Health & Research

Prevalence of Breast Cancer in Pakistan

Abstract

Breast cancer is frequently diagnosed cancer of females all over the world. The most common cancer in Pakistan also is breast cancer. Breast cancer incidence in Pakistan is 2.5 times greater than that in nearby countries like India and Iran.

The breast cancer associated risk factors are age, early menarche, family history, alcohol consumption and low socioeconomic status. Breast cancer is accounted for 23% of all cancer cases worldwide. In Asia Pakistan has the highest incidence rate of breast cancer except that in Jews and Israel. In Pakistan every year minimum of 90,000 females exposed to breast cancer. The breast cancer frequency in Karachi Pakistan is 69.1 per 100,000. This review article is aimed to provide update knowledge and comparative analysis about the prevalence, risk factors and incidence rate of breast cancer in Pakistan.

Introduction:

Breast cancer is frequently diagnosed malignancy of females in the biosphere(Malik, et al., 2016). Breast cancer is highly resolute in women because of late marriages, obesity, post-menopausal actions and late diagnosis of breast cancerby X-ray (kareem, et al., 2016). Existence of malignant lump in breast tissues indicates breast cancer, growth of cancer cells is continued with time and new defective cells are made (Desantis, et al., 2014). Cancer is becoming hazardous disease, as time passed, In the world specifically emerging countries like Pakistan cancer distribution is very fast (kareem, et al., 2016). Breast cancer is frequently diagnosed cancer in females for Karachi in addition to other parts of Pakistan (Sikandar, et al., 2015). Nearby tissues are also invaded by tumorous cells (Desantis, et al., 2014).  In Pakistan record keeping system at national level is not appropriate, so breast cancer data in Pakistan is not accurate (Noreen, et al., 2015).  Studies relating to epidemiology indicate that, the association among breast cancer and VDR (vitamin D receptor) gene can be changed by cultural characters shown by a population with a mutual heritage and values (Shaikh, et al., 2016).

As information of molecular biology is increased, breast cancer is now a day identified as diverse disease with various environmental, cultural and traditional differences (Newman, 2015). The elements which increase the risk of breast cancer are early men arches, first live birth in older age and no breast feeding (Sariego, et al., 2010). Oxytocin is secreted by nipples stimulation which results in generating nerve impulse to start milk ejection (Abuidhail, et al., 2014). Breast tissue is the site from where breast cancer is devised, usually it is devised from the inside layer of milk channels (Sariego, et al., 2010). Every year more than 1.2 million individuals with breast cancer are identified globally, as stated by WHO (World Health Organization) records (Zahra, et al., 2013). Multi factor molecular tests can define sub types of breast cancer like Blue Print (Bayraktar, et al., 2014). For the choice of chemotherapy, the important factor is the difference of triple negative breast cancer, in which carboplatin is as effective as docetaxel in basal-like sub-type but not as effective in other intrinsic sub types (Loibl, 2015). Tumor-infiltrating lymphocytesare frequently present in triple-negative, rapidly growing and other human epidermal growth receptor 2 (HER2) positive breast cancers(Adams,et al., 2014), and have been related with developed complete persistence, amplified PCR free of other analytical aspects and longer uninfected existence (Loi, et al., 2014).

Total No.Stage 0Stage1Stage2Stage3Stage4ReferencesStudy Duration
INMOL200    —Negligible number26.5%37.5%35.5%Mansha et al 2016
INMOL &Mayo Hospital563    —9%33%36%22%Kanwal et al., 2016Jan2009-Dec2009
INMOL593901%10%32%35%23%Khokher et al., 2012July2000-Dec2009
SKMCH & RC501802%07%43%23%08%Badar et al., 2011Jan2003-dec 2009
Retrospective Audit100    —1.3%70.3%17%Malik et al., 2015
INMOL & Mayo hospital1101    —9%37%39%15%Kanwal et al., 20162009
INMOL & SHL261    —3%33%52%12%Khokher et al 20162012-15

Table 1: showing the prevalence of breast cancer according to disease stage.

The patients of Aggressive breast cancer with over expression of HER2 protein are treated by trastuzumab; HER2 extracellular area is targeted by a re-combinant monoclonal antibody to overpower the downstream signaling pathways (Takashima, et al., 2014).In women sheltering BRCA1/2 germ-line alterations have increased lifetime risk of developing breast cancer. Pakistani women detected with triple negative breast cancer (TNBC),Hereditary BRCA1 analysis should be considered (Rashid, et al.,2015). Suggestion for hereditary BRCA1/2 testing for patients with TNBC are not universally acknowledged and differ between certified civilizations (Sharma, et al., 2014).In recent times, a harmful alteration (c.5101C>T) in the FANCM gene was recognized in BRCA1/2-negative familial patients with TNBC from Finland (Kiiski, et al., 2014) . In INMOL and Mayo hospital Lahore the total number of breast cancer registered are 563 during Jan 2009- dec 2009 and the percentage of of stages is 9% stage 1, 33% stage 2 and 36%, 22% in stage 3 and stage 4 respectively (Kanwal, et al., 2016). Badar et al conducted study in SKMCH & RC during Jan 2003- dec 2009 which revealed the 5018 total number of breast cancer cases and percentage in different stages 2%, 7% ,43%, 23% ,08% as stage 0, stage 1, stage 2, stage 3, stage 4 respectively (Badar, et al., 2011). Similarly the retrospective audit of 100 breast cancer patients showing the percentage in different stages 1.3% stage 1, 70.3% stage 2, 17% stage 4 (Malik, et al., 2015). In 2009 total 1101 breast cancer cases are registered in INMOL & Mayo hospital and the percentages of disease stage are 9% stage 1, 37% stage 2, 39% stage 3, 15% stage 4 (Kanwal, et al., 2016). During 2012-2015 the total 261 number of breast cancer cases is recorded in INMOL & SHL and the percentages of stage are 3% stage 1, 33% stage 2, 52% stage 3, 12% stage 4 (Khokher, et al 2016). During July- Dec 2009 the 5939 number of breast cancer recorded at INMOL and the percentage at different stages are 1% , 10% , 32% , 35% , 23% at stage 0 , stage 1 , stage 2 , stage 3 , stage 4 respectively (Khokher, et al., 2012). Mansha et al conducted study at INMOL the total 200 number of breast cancer cases are registered and the percentages of stage are negligible number at stage 1 , 26.5% at stage 2 , 37.5% at stage  3 , 35.5% at stage 4 (Mansha, et al 2016).

In a multiple logistic regression model Status of TNBC and presence of BRCA1 alterations have no depending relation of the simultaneous consideration of tumor histology, family phenotype, and tumor grade (Rashid, et al.,2015). Over expression of HER2 gene cause 15-30% of the invasive breast cancer(Han, et al., 2014). For invasive breast tumor patients, the selection ofanti-HER2 therapy and effective clinical results, correct assessment of human epidermal growth factor receptor 2 (HER2) status is quite essential (Afzal, et al., 2016). The increasing list of mutations and other genetic defects in patients with recurring breast cancer have shown by several current studies (Campbell, 2015).Cycloxygenase-2 enzyme produces Prostaglandins which have a role in breast carcinogenesis.  Pakistani patients the mutual COX-2 single nucleotide polymorphism (SNP) haplotype is associated with breast cancer related risk (Moatter, et al.,2015). Immunohis to chemistry (IHC) procedure is not able to explain the chromosomal and genetic alterations but it is regularly used to assess the HER2 on co-protein over expression (Afzal, et al., 2016). The cells which are positive for estrogen and progesterone receptor known as malignant cells can urge their growth by identifying signals from their respective hormones.Almost two tests are positive for hormone receptors for every three breast cancer patients (breast cancer.org. 2015). SNPs bring about genetic variances in breast cancer (BC) vulnerability between females from different societies(Mazhar, et al.,2016). In Pakistan Breast cancer is a distinct disease affecting younger women with a high frequency of violent molecular kinds (Khokhar, et al., 2016). Hyper insulinemia, too much production of extra glandular estrogen, and its metabolites are related with BC in overweight women (Mauras, et al., 2015).

Risk factors:

The identified leading contributing factors for breast cancer comprised: radiation exposure to chest in age less than 30, family history, genetics, no exercise, race, overweight, gestation, use of hormone replacement therapy, alcohol consumption, age, heavy breast, and smoking (Wafa, et al., 2014). Current statistics have emphasized that a risk factor for breast cancer incidence is benign pathology with atypia and even without atypia (Hartmann, et al., 2015). The factors related with breast cancer are early menarche (Porter,et al., 2008), delayed parity (Reigstad, et al., 2015), lack of breast feeding (Butt, et al., 2012). These factors are being observed in low and middle income countries like Pakistan, Bangladesh and India (Porter, 2008). Delayed parity is also risk factors of evolving breast cancer (Reigstad, et al., 2015). Assisted reproductive technology (ART) associated Hormonal exposure and Breast cancer related risk factors are family history (First degree relative) (Faheem, et al., 2007) early menarche,age, consumption of joint estrogen and progestin menopausal hormones, drinking alcohol (Asif, et al., 2014), lack of awareness (Shoukat, et al., 2013), lack of exercise, and low socioeconomic status regarding the disease (Asif, et al., 2014). Pre-menopausal breast cancer and postmenopausal breast have many of common risk factors, but less parity is risk factor only for post-menopausal breast cancer (Butt, et al., 2012). Menopausal age of greater than 50 years and Nulliparity are the factors which increase breast cancer risk. Age fewer than 25 years at first live birth and Breastfeeding was not defensive against breast cancer (Nazir, et al., 2015). There is Lack of knowledge in the Pakistani population about breast cancer epidemiology and etiology, but struggles done until now have also brought information of genetic origins in various cultural groups inside Pakistan (Shaukat, et al., 2013). The recurrent factor is the variation in genetic information between all possible risk factors of breast cancer (Asif, et al., 2014). Presence of human papilloma virus 16 (HPV16) has a positive correlation, which is found with estrogen receptor/ progesterone receptor (ER/PR) and HER2-positive breast cancers (Ilahi, et al., 2016).Our understanding of genetic predisposition to breast cancer has been improved by worldwide research efforts on various civilizations to but in spite of these findings, 75% of the familial risk of breast cancer rests unsolved (Shaukat, et al., 2013).The risk factors described by different studies are COX-2 SNP haplotype (moatter, et al., 2015) BRSA ½ (Rashid, et al., 2016) human interferon a2b (Ahmad, et al., 2016) smoking 20 packs/year and use of oral contraceptives (Zahra, et al 2013) in family history the consanguineous Marriage (Gillani, et al., 2006) first degree relative (Faheem, et al., 2007) old age at first pregnancy (Lai, et al., 1996).

Incidence rate

The most populated city of Pakistan is Karachi;in this city during 1998-2002 age-standardized rate of breast cancer were 69.1 out of 100,000 females, which is the maximum documented rate in Asia (Yasmeen and zaheer, 2014). In Pakistan the incidence of breast cancer is approximately 2.5 times greater than that in the nearby countries India and Iran (Yasmeen and zaheer 2014). The major health issue of females in Pakistan and also worldwide is breast cancer. Worldwide one fourth of all cancer cases is breast cancer with standardize incidence rate of 38.9 (Pimhanam, et al., 2014).

Graph 1 showing incidence rate of breast cancer in Pakistani females.

In recent times, incidence rate of breast cancer reported from Shaukat Khanum Memorial Cancer hospital is 21.5% between all and 45.9% between female patients (Badar et al., 2011).The incidence of breast cancer in women living in United States from Asia is 1.5-4 times more than that of women living in United States from other particular countries of origin (Shin, et al., 2010). Among Asians the incidence of breast cancer in Pakistan is highest After Jews in Israel, accounting for 34.6% of women cancers (Shaukat, et al., 2013). The incidence rates of breast cancer increased with age for all available years in Karachi. The incidence rates become higher sequentially and among people of age 15-50 years the rates are comparatively high but after the age of 50 years these rates show variation(Yasmeen and zaheer, 2014). Of all incident breast cancer premenopausal breast cancer included a considerably greater percentage in developing countries (average 47.3%) as compared to established countries(average 18.5%) (Ghiasvand, et al., 2014). aA study conducted in Quetta and Larkana shows the age specific incidence rate (ASIR) of  female breast cancer is 11.8 in Quetta and 20.6 in Larkana (Bhurgri, et al., 2006). The data from Agha Khan University Pathology based cancer registry (APCR) during the period of (1998-2002) shows the age specific incidence rate in females is 22.4 (Bhurgri, et al., 2005). Badar et al reported the ASIR of female breast cancer in Globocan during the time period of (2012) is 50.3 (Badar, et al., 2016). In Karachi the ASIR of female breast cancer during (2010-2015) is 87.9 which is highest incidence rate in Pakistan (Qureshi, et al., 2016). During the time period of (2010-2012) the ASIR of female breast cancer in Lahor is 47.6 (Badar, et al., 2016). Bhurgri et al revealed the ASIR of female breast cancer 51.7 during (1995-1997) in South Karachi (Bhurgri, et al., 2000).In Faisalabad the ASIR of female breast cancer is 6.54 during (2012) (Kareem, et al., 2016).

Prevalence

In Pakistan record keeping system at national level is not appropriate, so breast cancer data in Pakistan is not accurate (Noreen, et al., 2015). In Pakistan, the most frequently diagnosed cancer among females is also breast cancer, accounting for nearly one in nine female patients (Asif, et al., 2014). Breast cancer is accounted about 23% of all cancers worldwide (Jemal, et al., 2011).,About two third breast cancer cases are estrogen and progesterone receptor positive, according to the American Cancer Society (Silberman, 2014). The breast cancer incidence in young age women is increasing day by day in Pakistan. The data of Shoukat Khanum Memorial Cancer Hospital and Research Center(SKMCH&RC), the breast cancer incidence rate is high 45.42% for age group 45-49 years. In Pakistani females not many studies discovered the high expression of ER, PR and HER-2/neu(Barsa, et al., 2016). Worldwide mortality rate of women due to breast cancer is around 508,000in 2011 (Siegel, et al., 2013). It is thought that breast cancer is most frequently occur in established countries, but the truth is that, in un-established countries 50% breast cancer cases and 58% mortality rate was found (Ferlay, et al., 2015). Screening and early diagnosis of breast cancer are not good in Pakistan. More than 30% of the breast cancer is detected in stages III and IV, according to the record of (SKMCH & RC) (Badar, et al., 2011). Breast cancer is the most commonly diagnosed cancer in Pakistan. Among the registered cancer cases in Karachi has the maximum rate of breast carcinoma (38%) in women (MuN, 2015). Every year in Pakistan every minimum of 90,000 women exposed to breast cancer. During the time period of 1998-2002 the frequency of breast cancer in Karachi was 69.1 out of 100,000 (Bhurgri et al., 2004).The South Asian population based cancer registry data revealed that the highest age standardized rate at 69 per 100,000 of breast cancer is in Pakistan (Moore, et al., 2009). Worldwide breast cancer is the most commonly diagnosed cancer in females and in many countries its frequency is increasing progressively. The low risk Asian countries including Pakistan have been observed with an increase in breast cancer over the recent three decades (Mansha, et al., 2016). Breast cancer is the most commonlydiagnosed cancer and the major reason of cancer death among women, accounting for 14% of the cancer deaths and 23% of the total cancer cases (Jamal, et al., 2011). The 8 years period 2000-2008 data of Karachi Institute of Radiotherapy & Nuclear medicine (KIRAN) was published in 2009, it revealed ASIR of 0.40 in males and 38.2 in females  of age limit 0-75 years with percentage of 0.97 and 38.2 respectively (Hanif, et al., 2009).

 

Study population

 

Age Specific Incidence Rate

(A S I R)

 

References

 

Time period

 

Age Limit

 

Male

 

Female

Total% among allASIRtotal% among

all

ASIR
Lahore0-75701.00.8408245.047.6Badar, et al., 20162010-12
Karachi0-75388949.587.9Qureshi, et al. 20162010-2015
Faisalabad15-354.050.70.026.8343.86.54Kareem, et al., 20162012
KIRAN0-75320.970.40324399.038.2Hanif, et al., 20092000-2008
SKMCH & RC0-75 – – – –45.9 –Naz, et al., 20161995-2009
INMOL       – – – – –41 –Khokher, et al., 20122002-2009

Table 2 Showing age specific incidence rate of breast cancer in Pakistan.

The study of Faisalabad shows the total 3275 number of breast cancer patients registered in 2012 with ASIR rate of 0.02 in males and 6.54 in females with age limit of 15-35 (Kareem, et al., 2016). In Pakistani females different types of breast cancer are present (Baloch, et al., 2014). In Karachi during the time period of (2010-2015)total number of breast cancer are 3930 the number of breast cancer in females of age limit 0-75 years are 3889 with percentage of 49.5 and ASIR of 87.9 (Qureshi, et al., 2016). In Pakistan TNBC occurs most commonly, 636 cases from SKMCH & RC were analyzed their 10 year outcome analysis revealed (56.2 %) had their diagnosis made at less than 40 years of age; 30.5 % of the cases had TNBC (Bhatti, et al., 2014). During the time period of (2010-12), study in Lahore was conducted shows the total breast cancer patients of age limit 0-75 are 4152 among these 4082 are females and 70 are males with ASIR of 0.8 and 47.6 respectively (Badar, et al., 2016). The data of 7 years period (2004-2011) of Karachi Institute of Radiotherapy & Nuclear medicine (KIRAN) was published in 2014 shows 5331 number of breast cancer registries (Yasmeen and Zaheer, 2014). The study conducted at SKMCH during the time period of (1995-2005) shows the 8915 number of breast cancer registries (Badar, et al., 2011). The study conducted by Kareem et al in Faisal Abad during the time period of 2012 revealed the 245 number of breast cancer registries (Kareem, et al., 2016). The numbers of breast cancer registries at Surgical & Oncology Units of Civil Hospital are 100 females during (July-December 2012) (Memoon, et al., 2013). The 2397 numbers of breast cancer cases during (1992-2001) are present in Northern Pakistan (Jamal, et al., 2006). Shamsi et al conducted 1 year study during (2009- 2010) the numbers of breast cancer registered at Tertiary care hospital are 297 (Shamsi, et al., 2013). Karachi Cancer registry (KCR) shows the 709 number of breast cancer during (1995-1997) (Bhurgri, et al., 2007). The 150 number of breast cancer cases registered at Nuclear medicine Oncology and Radiotherapy Institute during the time period of 6 months ( January- July 2005) (Faheem, et al., 2007). Gillani et al revealed 564 number of breast cancer registered at SKMCH during the time period of (Jan-Dec 1998)(Gillani, et al., 2006).

Study populationNo. of all cancersNo. of breast cancerreferenceyearData duration
Total population/ yearMale %Female %Total no.Male %Female %
 

 

Lahore

 

 

100,000

 

 

57.2

 

 

42.7

 

 

4152

 

 

 

 

Badar, et al.20162010-2012
 

 

Karachi

 

 

100,000

 

 

41.9

 

 

58.1

 

 

3930

 

 

1.04

 

 

98.9

 

Qureshi, et al.

 

2016

 

2010-2015

 

 

Faisalabad

 

 

100,000

 

 

35.9

 

 

64.1

 

 

245

 

 

0.41

 

 

99.5

 

Kareem, et al.

 

2016

 

2012

 

 

INMOL

 

 

100,000

 

 

43.6

 

 

56.4

 

 

6718

 

 

2.05

 

 

97.5

 

Khokhar, et al.

 

2012

2002-2009
 

 

KIRAN

 

 

100,000

 

 

48.1

 

 

51.9

 

 

3275

 

 

0.98

 

 

99.0

 

Hanif, et al.

 

2009

2000-2008
 

 

Agha Khan

 

 

100,000

 

 

 

 

 

 

53,012

 

 

0.09

 

 

99.9

 

Bhurgri, et al.

 

2000

1991-2001
 

 

APCR

 

 

100,000

 

 

91.6

 

 

96.0

 

 

 

 

 

 

22.4

 

Bhurgri, et al.

 

2005

1992-2002
 

Northern Pakistan

 

 

100,000

 

 

 

 

 

 

2397

 

 

5.88

 

 

94.1

 

Jamal, et al.

 

2006

1992-2001
IRNUM Peshawar 

100,000

 

61

 

39

 – – – 

Zeb, et al.

 

2006

Jan2000-dec2004
 

Karachi South

 

100,000

 

50.6

 

49.4

 – – – 

Bhurgri, et al.

 

2000

1995-1997
 

AUKH

Quetta

 

100,000

 – – – 

0.7

 

13.0

 

Bhurgri, et al.

 

2002

Jan1998-dec1999
 

SKMCH & RC

 

100,000

 – – 

34038

 – – 

Naz, et al.

 

2016

Dec1995-dec 2009

Table 3 showing the frequency of cancer in different areas of Pakistan.

The study conducted during the time period of 2010-2012 in Lahore shows number of all cancers in males 57.2% and in females 42.7% and 4152 number of breast cancer cases (Badar, et al., 2016). The study conducted in Karachi revealed the number of all cancers 41.9% in males and 58.1% in females and total number of breast cancer 3930 with percentage of 1.04% in males and 98.9% in females (Qureshi, et al., 2016). Butt et al reported the 150 number of breast cancer cases at Mayo Hospital Lahore (MHL) during (2008-2009) (Butt, et al., 2012). A 5 years outcome analysis of time period (2008-20013) at Sir Ganga Ram Hospital (SGRH) revealed the 200 number of breast cancer cases registered (Zahra, et al., 2013). A data of 8 years period (2000-2008) at KIRAN shows the 3275 number of breast cancer registered (Haneef, et al., 2009).

Graph 2 showing the registries of breast cancer in different areas of Pakistan.

A data of 9 years period (2000-2009) of Institute of Nuclear Medicine and Oncology Lahore (INMOL) was published in 2012, it shows the 6718 number of breast cancer (Khokhar, et al., 2012). In Balochistan University of Information Technology (BUIT) and Center of Excellence for Nuclear Medicine (CENR) the 134 breast cancer cases are registered during the time period of (2010-2012) (Hameed, et al., 2012). A two years data of Armed Forces Institute of Pathology Rawalpindi (AFIP) during (2004-2006) revealed the 822 breast cancer patients registered (Memoon, et al., 2009). Figure 1 shows the prevalence of heterogeneous subtypes of breast cancer in different areas of Pakistan. A study was conducted by (Siddique, et al., 2000) in Karachi showing the percentage of sub-types in different age groups. Infiltrating ductal carcinoma 37% (40-49 years) and 81% in age range of (48 years) ductal carcinoma in situ 16.25% mucinous carcinoma 0.52% in-filtering lobular carcinoma 0.34% papillary carcinoma 0.17% in age range of (48 years) (Siddique, et al., 2000). Another study conducted in Peshawar revealed the percentage of subtypes as infiltrating ductal carcinoma 82.60% mucinous carcinoma 2.17% infiltering lobular carcinoma 6.50% papillary carcinoma 4.35% invasive lobular carcinoma 6.50% medullary carcinoma 2.17% in age range of (40-59 years) (Naeem, et al., 2008). Baloch, et al., 2014 reported the subtypes of breast cancer in females of age 15-80 years in Karachi such as infiltrating ductal carcinoma 78% ductal carcinoma in situ 2.40% mucinous carcinoma 12% infiltering lobular carcinoma 1.20% medullary carcinoma 6% benign lumps 39.70% (Baloch, et al., 2014). Another clinical survey in National Cancer institute Karachi revealed the prevalence of infiltrating ductal carcinoma in age group of (30-66 years) is 91% (Malik, 2002). Afridi and Ahmad revealed in their findings the prevalence of invasive intraductal carcinoma in age group of ( 31-53 years) is 94% in Karachi (Afridi and Ahmad, 2012). Study conducted in Karachi by Bhurgri revealed the prevalence of breast cancer subtypes in age group (48-95 years) 92.10% benign lumps 1% ductal carcinoma in situ (Bhurgri, 2005).

Worldwide distribution

Globally the breast cancer (BC) is the frequently occurring malignancy of females (Barsa, et al., 2016). In all study populations breast cancer incidence rates are progressively high with time.In Southeastern Asia rates were relatively increased and became gradually lower alongside a south-to-north slope(Shin, et al., 2010). The most frequently diagnosed cancer in females is breast cancer worldwide; it is the malignancy of breast tissue. Breast cancer is stated 23% of all cancer cases globally(Jamal, et al., 2011). Breast cancer is most frequently diagnosed females cancer in United States cancer, 1 of 8 females are affected by it (Siegel, et al., 2013). Through different people there is extensive variation in incidence of age standardized breast cancer globally, in Western Europe the incidence is 89.9 per 100,000 women and in Eastern Africa 19.3 per 100,000 women (Ferlay, et al., 2010). Breast cancer is the most frequently occurring malignancy and a principal reason of death in females all over the biosphere (Ehtesham, et al., 2015). Conferring to a current inspection, in Asian countries about 25 % of all cancer cases have been recognized astransmissible factor (Huang, et al., 2015). Women breast cancer incidence is intensely associated with age, signifying a relation with hormonal prominence. Pakistani females between ages 20 to 35 years are recurrently stated with advanced stages of breast cancer in Karachi hospitals in contrast to worldwide studies(Naveed, et al., 2014).Globaly Breast cancer among women positions the second most principal cancer among females (Du, et al., 2014). In Pakistan breast cancer is the most commonly identified cancer, with maximum mortality rate in Asian population nextto the Israeli Jews. The breast cancer incidence rate is analogous with uppermost risk areas in the biosphere (Bhurgri, et al., 2006). The most frequent malignancy is breast cancerbecause of overall risk of its developmentbetween the white women with approximations of 1 out of 8 American women and 1 out of 12 British (Khan, et al., 2014).

Graph 3 showing age standardized incidence rates (ASR)/100,000 for breast cancers in Pakistan compared to Asian population.

ASR of female breast cancer in Pakistan as compared to Asian population is described in different studies. According to the studies conducted the ASR of female breast cancer in Pakistan is 69 per 100,000 (Yasmeen and Zahra, et al., 2014) in Kuwait 46.7/100,000 in Philippines 47/100,000 in Malaysia 38.7/100,000 in Russia 45.6/100,000 in Japan 51.5/100,000 in China 22.1/100,000 (Qureshi, et al., 2016) in Israel (Jews) 80.5/100,000 in Singapore 65.7/100,000 in Bahrain 42.5/100,000 (Ghoncheh, et al., 2015) in Turkey  Izmir 22.4/100,000 (Fidaner, et al., 2001) in India 22.9/100,000 (Ferley, et al., 2008) Iran 28.1/100,000 (Badar, et al., 2015) in Cyprus, Bangladesh and Afghanistan ASR is 78.4/100,000, 21.7/100,000 and 35/100,000 respectively (Qureshi, et al., 2016).

Conclusion

Breast cancer is a major health burden. It persists in spite of many research studies conducted to understand and evaluate the genetics and risk factors behind the breast cancer and to control the breast cancer incidence rate. In conclusion this review article established the fact that many breast cancer risk factors are involved in increasing the prevalence of breast cancer in Pakistan.

 

 

 

 

 

 

 

 

 

 

 

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