Date Published: September 16, 2019
Publisher: Public Library of Science
Author(s): Marwa Maweya Abdelbagi Elbasheer, Ayah Galal Abdelrahman Alkhidir, Siham Mohammed Awad Mohammed, Areej Abuelgasim Hassan Abbas, Aisha Osman Mohamed, Isra Mahgoub Bereir, Hiba Reyad Abdalazeez, Mounkaila Noma, Erin Bowles.
Breast cancer is the most prevalent cancer among females worldwide including Sudan. The aim of this study was to determine the spatial distribution of breast cancer in Sudan.
A facility based cross-sectional study was implemented in eighteen histopathology laboratories distributed in the three localities of Khartoum State on a sample of 4630 Breast Cancer cases diagnosed during the period 2010–2016. A master database was developed through Epi InfoTM 220.127.116.11 for computerizing the data collected: the facility name, type (public or private), and its geo-location (latitude and longitude). Personal data on patients were extracted from their respective medical records (name, age, marital status, ethnic group, state, locality, administrative unit, permanent address and phone number, histopathology diagnosis). The data was summarized through SPSS to generate frequency tables for estimating prevalence and the geographical information system (ArcGIS 10.3) was used to generate the epidemiological distribution maps. ArcGIS 10.3 spatial analysis features were used to develop risk maps based on the kriging method.
Breast cancer prevalence was 3.9 cases per 100,000 female populations. Of the 4423 cases of breast cancer, invasive breast carcinoma of no special type (NST) was the most frequent (79.5%, 3517/4423) histopathological diagnosis. The spatial analysis indicated as high risk areas for breast cancer in Sudan the States of Nile River, Northern, Red Sea, White Nile, Northern and Southern Kordofan.
The attempt to develop a predictive map of breast cancer in Sudan revealed three levels of risk areas (risk, intermediate and high risk areas); regardless the risk level, appropriate preventive and curative health interventions with full support from decision makers are urgently needed.
Breast cancer (BC) is a disease characterized by different pathologies, biological characteristics and clinical behaviors. It is the leading cancer among females worldwide with 641,000 cases reported in 1980 and 1,643,000 cases in 2010; the annual incidence increase between the two years was 3.1% . In the year 2015 the WHO reported 571000 deaths from BC  while in 2018 it represented 24.2% of all cancers and 15% of deaths due to cancer among females . Furthermore by the year 2020, 1.7 million new cases are expected mostly in the developing countries . The recent shift in its burden in the developing world is revealed by a high mortality rate and a poorer overall survival [2, 4]. The geographical distribution of BC in Africa revealed a marked variation in incidence within the continent with a high incidence rate of 130 cases per 100,000 in Northern African countries and a lowest rate of 95 cases per 100,000 recorded in the Western part of the African continent . The highest standardized mortality rate worldwide according to WHO six regions was found in the East Mediterranean Office (EMRO) and Africa Regional Office (AFRO) with respectively 18.6% and 17.2% . On the other hand breast cancer among males is still considered a rare condition, representing 1% of the total breast cancer patients in Europe compared to over 6% in Central African countries .
A total of 4423 cases of breast cancer were recorded (2010–2016) from eighteen laboratories distributed in Khartoum State. Patients were aged 12 to 103 years with an average (median) age of 48 years. They were predominately females 97.4% (4300/4413). The mean age at presentation was higher in males (61 years ±14.9) than in females (49 years ±14.2). Of the 4423 cases of breast cancer, invasive breast carcinoma of no special type (NST) was the most frequent histopathological diagnosis (79.5%, 3517/4423) followed by special subtypes of invasive carcinoma (12.4%, 547/4423) and precursor lesions (3.2%, 142/4423) and the remaining 4.9% were classified as others. Females were paying the highest burden with a crude prevalence of 3.9 cases per 100,000 female population, ranging from 0.3 (Gedaref and Western Kordofan) to 22.1 in Khartoum as shown by Table 1 and Fig 2. On the other hand, male breast cancer was <1 per 100,000 male population. Our findings revealed a crude prevalence of 3.9 cases per 100,000 female populations for the period 2010 to 2016. This burden in Sudan females was also reported elsewhere in Sub-Saharan African countries, fluctuating from 4.5% (Zimbabwe) to 38.9/100 000 females in (South Africa) . The crude prevalence of male breast cancer was 0.1 cases per 100,000 population which is much lower than figures reported by the Surveillance, Epidemiology and End Result (SEER) Program which showed that the rate of male breast cancer in the USA was 1.44 for 100,000 men in 2010  Our findings provided an understanding of the pattern of the spatial distribution of breast cancer country wide with hot spots defined as high risk and intermediate risk areas. As further data may be needed to improve the risk map, the decision makers and the health professionals should for equity reasons look at decentralizing of the health system which could not be efficient and operational if all the expertise are concentrated mainly in the State hosting the capital of country. Source: http://doi.org/10.1371/journal.pone.0211085