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Breast Cancer in Bedouin-Arab Patients in Southern Israel: Epidemiologic and Biologic Features in Comparison with Jewish Patients

  • Lazarev, Irina (Department of Oncology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev) ;
  • Flaschner, Maayan (Department of Oncology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev) ;
  • Geffen, David B. (Department of Oncology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev) ;
  • Ariad, Samuel (Department of Oncology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev)
  • Published : 2014.10.11

Abstract

Background: Breast cancer (BC) is the most frequent cancer type, and the leading cause of death from cancer among women in Israel. The Bedouin-Arab (BA) population in southern Israel is characterized by a high rate of consanguinity, common hereditary disorders, and transition from a semi-nomadic, traditional society to a more sedentary and urbanized society. In this hospital-based study, the demographic and the clinicopathological characteristics of BC in BA were compared with Jewish patients. Materials and Methods: 85 BA patients treated at the Soroka Medical Center, Beer Sheba, during the years 2004-2012, were studied and compared with 180 consecutive Jewish patients treated during the year 2007. Clinicopathological features compared included age, menopausal state, number of births, a history of BC in first-degree relatives, tumor size (T), extent of lymph-node involvement (N), distant metastases (M), stage, grade, estrogen and progesterone receptor (ER/PR), and Her2 status. Types of treatment, relapse rate and site, as well as outcome were also studied. Cox's regression models were applied for studying disease-free, and overall survival. Results: Compared with Jewish patients, BA patients were younger (average age $49{\pm}12$ yrs vs $59{\pm}13$, p<0.001), had a lower rate of BC in first-degree relatives (p<0.001), and a larger number of births ($6{\pm}4.2$ vs $2.5{\pm}1.9$, p<0.001). BA patients had larger tumors (p=0.02), more extensive lymph-node involvement (p=0.002), and more advanced stage (p=0.003). Grade, ER, PR, and Her2 status were similar in the two ethnic groups. Relapse type was most commonly systemic in BA patients (p=0.05), and loco-regional in Jewish patients (p=0.02). Median survival was 63, and 35 months for Jewish and BA patients, respectively (log-rank test, p=0.02). In Cox multivariate analysis, stage and PR status (HR-0.14, p<0.0001; HR-3.11, p=0.046), but not ethnicity, influenced overall survival. Conclusions: BC presents a decade earlier, and with more advanced disease in BA compared with Jewish patients. Biologic parameters including grade, ER, PR, and Her2 status were similar in both groups. Although prognosis was worse in BA than in Jewish patients, it was affected only by stage and PR status, but not by ethnicity.

References

  1. Bailey C (1980). Dating the arrival of the Bedouin tribes in Sinai and the Negev. J Econ Soc Hist Orient, 28, 21-4.
  2. Abu-Saad K, Shai I, Kaufman-Shriqui V, et al (2009). Bread type intake is associated with lifestyle and diet quality transition among Bedouin Arab adults. Br J Nutrition, 102, 1513-22. https://doi.org/10.1017/S0007114509990675
  3. Al-Kuraya K, Schraml P, Sheikh S, et al (2005). Predominance of high-grade pathway in breast cancer development of Middle East women. Mod Pathol, 18, 891-7. https://doi.org/10.1038/modpathol.3800408
  4. Al-Tamini DM, Shawarby MA, Ahmed A, et al (2010). Protein expression profile and prevalence pattern of the molecular classes of breast cancer: a Saudi population based study. BMC Cancer, 10, 223. https://doi.org/10.1186/1471-2407-10-223
  5. Baron-Apel O (1999). Breast cancer. In: Green M, eds. The state of health in Israel in 1999. Jerusalem: Israel Center for Disease control, 213, 91-5.
  6. Bener A, Ayoubi HR, Ali AI, et al (2010). Does consanguinity lead to decreased incidence of breast cancer? Cancer Epidemiol, 34, 413-8. https://doi.org/10.1016/j.canep.2010.04.004
  7. Elston CW, Ellis IO (1991). Pathologic prognostic factors in breast cancer. I. the value of histological grades in breast cancer. experience from a large study with long-term followup. Histopathology, 19, 403-10. https://doi.org/10.1111/j.1365-2559.1991.tb00229.x
  8. Chouchane L, Boussen H, Sastry KS (2013). Breast cancer in arab populations: molecular characteristics and disease management implications. Lancet Oncol, 10, 417-24.
  9. Donnelly TT, Khater AH, Al-Bader SB, et al (2013). Arab women's breast cancer screening practices: a literature review. Asian Pac J Cancer Prev, 14, 4519-28. https://doi.org/10.7314/APJCP.2013.14.8.4519
  10. El Saghir NS, Seoud M, Khalil MK, et al (2006). Effects of young age at presentation on survival in breast cancer. BMC Cancer, 6, 194. https://doi.org/10.1186/1471-2407-6-194
  11. Fraser D, Abu-Saad k, Abu-Shareb H (2001). The relative importance of traditional and “modern” foods for israeli negev bedouins. a population in transition. Nutr Metab Cardiovasc Dis, 11, 66-9.
  12. Fraser D, Bilenko N, Vardy H, et al (2008). Differences in food intake and disparity in obesity rates between adult Jews and Bedouins in southern Israel. Eth Dis, 18, 13-8.
  13. Hemminki K, Mousavi SM, Sundquist J, et al (2011). Does the breast cancer age at diagnosis differ by ethnicity? a study on immigrants to sweden. The Oncologist, 16, 146-54. https://doi.org/10.1634/theoncologist.2010-0104
  14. Israel Cancer Registry, Jerusalem. http://www.old.health.gov.il/download/pages/shad2001-final.pdf
  15. Israel Central Bureau of Statistics. Statistical Abstract of Israel 2013-No 64. Society and Population. http://www.cbs.gov.il/reader
  16. Keinan-Boker L, Baron-Epel O, Fishler Y, et al (2013). Breast cancer trend in Israeli Jewish and Arab women, 1996-2007. Eur J Cancer Prev, 22, 112-20. https://doi.org/10.1097/CEJ.0b013e3283581d3c
  17. Kenan G, Burck L (2002). Trends in patrilineal parallel first cousin marriages among israeli-arabs. Ann Hum Biol, 29, 398-413. https://doi.org/10.1080/03014460210151480
  18. Singletary SE, Allred C, Ashley P et al (2002). Revision of the american joint committee on cancer staging system for breast cancer. J Clin Oncol, 20, 3628-36. https://doi.org/10.1200/JCO.2002.02.026
  19. Nebet A, Brinkmann B, Majumder PP et al (2001). They chromosome of jews as part of the genetic landscape of the middle-east. Am J Hum Genet, 69, 1095-112. https://doi.org/10.1086/324070
  20. Nissan A, Spira RM, Hamburger T et al (2004). Clinical profile of breast cancer in arab and jewish women in the Jerusalem area. Am J Surg, 188, 62-7. https://doi.org/10.1016/j.amjsurg.2003.11.039
  21. Ortashi O (2013). Gynecological cancer services in Arab countries: present scenario, problems and suggested solutions. Asian Pac J Cancer Prev, 14, 2147-50. https://doi.org/10.7314/APJCP.2013.14.3.2147
  22. Silberstein T, Burg A, Blumenfeld J, et al (2013). Saturated fatty acid composition in human milk in Israel. a comparison between Jewish and Bedouin women. IMAJ, 15, 156-9.
  23. Slaoui M, Razine R, Ibrahimi A, et al (2014). Breast cancer in Morocco: a literature review. Asian Pac J Cancer Prev, 15, 1067-74. https://doi.org/10.7314/APJCP.2014.15.3.1067
  24. Zidan J, Sikorsky N, Basher W, et al (2012). Differences in pathological and clinical features of breast cancer in Arab as compared to Jewish women in Northern Israel. Int J Cancer , 131, 924-9. https://doi.org/10.1002/ijc.26431
  25. Zlotogora J (2013). Mendelian disorders in the non-jewish population of israel. publication of the department of community genetics, public health services, ministry of health, israel. http://www.health.gov.il/Subjects/Genetics/Documents/book_jews.pdf

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