title: Presenting features, treatment patterns and outcomes of patients with breast cancer in Pakistan: Experience at a university hospital.
abstract: BACKGROUND
  Breast cancer is the most common cancer in Pakistani women. We report the presenting features, treatment patterns and survival of breast cancer from a University Hospital in Southern Pakistan and compare the data with international population based studies.
  
  
  METHODS
  Medical records of patients diagnosed to have breast cancer between January 1999 and November 2008 were reviewed retrospectively.
  
  
  RESULTS
  A total of 845 patients were identified. Median age of diagnosis was 48 years (range 18-92). Clinical stage was as follows: Stage I 9.9%; Stage II 48.5%; Stage III 26.2%; Stage IV 13.8%; data not available 1.5%. Approximately, half (51.6%) were estrogen receptor (ER) positive and 17.5% over-expressed Her2/neu. Nearly 23% patients received neo-adjuvant chemotherapy while 68.9% received adjuvant chemotherapy. Anthracycline based treatment was the most common treatment until 2003 while later on, patients also received taxanes and trastuzumab based therapy. Age, stage, tumor size, lymph node status, tumor grade, ER status, treatment with hormonal therapy and radiation were the major predictive factors for overall survival (OS). We report an impressive 5 year OS of 75%, stage specific survival was 100%, 88% and 58% for Stages I, II and III respectively.
  
  
  CONCLUSIONS
  The majority of patients present at a younger age and with locally advanced disease. However, short term follow-up reveals that the outcomes are comparable with the published literature from developed countries. Long-term follow-up and inclusion of data from population-based registries are required for accurate comparison.
authors.affiliation: Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Oncology Section, The Aga Khan University Hospital, Nairobi, Kenya.
authors.forename: A J
authors.initials: AJ
authors.lastname: Shaikh
authors.affiliation: Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Y A
authors.initials: YA
authors.lastname: Rashid
authors.affiliation: Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: N
authors.initials: N
authors.lastname: Masood
authors.affiliation: Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Atv
authors.initials: A
authors.lastname: Mohammed
authors.affiliation: Aga Khan Medical College, Karachi, Pakistan.
authors.forename: U Z
authors.initials: UZ
authors.lastname: Malik
authors.affiliation: Medical Oncology, Jinnah Postgraduate Medical Institute, Karachi, Pakistan.
authors.forename: G
authors.initials: G
authors.lastname: Haider
authors.affiliation: Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: N
authors.initials: N
authors.lastname: Niamutullah
authors.affiliation: Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: S
authors.initials: S
authors.lastname: Khan
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008875:Middle Aged; D010154:Pakistan; D016019:Survival Analysis; D016896:Treatment Outcome