Trends in breast cancer staging at diagnosis associated with screening campaigns in Lebanon

Abstract

Mammography screening remains the best policy for early cancer detection, by shifting the disease at diagnosis to more locally confined stages, which carry lighter treatments and better prognoses. Breast cancer awareness campaigns calling for mammography screenings have been on-going in Lebanon since 2002. National guidelines call for an annual mammography starting 40, for women with no known family history of breast cancer. Changes in breast cancer staging at diagnosis as a consequence of documented improvements in mammography uptake remain to be described. We have reviewed 3501 breast cancer cases treated and-or diagnosed in the American University of Beirut Medical Center between the years 1990 and 2016. After stratifying those cases by age, we have trended the extracted stages versus time. Results were compared between the pre-screening (1990 to 2001) and the post-screening period (2002 to 2016), and then stratified into two age groups (less than 40 and 40 years and older). Median age at presentation for all the case-series was 51 years, with little changes over the study period. During the post-screening period, stage I accounted for 30percent, stage II for 43percent, stage III for 15percent and stage IV for 12percent of the cases. Stage I cases had more than doubled in comparison to the years before the implementation of the awareness campaigns when stage I represented 14percent in 1990-2001. Stage III cases displayed a mirror decrease between the two periods, coming down from an initial 35percent. The increase in stage I was significantly more prominent in the sub-group of women aged 40 years and above, compared to younger ones. Shifts in staging happened in parallel with a concurrent rise in reported uptake of mammography screening. Our findings indicate that stages of breast cancer at diagnosis have been steadily and significantly showing a shift upwards towards less advanced stages over a 27-year interval. Trends in earlier detection of the disease are likely associated with the rise of the awareness and screening campaigns, and i