Twenty years of breast cancer in Iran: downstaging without a formal screening program

Abstract

Background: Breast cancer (BC) is the most common malignancy among Iranian women. Although the relative incidence of BC is low, the cause-specific mortality is much higher than developed countries. The present study surveyed the overall trend of BC in Tehran.Patients and methods: All breast pathologic records were studied in five major hospitals in Tehran during three phases (1: 1985–1995; 2: 1996–2000; and 3: 2001–2005). Malignant cases were classified according to the tumor–node–metastasis classification. Data were compared across the study.Results: Of 9050 medical records from male and female patients with ‘breast disease’, 2946 females with BC were included. A significant increase in the diagnosis of palpable early BCs (stage II increased, stage III decreased) was observed between phases 1 and 2. A relative increases in stages 0 and I were noted between phases 3 and 2. Nevertheless, 76.8% of cases were T2 or higher and 65.3% had positive lymph nodes in the last phase. The proportion of patients with stage IIIb was increased in phase 3, despite the reduction in phase 2.Conclusions: Despite the relative improvement in the status of BC patients, the vast majority are diagnosed in advanced stages. Specific screening measures should be implemented in Iran.