Risk Factors for Stage IV Breast Cancer at the Time of Presentation in Turkey


Background: Breast cancer (BC) is the one of the most common cancers in women. It is also a leading causeof death. Unfortunately, some patients initially present with distant metastases and are diagnosed with stage IVdisease that is nearly always, by then, incurable. This retrospective analysis investigated the risk factors for stageIV BC that may underlie such late presentation. Materials and
Methods: In all, 916 patients with BC who visitedthe medical oncology polyclinic of eight different centres in Turkeybetween December 2011 and January 2013were analysed.
Results: A total of 115 patients (12.6%) presented with stage IV disease. In univariate analysis;to comparing these with patients at other stages, no statistical difference was found for median diagnosis age orage at menarche (p=0.611 and p=0.820), whereas age at menopause and age at first live birth were significant(p=0.018 and p=0.003). No difference was detected in terms of accompanying diseases, use of oral contraceptivesand hormone replacement therapy, smoking, alcohol consumption and the rate of family history of BC betweenthe patients (p=0.655, p=0.389, p=0.762, p=0.813, p=0.229, p=0.737). However, screening methods were employedless often, the rate of illiteracy was higher, and the rate of other cancers was higher in patients with stage IVBC (p=0.022, p=0.022, p=0.018). No statistical difference was observed between the patients in terms of tumourhistopathology, and status of oestrogen receptor, progesterone receptor, or human epidermal growth factor-2receptor (p=0.389, p=0.326, p=0.949, p=0.326). Grade 3 tumours were more frequent in patients with stage IVdisease (p<0.001). On multivariate analysis, risk factors for stage IV breast cancer at the time of presentationwere found to be age at first live birth and educational level (p=0.003 and p=0.047).
Conclusions: Efforts shouldbe made to perform mammography scans, in particular, at regular intervals through national training programsfor all women, particularly those with family histories of breast and other types of cancer, and to establish earlydiagnosis of BC long before it proceeds to stage IV. Additionally, women’s education had better be upgraded.In order to make women aware of BC, national education-programmes must be organised.