Breast Cancer Pattern and Chemotherapy Response - anInstitutional Study in Pakistan

Background: This study was planned to audit female breast cancers and their chemotherapy in a busypublic sector institution. As a case-study, Pakistan provides an opportunity to explore the issue in a low-GDP,low-literacy, populous developing country.
Method: Retrospective analysis of the records at Karachi Instituteof Radiotherapy and Nuclear Medicine.
Results: A total of 3,431 female breast cancer patients presented during2001-2008, half being <45 years, mostly suffering from infiltrating ductal carcinoma of breast. Further analyzinga subgroup of 183 consecutive patients over six months revealed that only 1.6% were at stage-I, whereas 75%had node-positive disease, including 19.1% with distant metastases. Some 41.6% were either high grade orpoorly differentiated. The low grade tumors showed a two-fold likelihood of ER and PR positivity as comparedto high grade lesions. 5-Flourouracil, doxorubicin and cyclophosphamide (FAC) constituted the most commonchemotherapy. Earlier diagnosis was associated with complete remission. Overall, 33% developed myelotoxicity,more often if age ≥45 years (p=0.012), out of which 60% needed active correction. All those patients who did notexperience a drop in total leukocyte count (TLC) below 4×109/L did not show complete remission.
Conclusions:Infiltrating ductal carcinoma of the breast is the most common type. FAC is the most common chemotherapy.Tendency for late diagnosis, metastatic disease, treatment failure as well as leukopenia especially in ≥45 yearsis present. Failure to show leukopenia is suggestive of poor therapeutic outcome.