Survival Rate of Breast Cancer and Related Factors in Iran: A 27-Year Follow-Up
Abstract
Background: Several factors can affect the survival of patients with breast cancer (BC). We estimated BC patients' 5-, 10-, and 15-year survival rates and influential factors in a single medical center during the last three decades.
Methods: We enrolled patients diagnosed with BC managed in the Cancer Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran from 1991 to 2018. All patients were followed to check the patients' status. The data were analyzed regarding demographic, clinical, pathological, and molecular biology characteristics. Descriptive and survival analyses were performed. Kaplan Meier and Cox proportional hazards regression models were used for survival analysis.
Results: Overall, 4, 429 women were included. The mean age was 49. 11 (±11. 98) yr. Nearly 70% of the patients had high school degrees. Totally, 35% of patients were diagnosed in the advanced stages of BC. Estrogen Receptor (ER), Progesterone Receptor (PR), and human epidermal growth factor receptor 2 (HER2) were positive in 72. 50%, 66. 90%, and 16. 20% of the cases, respectively. About 11. 6% of patients died. The overall 5-, 10-, and 15-year survival rates of BC were 90%, 83%, and 75%, respectively. In the Cox proportional hazard analysis, the survival rate was affected by literacy level, positive lymph nodes, lymphovascular invasion, ER, tumor size, and pathological grade.
Conclusion: This is the first report on the 15-year survival rate of BC and its influential factors, from a medical center in Iran. The results were acceptable and comparable with those of developed countries due to scientific protocols, teamwork, and effective follow-up in a developing country.
1. Bray F, Laversanne M, Sung H, et al (2024). Global cancer statistics 2022: GLO-BOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 74 (3):229-263.
2. Ministry of Health and Medical Education (2023). Annual Report of Iranian Na-tional Population-based Cancer Registry "2018", Tehran, Iran
3. Haghighat S, Omidi Z, Ghanbari A (2022). Trend of breast cancer incidence in Iran during a fifteen-year interval ac-cording to National Cancer Registry Reports. IJBD, 15 (2):4-17.
4. Dafni U, Tsourti Z, Alatsathianos I (2019). BC Statistics in the European Un-ion:Incidence and Survival across Euro-pean Countries. Breast Care (Basel), 14:344-353.
5. Akbari ME, Akbari A, Khayamzadeh M, et al (2023). Ten-Year Survival of Breast Cancer in Iran: A National Study. Breast Care (Basel), 18 (1):12-21.
6. Wilkinson L, Gathani T (2022). Under-standing breast cancer as a global health concern. Br J Radiol, 95 (1130):20211033.
7. Ji P, Gong Y, Jiang CC (2020). Association between socioeconomic factors at diag-nosis and survival in breast cancer. Can-cer Med, 9 (5):1922-1936.
8. Olfatbakhsh A, Heidari L, Omidi Z (2022). Long-term Survival and Prognostic Fac-tors of Breast Cancer. Arch Iran Med, 25 (9):609-616.
9. Akbari A, Khayamzadeh M, Salmanian R, et al (2019). National cancer mortality-to-incidence ratio (MIR) in Iran. Int J Cancer Manag, 12 (6):e94145.
10. Nolte E, Morris M, Landon S (2022). Ex-ploring the link between cancer policies and cancer survival. Lancet Oncol, 23 (11):e502-e514.
11. Ziaei JE, Sanaat Z, Asvadi I (2013). Survival analysis of breast cancer patients in northwest Iran. Asian Pac J Cancer Prev, 14 (1):39-42.
12. Fallahzadeh H, Momayyezi M, Akhundzar-deini R (2014). Five-year survival of women with breast cancer in Yazd. Asian Pac J Cancer Prev, 15 (16):6597-601.
13. Fouladi N, Amani F, Harghi AS (2011). Five-year survival of women with breast cancer in Ardabil, north-west of Iran. Asian Pac J Cancer Prev, 12 (7):1799-801.
14. Maajani K, Jalali A, Alipour S (2019). The global and regional survival rate of women with breast cancer. Clin Breast Cancer, 19 (3):165-177.
15. Zorlutuna Ş (2022). Survival Rate and Prog-nostic Factors in Turkish Women Pa-tients with Breast Cancer. Iran J Public Health, 51 (2):375-85.
16. https://www.canada.ca/en/public-health
17. Available from: American Cancer Society. Breast Cancer Facts & Figures 2022-2024. Atlanta:American Cancer Society, Inc. 2022.
18. Miller KD, Nogueira L, Mariotto AB (2019). Cancer treatment and survivorship sta-tistics, 2019. CA Cancer J Clin, 69 (5):363-385.
19. Özmen V, Özmen T, Doğru V (2019). Breast Cancer in Turkey; an Analysis of 20. 000 Patients with Breast Cancer. Eur J Breast Health, 15 (3):141-146.
20. Elias-Rizk T, Issa E, Ammanouil E (2024). Breast Cancer Screening in Lebanon: Understanding Knowledge, Attitudes and Barriers. Clinical Epidemiology and Global Health, 29:101733.
21. Tan M, Jamil A, Ismail R (2023). Breast cancer and breast cancer screening use—beliefs and behaviours in a na-tionwide study in Malaysia. BMC Public Health, 23:1319.
22. National Cancer Institute (20204). SEER is an authoritative source for cancer statis-tics in the United States. Available from: https://seer.cancer.gov/
23. Bab S, Abdifard E, Elyasianfar S (2019). Time trend analysis of breast cancer in Iran and its six topographical regions. J Med Life, 12 (2):140-149.
24. Bidoli E, Virdone S, Hamdi M (2019). Worldwide Age at Onset of Female Breast Cancer: A 25-Year Population-Based Cancer Registry Study. Sci Rep, 9 (1):14111.
25. Kim HJ, Kim S, Freedman RA, et al (2022). The impact of young age at diagnosis (age <40 years) on prognosis varies by breast cancer subtype. Breast, 61:77-83.
26. Nematolahi S, Ayatollahi SMT (2017). A comparison of breast cancer survival among young, middle-aged, and elderly patients in southern Iran. Epidemiol Health, 39:e2017043.
27. Soni A, Verma Y, Chauhan A (2023). Male breast cancer: a 30-year retrospective analysis. Ecancermedicalscience, 17:1551.
28. Hashemzadeh S, Aligholipour Maleki R (2012). The incidence of breast cancer in northwest Iran. J Cardiovasc Thorac Res, 4 (1):5-9.
29. Maajani K, Khodadost M, Fattahi A, et al (2020). Survival rates of patients with breast cancer in countries in EMRO. East Mediterr Health J, 26 (2):219-232.
30. Fathalla A, Hafez M (2016). Breast Cancer in Males, Does It Really Differ? Na-tional Cancer Institute Experience, Egypt. Journal of Cancer Therapy, 7:344-351.
31. Scomersi S, Giudici F, Cacciatore G (2021). Comparison between male and female breast cancer survival using propensity score matching analysis. Sci Rep, 11:11639.
32. Sanli AN, Tekcan DE, Altundag MK (2024). Is There a Survival Difference between Male and Female Breast Cancer Sub-types According to the Prognostic Stag-ing System? A Population-Based Cohort Study. Am Surg, 90 (4):788-799.
33. Wang F, Shu X, Meszoely I (2019). Overall Mortality after Diagnosis of Breast Can-cer in Men vs Women. JAMA Oncol, 5 (11):1589-1596.
34. Dos-Santos-Silva I, De Stavola BL, Renna NL (2019). Ethnoracial and social trends in breast cancer staging at diagnosis in Brazil, 2001-14. Lancet Glob Health, 7 (6):e784-e797.
35. Luciana da Rosa, Vera Radün (2012). Sur-vival rates to woman with breast cancer: Review. Text Context Nursing, Florianópolis, 21 (4):980-9.
36. Yadollahi M, Siavashi E, Mostaghim S (2022). The Relationship between Health Literacy and Patient Participation in Medical Decision Making Among Breast Cancer Patients. Arch Breast Cancer, 13:183-8.
37. Omidi Z, Koosha M, Nazeri N (2022). Sta-tus of breast cancer screening strategies and indicators in Iran. J Res Med Sci, 27:21.
38. Akbari ME, Khayamzadeh M, Mirzaei HR (2020). Saving the breast saves the lives of breast cancer patients. Int J Surg Oncol, 2020:8709231.
39. Olfatbakhsh A, Haghighat S, Tabari M (2018). Patient satisfaction and body im-age following mastectomy, breast-conserving therapy, and mastectomy with reconstruction. Arch Breast Cancer, 171-180.
40. Meshkat M, Baghestani AR, Zayeri F (2020). Survival Rate and Prognostic Factors among Iranian Breast Cancer Patients. Iran J Public Health, 49 (2):341-350
41. Fallahzadeh H, Mohammadzadeh M, Pah-lavani V (2018). A study on the prognos-tic factors of breast cancer survival time. Journal of Isfahan Medical School, 36 (466):49-55
42. Haghighat S, Olfatbakhsh A, Sadjadian A (2013). Evaluation of survival and related factors in breast cancer patients re-ferred to the breast disease center. Jour-nal of Breast Disease, 6:28 –36. [Persian]
43. Rakhsha A, Anvari A, Razzaghdoust A, et al (2017). Clinical outcome and prognostic factors for very young patients with breast cancer. Int J Cancer Manag, 10 (9):e11772.
2. Ministry of Health and Medical Education (2023). Annual Report of Iranian Na-tional Population-based Cancer Registry "2018", Tehran, Iran
3. Haghighat S, Omidi Z, Ghanbari A (2022). Trend of breast cancer incidence in Iran during a fifteen-year interval ac-cording to National Cancer Registry Reports. IJBD, 15 (2):4-17.
4. Dafni U, Tsourti Z, Alatsathianos I (2019). BC Statistics in the European Un-ion:Incidence and Survival across Euro-pean Countries. Breast Care (Basel), 14:344-353.
5. Akbari ME, Akbari A, Khayamzadeh M, et al (2023). Ten-Year Survival of Breast Cancer in Iran: A National Study. Breast Care (Basel), 18 (1):12-21.
6. Wilkinson L, Gathani T (2022). Under-standing breast cancer as a global health concern. Br J Radiol, 95 (1130):20211033.
7. Ji P, Gong Y, Jiang CC (2020). Association between socioeconomic factors at diag-nosis and survival in breast cancer. Can-cer Med, 9 (5):1922-1936.
8. Olfatbakhsh A, Heidari L, Omidi Z (2022). Long-term Survival and Prognostic Fac-tors of Breast Cancer. Arch Iran Med, 25 (9):609-616.
9. Akbari A, Khayamzadeh M, Salmanian R, et al (2019). National cancer mortality-to-incidence ratio (MIR) in Iran. Int J Cancer Manag, 12 (6):e94145.
10. Nolte E, Morris M, Landon S (2022). Ex-ploring the link between cancer policies and cancer survival. Lancet Oncol, 23 (11):e502-e514.
11. Ziaei JE, Sanaat Z, Asvadi I (2013). Survival analysis of breast cancer patients in northwest Iran. Asian Pac J Cancer Prev, 14 (1):39-42.
12. Fallahzadeh H, Momayyezi M, Akhundzar-deini R (2014). Five-year survival of women with breast cancer in Yazd. Asian Pac J Cancer Prev, 15 (16):6597-601.
13. Fouladi N, Amani F, Harghi AS (2011). Five-year survival of women with breast cancer in Ardabil, north-west of Iran. Asian Pac J Cancer Prev, 12 (7):1799-801.
14. Maajani K, Jalali A, Alipour S (2019). The global and regional survival rate of women with breast cancer. Clin Breast Cancer, 19 (3):165-177.
15. Zorlutuna Ş (2022). Survival Rate and Prog-nostic Factors in Turkish Women Pa-tients with Breast Cancer. Iran J Public Health, 51 (2):375-85.
16. https://www.canada.ca/en/public-health
17. Available from: American Cancer Society. Breast Cancer Facts & Figures 2022-2024. Atlanta:American Cancer Society, Inc. 2022.
18. Miller KD, Nogueira L, Mariotto AB (2019). Cancer treatment and survivorship sta-tistics, 2019. CA Cancer J Clin, 69 (5):363-385.
19. Özmen V, Özmen T, Doğru V (2019). Breast Cancer in Turkey; an Analysis of 20. 000 Patients with Breast Cancer. Eur J Breast Health, 15 (3):141-146.
20. Elias-Rizk T, Issa E, Ammanouil E (2024). Breast Cancer Screening in Lebanon: Understanding Knowledge, Attitudes and Barriers. Clinical Epidemiology and Global Health, 29:101733.
21. Tan M, Jamil A, Ismail R (2023). Breast cancer and breast cancer screening use—beliefs and behaviours in a na-tionwide study in Malaysia. BMC Public Health, 23:1319.
22. National Cancer Institute (20204). SEER is an authoritative source for cancer statis-tics in the United States. Available from: https://seer.cancer.gov/
23. Bab S, Abdifard E, Elyasianfar S (2019). Time trend analysis of breast cancer in Iran and its six topographical regions. J Med Life, 12 (2):140-149.
24. Bidoli E, Virdone S, Hamdi M (2019). Worldwide Age at Onset of Female Breast Cancer: A 25-Year Population-Based Cancer Registry Study. Sci Rep, 9 (1):14111.
25. Kim HJ, Kim S, Freedman RA, et al (2022). The impact of young age at diagnosis (age <40 years) on prognosis varies by breast cancer subtype. Breast, 61:77-83.
26. Nematolahi S, Ayatollahi SMT (2017). A comparison of breast cancer survival among young, middle-aged, and elderly patients in southern Iran. Epidemiol Health, 39:e2017043.
27. Soni A, Verma Y, Chauhan A (2023). Male breast cancer: a 30-year retrospective analysis. Ecancermedicalscience, 17:1551.
28. Hashemzadeh S, Aligholipour Maleki R (2012). The incidence of breast cancer in northwest Iran. J Cardiovasc Thorac Res, 4 (1):5-9.
29. Maajani K, Khodadost M, Fattahi A, et al (2020). Survival rates of patients with breast cancer in countries in EMRO. East Mediterr Health J, 26 (2):219-232.
30. Fathalla A, Hafez M (2016). Breast Cancer in Males, Does It Really Differ? Na-tional Cancer Institute Experience, Egypt. Journal of Cancer Therapy, 7:344-351.
31. Scomersi S, Giudici F, Cacciatore G (2021). Comparison between male and female breast cancer survival using propensity score matching analysis. Sci Rep, 11:11639.
32. Sanli AN, Tekcan DE, Altundag MK (2024). Is There a Survival Difference between Male and Female Breast Cancer Sub-types According to the Prognostic Stag-ing System? A Population-Based Cohort Study. Am Surg, 90 (4):788-799.
33. Wang F, Shu X, Meszoely I (2019). Overall Mortality after Diagnosis of Breast Can-cer in Men vs Women. JAMA Oncol, 5 (11):1589-1596.
34. Dos-Santos-Silva I, De Stavola BL, Renna NL (2019). Ethnoracial and social trends in breast cancer staging at diagnosis in Brazil, 2001-14. Lancet Glob Health, 7 (6):e784-e797.
35. Luciana da Rosa, Vera Radün (2012). Sur-vival rates to woman with breast cancer: Review. Text Context Nursing, Florianópolis, 21 (4):980-9.
36. Yadollahi M, Siavashi E, Mostaghim S (2022). The Relationship between Health Literacy and Patient Participation in Medical Decision Making Among Breast Cancer Patients. Arch Breast Cancer, 13:183-8.
37. Omidi Z, Koosha M, Nazeri N (2022). Sta-tus of breast cancer screening strategies and indicators in Iran. J Res Med Sci, 27:21.
38. Akbari ME, Khayamzadeh M, Mirzaei HR (2020). Saving the breast saves the lives of breast cancer patients. Int J Surg Oncol, 2020:8709231.
39. Olfatbakhsh A, Haghighat S, Tabari M (2018). Patient satisfaction and body im-age following mastectomy, breast-conserving therapy, and mastectomy with reconstruction. Arch Breast Cancer, 171-180.
40. Meshkat M, Baghestani AR, Zayeri F (2020). Survival Rate and Prognostic Factors among Iranian Breast Cancer Patients. Iran J Public Health, 49 (2):341-350
41. Fallahzadeh H, Mohammadzadeh M, Pah-lavani V (2018). A study on the prognos-tic factors of breast cancer survival time. Journal of Isfahan Medical School, 36 (466):49-55
42. Haghighat S, Olfatbakhsh A, Sadjadian A (2013). Evaluation of survival and related factors in breast cancer patients re-ferred to the breast disease center. Jour-nal of Breast Disease, 6:28 –36. [Persian]
43. Rakhsha A, Anvari A, Razzaghdoust A, et al (2017). Clinical outcome and prognostic factors for very young patients with breast cancer. Int J Cancer Manag, 10 (9):e11772.
| Files | ||
| Issue | Vol 54 No 4 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Breast Neoplasm Disease Management Epidemiology Iran Survival | ||
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How to Cite
1.
Akbari ME, Akbari A, Akbari M, Khayamzadeh M. Survival Rate of Breast Cancer and Related Factors in Iran: A 27-Year Follow-Up. Iran J Public Health. 2025;54(4):870-880.
