Risk factors for stage IV breast cancer at the time of presentation in Turkey.
BACKGROUND
Breast cancer (BC) is the one of the most common cancers in women. It is also a leading cause of death. Unfortunately, some patients initially present with distant metastases and are diagnosed with stage IV disease that is nearly always, by then, incurable. This retrospective analysis investigated the risk factors for stage IV BC that may underlie such late presentation.


METHODS
In all, 916 patients with BC who visited the medical oncology polyclinic of eight different centres in Turkeybetween December 2011 and January 2013 were analysed.


RESULTS
A total of 115 patients (12.6%) presented with stage IV disease. In univariate analysis; to comparing these with patients at other stages, no statistical difference was found for median diagnosis age or age at menarche (p=0.611 and p=0.820), whereas age at menopause and age at first live birth were significant (p=0.018 and p=0.003). No difference was detected in terms of accompanying diseases, use of oral contraceptives and hormone replacement therapy, smoking, alcohol consumption and the rate of family history of BC between the patients (p=0.655, p=0.389, p=0.762, p=0.813, p=0.229, p=0.737). However, screening methods were employed less often, the rate of illiteracy was higher, and the rate of other cancers was higher in patients with stage IV BC (p=0.022, p=0.022, p=0.018). No statistical difference was observed between the patients in terms of tumour histopathology, and status of oestrogen receptor, progesterone receptor, or human epidermal growth factor-2 receptor (p=0.389, p=0.326, p=0.949, p=0.326). Grade 3 tumours were more frequent in patients with stage IV disease (p<0.001). On multivariate analysis, risk factors for stage IV breast cancer at the time of presentation were found to be age at first live birth and educational level (p=0.003 and p=0.047).


CONCLUSIONS
Efforts should be made to perform mammography scans, in particular, at regular intervals through national training programs for all women, particularly those with family histories of breast and other types of cancer, and to establish early diagnosis of BC long before it proceeds to stage IV. Additionally, women's education had better be upgraded. In order to make women aware of BC, national education-programmes must be organised.
Department of Medical Oncology, Abant Izzet Baysal University, Faculty of Medicine, Turkey E-mail : ummuguluyeturk@yahoo.com.tr.
Ummugul
U
Uyeturk
Ali Murat
AM
Tatli
Sebahat
S
Gucuk
Berna
B
Oksuzoglu
Arife
A
Ulas
Nilufer
N
Avci
Mehmet Fatih
MF
Ozbay
Seyda
S
Gunduz
Muhammed Bulent
MB
Akinci
Derya Kivrak
DK
Salim
Ozlem Uysal
OU
Sonmez
Fatma
F
Akdag
Hasan
H
Ergenc
D000428:Alcohol Drinking / Q000009:adverse effects; D001943:Breast Neoplasms / Q000175:diagnosis / Q000209:etiology*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000209:etiology*; D018275:Carcinoma, Lobular / Q000175:diagnosis / Q000209:etiology*; D003276:Contraceptives, Oral / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D007722:Health Knowledge, Attitudes, Practice; D020249:Hormone Replacement Therapy; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014421:Turkey
D003276:Contraceptives, Oral; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human