease right, left or bilateral, type of surgery. Comparison of these factors in two countries both of them they have no national screening program for breast cancer like Sudan and Greece, but there is difference in population education. The breast cancer patients in Greece are treated at specialized breast units and in Sudan patients are treated in general hospitals by general surgeons. General objectives: To evaluate different modalities of breast cancer treatment set up and outcomes of breast cancer in both countries Sudan and Greece. Methods: The study is a comparative cross sectional case control study performed at Bashair Alneelain University Teaching & Elsharif Hospitals in Sudan, Hippokrateion General Hospital of the University of Athens and Alexandra General Hospital of the University of Athens in Greece. Inclusion criteria: included female patients that were diagnosed with breast cancer underwent appropriate treatment and with five years survival rate. The study compared 100 breast cancer patients from Sudan and 94 breast cancer patients from Greece. Control 100 female patients from Sudan and 66 female patients from Greece diagnosed with a benign disease of the breast. Informed consent was obtained in all cases. Results: The first result we found more invasive breast cancer in Sudan than in Greece (42.27%), and (9.28%) for noninvasive than Greece (29.8%), and (19.07%) respectively, the p-value of chi-square test (.001) more bilateral breast cancer in Greek patients. There is significant increase of mastectomy in Sudan than in Greece, more chemotherapy on the other hand more conservative breast surgery and hormonal therapy in Greece and recurrence occurs on the contralateral breast. Conclusion: Breast cancer patients in Sudan presents at late stage, younger age group with negative estrogen receptors tumors and higher rate of local recurrence. Breast cancer cases in Greece are diagnosed at earlier stage and old age group than in Sudan, bilateral, estrogen receptors positive treated with hormonal therapy and conservative breast surgery. Management of breast cancer at specialized breast clinics gives better outcome even in countries where there is no national screening program for early detection of breast cancer.