Abstract
Breast cancer (BC) is the most frequent cancer type, and the leading cause of death from cancer among women in Israel. The Bedouin-Arab (BA) population in southern Israel is characterized by a high rate of consanguinity, common hereditary disorders, and transition from a semi-nomadic, traditional society to a more sedentary and urbanized society. In this hospital-based study, the demographic and the clinicopathological characteristics of BC in BA were compared with Jewish patients. 85 BA patients treated at the Soroka Medical Center, Beer Sheba, during the years 2004-2012, were studied and compared with 180 consecutive Jewish patients treated during the year 2007. Clinicopathological features compared included age, menopausal state, number of births, a history of BC in first-degree relatives, tumor size (T), extent of lymph- node involvement (N), distant metastases (M), stage, grade, estrogen and progesterone receptor (ER/PR), and Her2 status. Types of treatment, relapse rate and site, as well as outcome were also studied. Cox's regression models were applied for studying disease-free, and overall survival. Compared with Jewish patients, BA patients were younger (average age 49±12 yrs vs 59±13, p<0.001), had a lower rate of BC in first-degree relatives (p<0.001), and a larger number of births (6±4.2 vs 2.5±1.9, p<0.001). BA patients had larger tumors (p=0.02), more extensive lymph-node involvement (p=0.002), and more advanced stage (p=0.003). Grade, ER, PR, and Her2 status were similar in the two ethnic groups. Relapse type was most commonly systemic in BA patients (p=0.05), and loco-regional in Jewish patients (p=0.02). Median survival was 63, and 35 months for Jewish and BA patients, respectively (log-rank test, p=0.02). In Cox multivariate analysis, stage and PR status (HR-0.14, p<0.0001; HR-3.11, p=0.046), but not ethnicity, influenced overall survival. BC presents a decade earlier, and with more advanced disease in BA compared with Jewish patients. Biologic parameters including grade, ER, PR, and Her2 status were similar in both groups. Although prognosis was worse in BA than in Jewish patients, it was affected only by stage and PR status, but not by ethnicity.
Highlights
Breast cancer (BC) is the most frequent cancer type and the leading cause of death among women in Israel (BaronApel, Israel Center for Disease Control) a
The genetics of BA of the Negev resembles that of the population of the Arabian Peninsula (Nebet et al, 2001) supporting the view that the BA population of the Negev originated in the Arabian Peninsula (Bailey et al, 1980) Numerous hereditary disorders, a few of which are peculiar to the BA population of the Negev have been described (Kenan et al, 2002; Zlotogora et al, 2013), and are related to a high rate of consanguinity in this population (Kenan et al, 2002)
We have studied the characteristics of BC in, BA and Jewish patients, two different ethnic groups residing in the same geographical region of southern Israel
Summary
Breast cancer (BC) is the most frequent cancer type and the leading cause of death among women in Israel (BaronApel, Israel Center for Disease Control) a. Time-trends in the incidence of BC have been different in Jewish and Israeli-Arab populations. The incidence of BC in Israeli-Arabs continued to increase by 98% over the same time-period. Age-adjusted incidence rates in Jews and Israeli-Arabs in 2010 reached levels of 91, and of 53 cases per 100,000 per year, respectively (Israel Cancer Registry, Jerusalem). Compared with Jewish women, BA women have a higher rate of obesity and age-adjusted body mass index (Fraser et al, 2008), and a higher saturated fatty acid composition in human milk (Silberstein et al, 2013). Hormones, and environment may all interact to cause BC, the high prevalence of consanguinity, combined with a rapid changeover in lifestyle and nutrition, make the BA population of the Negev highly attractive for studying BC
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