Abstract
This paper reviews the escalating burden of breast cancer (BC) in the Middle East (ME) and the prevalence of modifiable risk factors and underscores opportunities to promote the prevention of the disease. Similar to more developed countries, BC is the most frequent cancer among women in countries of the ME, accounting for one-third of total cancer cases and 24% of total cancer deaths. Average age at BC diagnosis appears to be a decade earlier in Middle Eastern countries compared to the Western countries, and its incidence is predicted to further increase. Although incidence rates of BC are still lower in Middle Eastern countries than Western ones, mortality rates are similar and at times even higher. It is estimated that 30% of BC cases are due to environmental and lifestyle factors, such as obesity and diet and hence can be preventable. The ME suffers from surging rates of obesity, with eight of its countries ranking among the highest worldwide in obesity prevalence among adults aged 18 and above. ME countries with the highest prevalence of obesity that are among the top 20 worldwide include United Arab Emirates (UAE), Lebanon, Egypt, Libya, Qatar, Saudi Arabia, Jordan, and Kuwait with rates ranging from 30% in UAE to 37% in Kuwait. In parallel, studies in the ME have consistently showed a shift in dietary intake whereby traditional diets, rich in fruits and vegetables, are progressively eroding and being replaced by westernized diets high in energy and fat. Accumulating evidence is reporting convincing association between consumption of such westernized diets and higher BC risk. Addressing these risk factors and studying their association with BC in terms of their nature and magnitude in Middle Eastern countries could provide the basis for intervention strategies to lower the risk and alleviate the burden of BC in these countries.
Highlights
The most common cancer among women is breast cancer (BC), representing about 25% of all cancers
In Middle Eastern countries, the incidence of BC occurs in women at an average age of diagnosis of
It should be cautioned that the reported increases in the incidence of BC in the Middle East (ME) over the last decade may be attributed, in part, to the increase in number of cancer registries, as well as to the wide adoption of mammographic screening programs, an effort supported by several awareness campaigns since 2004 [1, 7, 8]
Summary
The most common cancer among women is breast cancer (BC), representing about 25% of all cancers. Nutrition and Breast Cancer Prevention the post-menopausal stage whereas body mass index (BMI) did not have a significant effect on BC’s incidence during the premenopausal stage [12] Similar to these findings, another meta-analysis summarized the results of 9 cohort studies and 22 case–control studies and showed that with every 5 units increase in BMI, BC’s risk among postmenopausal women increases by 33% and decreases by 10% among premenopausal women [13]. CUP graded the evidence of the link between high intake of red and processed meats and increased risk of BC as limited in both pre- and post-menopausal women, which calls for further studies to understand these potential associations. The mechanism by which vitamin D can affect BC has been speculated in the literature, stating that the biologically active form of vitamin D binds to the vitamin D receptor in normal breast epithelium and this complex regulates the cell cycle, promotes differentiation, increases cell-to-cell adhesion, protects cells from DNA damage, regulates cytokines, activates immune cells, and suppresses inflammation, reducing malignant transformations [72]
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