10 Years of breast cancer treatment trends in Fars Province, report of Shiraz Breast Cancer Registry

Background

Despite global recommendations favoring breast-conserving surgery (BCS) with radiotherapy for early-stage breast cancer, there is limited long-term evidence on surgical trends and survival outcomes in low- and middle-income countries such as Iran. Understanding these patterns is crucial to improving treatment equity and patient outcomes. This study aimed to evaluate two-decade trends in surgical approach selection for breast cancer and to compare survival outcomes between BCS and mastectomy in Fars province, Iran.

Methods

Data from 10,091 women diagnosed with breast cancer between 2000 and 2022 were extracted from the Shiraz Breast Cancer Registry. Patients were categorized into four groups based on type of surgery (BCS or mastectomy) and receipt of radiotherapy. Logistic regression was used to identify factors influencing treatment selection. Survival and recurrence were analyzed using Kaplan-Meier and factors affecting survival were evaluated using the Cox regression model.

Results

Between 2000 and 2022, the proportion of patients undergoing BCS plus radiotherapy increased from 30.5 % to 73.8 %, surpassing mastectomy. The BCS plus radiotherapy group showed the most favorable outcomes, with the lowest breast cancer-specific mortality (6.2 %), recurrence rate (10.2 %), and the highest 10-year BCSS (96.01 %). These associations remained significant after multivariable adjustment.

Conclusion

This study reveals a significant shift toward BCS plus radiotherapy in southern Iran over the past two decades. BCS with radiotherapy is associated with superior survival outcomes compared to mastectomy. However, access barriers continue to prevent many women from receiving the optimal surgical approach, indicating the need for policy and health system interventions.