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Epidemiology and prevalence of breast cancer: A retrospective study in a tertiary health care center in Kolkata over one decade



Background: Breast cancer is a major public health problem for women throughout the world. According to GLOBOCAN 2012, India along with the United States and China is responsible for almost one-third of global breast cancer burden. There has been 11.54% increase in incidence and 13.82% increase in mortality due to breast cancer in India from 2008 to 2012. According to GLOBOCAN 2018, for both sexes, breast cancer second most common cancer after lung cancer accounting for 11.6% of total cases. Most of the cases diagnosis at an advanced stage because of inadequate screening, lack of appropriate medical facilities thereby increasing breast cancer mortality. It is the second most common malignancy among Indian women accounting for 7% of global burden of breast cancer. Incidence of breast carcinoma varied in the different regions of the world with lowest incidence in Africa, Asia and highest incidence in North America and Europe. This geographic variability is not only to environmental factors but also to lifestyle. There is a paucity of epidemiological data regarding carcinoma of breast.

Objectives: The aims of our study were to evaluate the prevalence and epidemiology of breast cancer in our institution, N.R.S. Medical College Kolkata.

Materials and Methods: We have analyzed 4172 newly diagnosed breast carcinoma cases, registered at N.R.S. Medical College and Hospital, Kolkata, West Bengal, India, over one decade, in between January 2008 and December 2017 retrospectively. A total of 4172 cases confirmed by pathological examination were included for analysis. Demographic and clinicopathological profile and management offered to the breast cancer patients were recorded from the medical records file. The staging was performed using American Joint Committee on Cancer tumor, node, and metastasis classification staging system.

Results: In our study, about 63% of the patients came from urban areas and 37% from rural areas. The mean age at diagnosis was 52 ± 9.5 years, with a range from 26 to 82 years. The age at menarche in this study ranged from 10 to 16 years, mean being 12 ± 1.5 years. Age at the time of first pregnancy ranged from 19 to 32 years, with the mean age being 22 ± 6.2 years. Family history of breast carcinoma in first and second degree relatives was found in 92 (2.2%) patients in this study. Approximately 5% (216) patients were nulliparous. About 63% of the patients were postmenopausal while 36% were premenopausal. Common presenting symptoms include breast lump (100%) and axillary swelling (33%). Histologically, 99.5% cases were infiltrating ductal carcinoma, and it was most common histology. Most patients were diagnosed with Grade II tumors (45%) followed by Grades I and III, and approximately 75% of the patients were in Stages II and III and 10% patients in Stage IV. The most common site of metastasis was lung (33%), bone (26%), liver (23%), and brain (14%).

Conclusions: The majority of the breast carcinoma patients presented with Stages II and III disease, approximately 99% cases were infiltrating ductal carcinoma, not otherwise specified and were mainly Grade II followed by Grade III disease. The prevalence of estrogen receptor, progesterone receptor hormone receptor status and Her2/neu status in the population needs further investigation in the future. The government needs to urgently strengthen and augment the existing facilities including screening, which is inadequate at present to handle the current breast cancer load in India.

Key words: Breast Carcinoma; Epidemiology; Risk Factors; Age

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