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Prof. Dr. Nada A. S. Al Alwan

“Demographic and Clinical Profiles of Female Patients Diagnosed with Breast Cancer in Iraq

By Prof.  Dr.  Nada A. S. Al Alwan    

Breast cancer remains the most common encountered malignancy among the Iraqi population since three decades. Apart from genetic predisposition, demographic and clinical factors have an impact on developing the disease.

To highlight the main demographic characteristics and clinical profiles of female patients registered with breast cancer in Iraq; focusing on the impact of age.

This retrospective study enrolled 1172 female patients who were diagnosed with breast cancer at the Main Center for Early Detection of Breast Cancer/Medical City Teaching Hospital in Baghdad. Data were extracted from an established information system, developed by the principal author under supervision of WHO, that was based on valid clinical records of Iraqi patients affected by breast cancer. The studied demographic and clinical variables included age at presentation, marital and educational status, number of parity, age at first child birth, history of lactation, hormonal therapy, family history of breast cancer or any other malignancy. The recorded information regarding clinical examination comprised positive palpable lumps, bloody nipple discharge, skin changes, bilateral breast involvement, tumor size, lymph node status and the stage of the disease.

The mean age at presentation was 51 years; patients under the age of 50 constituted 46.8%. Overall 9.8% were not married, 22.4% were illiterate whereas 19.2% graduated from universities. About 72% of the patients had more than two children, merely 7.5% delivered their first child after the age of 35 years and only 11% were nulliparous. History of lactation and hormonal therapy was recorded in 57.6% and 19.4% respectively.  Family history of cancer was positive in 28.8% and breast cancer specifically in 18.7%.  Clinically, the most common presenting symptom was breast lumps (95%) followed by skin changes/ulcerations (6.7%) and bloody nipple discharge (4.3%). Bilateral breast involvement was encountered in 4.7%. More than two third of the patients (68.2%) had palpable axillary lymph nodes; classifying 40.5% into advanced stages III and IV. In general stages I, II, III, IV comprised 12%, 47.5%, 31.9% and 8.6% respectively. Upon stratifying the studied sample with respect to age at diagnosis, it was observed that the frequency of unmarried patients was significantly higher among younger women under the age of 50 years, whereas illiteracy and nulliparity features were statistically lower (p < 0.05).

A considerable proportion of breast cancer patients in Iraq still present with locally advanced disease at the time of diagnosis. That justifies the necessity to promote public awareness educational campaigns in order to strengthen our national early detection program. Excluding the marital status, level of education and number of parity, there was no statistical difference regarding the impact of age on the demographic and clinical profiles of breast cancer among premenopausal versus postmenopausal Iraqi patients.

Biography: 

 Prof.  Dr.  Nada A. S. Al Alwan   

  • Professor of Pathology, Director, National Cancer Research Centre
  • Executive Director, National Program for Early Detection of Breast Cancer, MoHESR
  • Scientific Supervisor, Breast Cancer Early Detection Program, Oncology Teaching Hospital, Medical City, MoH.
  • Chairperson, Medical Committee, Iraqi Scientific Research Council
  • National Project Coordinator/Counterpart, IAEA Capacity Building Project for Strengthening Radiotherapy and Nuclear Medicine in Iraq
  • Principal Investigator, Regional Breast Cancer Research Project, WHO / IARC
  • Member, Iraqi Cancer Board (c/o Early Cancer Detection & Research)
  • Scientific Adviser, Supreme Pathology Accreditation Committee

As a Professor of Pathology since 2001, Nada Alwan collaborated in organizing the National Program for Early Detection and Down Staging of Breast Cancer in Iraq (MoH, 2001) and served as its Executive Director. In 2008, Prof. Alwan established the “Iraqi National Breast Cancer Research Program”, which is chaired by the Ministry of Higher Education and Scientific Research (MoHESR). Following a visit to the Screening Unit of IARC (International Agency for Research on Cancer) in 2010, she developed, with their assistance, a comprehensive online information system data base for Iraqi patients complaining of breast cancer.  In 2011, WHO/EMRO and IARC utilized that model to compare the demographic characteristics, clinico-pathological presentations and management outcomes among patients affected with breast cancer in countries within the Eastern Mediterranean Region through implementing a “Regional Comparative Breast Cancer Research Project”; Iraq represented by Nada Alwan acting as the Principal Investigator.

Prof. Alwan published 88 scientific articles in peer reviewed journals focusing on cancer burden in Iraq. In 2017, she worked as an Academic Visitor at Oxford University, Nuffield Division of Clinical Laboratory Sciences on a joint research project with Prof. David Kerr comparing the demographic and clinico-pathological profiles of breast cancer among Iraqi and British patients. She has published over 70 articles on the topic of cancer; focusing on the burden of breast cancer in Iraq and the means of its control.

Within the fields of adopting national cancer control strategies and establishing early detection programs, Prof. Alwan served as an international expert and technical advisor to WHO/EMRO, IAEA, Technical Cooperation Program, US Middle East Partnership Initiative, Suzan G Komen for the Cure and the Jordan National Breast Cancer Program.