Breast Cancer Stage Migration in Saudi Arabia: Examining the Influence of Screening.

In 1992, the Saudi Cancer Registry (SCR), a population-based registry, was established under the authority of the Ministry of Health (MOH). In 2014, the SCR was moved to the Saudi Health Council under the department of national registries in the National Center for Health Information. The SCR consists of the main office, which oversees data collection from all over the country through five regional offices to ensure full coverage of all healthcare facilities in the Kingdom. Cancer data are abstracted from patients’ medical records based on clinical and/or histopathological diagnosis by SCRtrained cancer registrars. Breast cancer is the most common malignancy among women in Saudi Arabia, with 2463 cases diagnosed between January and December of 2017. Breast cancer accounted for 17.7% of all cancers reported in Saudi citizens, and 30.9% of all cancers recorded among women of all ages. SCR statistics for annual breast cancer incidence (BCI) and the percentage of each stage/ year were analyzed to describe the impact of breast cancer screening on improving early-detection rates. Annual reports are available online where data from time points that corresponded to a milestone were extracted. A total of 10,970 incident breast cancer cases spanning 17 years were included in the analysis; data were graphed and trends were compared. In the SCR, stages were constantly classified as localized, regional, distant, and unknown, described in its own manual (staging is the grouping of cancer cases into broad categories based on the extent of the disease staging according to the Surveillance, Epidemiology, and End Results [SEER] Summary Stage 2000). The annual BCI increased by fivefold over 17 years (Fig. 1A). Until 2006–2007, there was a remarkably high percentage of regional stage, followed by a decrease in subsequent years, which was mirrored by a steady increase in localized stage. (Fig. 1B). The low percentage of early-stage disease in this review during the prescreening era (2001–2006) is likely because of delayed presentation and referral and lack of screening and awareness. Additionally, women aged 40 or older between 2001 to 2006 were born in the 1960s and preceding years when education and schooling for girls were limited, resulting in less self-care and health awareness. In recent years, the incidence of localized stages has surpassed that of regional stages, and 2007– 2008 marked the beginning of stage migration. (Fig. 1B). This considerable shift in stage distribution was caused by a change either in the staging system, which did not occur in this case, or an improvement in breast cancer awareness and screening programs. The breast cancer awareness–raising activity developed with the formation of the national breast cancer awareness program committee in 2003 as a non-profit initiative by the founder of the Zahra Breast Cancer Association, which was established later in 2007. Several nongovernmental organizations have also founded breast screening programs in different regions of the Kingdom. Interestingly, several pilot screening projects in different regions (Riyadh, Dammam, Jeddah, and Al-Qassim) were initiated as early as 1997. All commonly reported low uptake rates and low cancer detection compared with western countries; however, follow-up periods were short, ranging from 2 to 5 years. In 2012, the MoH initiated a nationwide Breast Cancer Early Detection (BCED) project to promote primary prevention through advertising awareness of modifiable risk factors associated with breast cancer, and secondary prevention through mammography for average-risk women who are . 40 years old. Designated facilities, including mobile units across the Kingdom equipped with mammograms were made available and accessible free of charge for citizens. October is recognized nationally as the breast cancer awareness month, mirroring the international cancer calendar. Nonetheless, screening facilities are accessible throughout the