A survey of suspected familial breast cancer in Iraqi Kurdish women.

Abstract

1602 Background:Health services in Iraq are trying to catch up with the developed world. Breast cancer is the most common cancer in women and the second cause of cancer related deaths. Most of our breast cancer patients present with incurable, advanced disease. BRCA1 and BRCA2 mutations and other familial cancer syndromes are expected to account for a fraction of all cases and potentially, more than 10% of high-risk patients carry a genetic mutation. Genetic counseling is an evolving area and currently is non-existent in Iraq. Methods: After appropriate institutional approvals were obtained, 500 women with breast cancer who were seen at our center were interviewed using a questionnaire for the following: history of breast cancer, endogenous and exogenous hormonal history and family history of breast and ovarian cancer in first and second degree relatives. Patients were stratified into high-, moderate and average risk groups. High risk patients were compared to average risk patients in regard to hormonal history. Results: Two hundred and five women completed the questionnaire and had the required medical record data available. The median age was 48 years (range 23-92). Hormonal history in the high- and average risk groups were similar (12.8[SD1.3] vs. 13.1[SD1.2]; p=0.33), (25.8[SD4.9] vs. 24.2[SD5.1]; p=0.48) for menarche and first birth respectively. Forty six patients (22%) were < 40 years. Twenty-nine (14%) had positive family history, of those 23 (11%) were considered high-risk. Sixty-eight (33%) were considered candidates for genetic counseling. Conclusions: Hormonal risk factors in the average- and high-risk patient subsets seemed to be similar. The rates of patients having first and second degree relatives affected by breast and ovarian cancer are similar to that seen in Western countries. A third of our patients are candidates for genetic counseling. Therefore at least 3.3%, constituting one tenth of our 33% candidate patients may have a familial cancer syndrome, below the 5-10% quoted for Western women. These estimates are well within the rates seen in Western countries but Kurdish breast cancer patients are unusually young and estimates do not appear to reflect a lifetme risk extending into the postmenopausal population.