Clinicopathological Features and Trends in the Incidence of Female Breast Cancer : Results of the Northern Tunisia Cancer Registry (1994–2018)

Khiari, Houyem; Henchiri, Soumaya; Sakhri, Saida; Chourou, Hajer; Ben Aziza, Rim; Ben Mansour, Hajer; Benfguira, Cyrine; Mahjoub, Najet; Mrabet, Ali

doi::10.31557/APJCP.2026.27.10.3533

Clinicopathological Features and Trends in the Incidence of Female Breast Cancer : Results of the Northern Tunisia Cancer Registry (1994–2018)

Document Type : Research Articles

Authors

¹ Department of Epidemiology, Salah Azaiez Institute of Tunis, Tunisia.

² Directorate of Basic Healthcare, Tunis, Tunisia.

³ Department of Surgery, Salah Azaiez Institute of Tunis, Tunisia.

⁴ Maternity and Neonatology Center of Tunis, Tunisia.

⁵ Department of Medical Oncology, Salah Azaiez Institute of Tunis, Tunisia.

⁶ Department of Oncology, Salah Azaiez Institute of Tunis, Tunisia.

⁷ Health Minsitery, General Directorate of Military Health, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.

:10.31557/APJCP.2026.27.10.3533

Abstract

Introduction: Breast cancer (BC) is the most common cancer in women worldwide and in Tunisia. The objective of this study was to (1) describe the epidemiological characteristics of BC from the Northern Tunisia Cancer Registry (NTCR) in 2018, and (2) analyze trends in the incidence of BC over the period 1994–2018. Methods: This was a population-based retrospective study using data from the Northern Tunisia Cancer Registry (NTCR). During the period 1994–2018, a total of 21,673 primary female BC cases were analysed. The NTCR collected, actively and retrospectively, data from all sources of cancer-related care in both public and private healthcare sectors across the Northern Tunisia region. This region encompasses 2,813,900 females. Crude and standardized incidence rates were calculated. Incidence trend analysis was performed using Joinpoint software, version 6.0.1. Results: The results of this study showed a significant increase in the incidence of BC in northern Tunisia from 30.0/100,000 in 1994 to 52.4/100,000 in 2018, with an Average Annual Percentage Change (AAPC) of 2.7%; 95% confidence interval (CI) [1.8; 3.6]; p<0.05. The trend in BC incidence across age groups in women showed a significantly increasing trend for the 55–74-year age groups. The proportion of localized BC increased from 28.3% in 1994 to 46.5% in 2018, with an AAPC of 2%; 95% CI [1.4; 2.7]; p<0.001. On the other hand, the trend in the proportion of cases with distant-stage disease showed a downward trend from 17.8% to 14.6%; 95% CI [-1.6; 0.1]; p=0.06. The trend in the mean tumor size of BC during the period 1994–2018 showed a significantly downward trend, from 3.5 cm in 1994 to 2.6 cm in 2018, with an AAPC of -1.57; 95% CI [-2.0; -1.2]; p<0.001. The morphological verification percentage was 97.2%. Conclusion: The results of this study suggest the need to strengthen the current strategy for early diagnosis of BC and to improve care with equitable access for all Tunisian women.

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