Breast Cancer Diagnosis and Management in an Area of Protracted Conflict: A Case Series from Northwest Syria

TL;DR

This study examines breast cancer care challenges in northwest Syria, showing late diagnoses, high mastectomy rates, and how displacement worsens survival.

Contribution

The study provides novel insights into breast cancer management in conflict zones, emphasizing displacement's impact on survival and treatment delays.

Findings

Most patients presented with late-stage breast cancer (stages II and III).

Displacement was associated with significantly lower predicted survival.

Radiotherapy access was severely limited, contributing to poor treatment outcomes.

Abstract

Background
 Breast cancer remains a significant public health challenge in conflict-affected regions. This study aims to investigate the impact of armed conflict on the burden of breast cancer in female patients in northwest Syria, focusing on clinical presentations, management, diagnosis, access to care, and treatment outcomes.

Methods
 We conducted a retrospective analysis of breast cancer patients diagnosed at the Idlib Oncology Center between March 2017 and January 2022. Data were extracted from clinical files and analyzed in R. The study was conducted at the Idlib Oncology Center, the main referral center for cancer care in northwest Syria, serving a population of 4.6 million.

Results
 A total of 192 patients were included, with a median age of 45.5 years (interquartile range [IQR]: 40–56). Of 108 patients, 56.5% were internally displaced. Most patients were diagnosed with invasive ductal carcinoma (81.3%), and the majority presented at stages II and III (34.8 and 59%, respectively). Among 192 patients, 95.8% underwent surgery, with 96.6% having a mastectomy and 90.7% receiving chemotherapy. The median interval from symptom onset to diagnosis was 100.5 days, that from diagnosis to surgery was 14.5 days, and that from surgery to radiotherapy was 229 days. No significant effect was observed for chemical weapon exposure or family loss on survival. Displacement was associated with significantly lower predicted survival (
p
 = 0.0038; 95% confidence interval [CI]: 0.05064–0.2570).

Conclusions
 This study highlights a high prevalence of late-stage breast cancer, a high rate of mastectomies, delayed access to radiotherapy, and long delays between diagnosis and treatment in northwest Syria. Displacement negatively affects survival rates. Additionally, the substantial lack of radiotherapy in patients needing it and prolonged intervals between treatments contribute to poorer outcomes. Establishing localized oncology services and increasing funding for cancer medications and radiotherapy would improve access to necessary oncology care in this region.