Breast cancer accounts for about 26% of all newly diagnosed cancers in women aged 20 to 59 years. As part of

a basic program for cancer control, the present cross sectional descriptive study was conducted with the objective

of determining the epidemiology of breast cancer in Ardabil province during 2003-2010. Necessary information

on 469 recorded cases of breast cancer in the registry were collected by check list from patient’s files and then

analyzed by statistical methods with SPSS.16 software. Some 455 of the patients (97%) were female, 329 (70.1%)

residing in Ardabil. The mean age was 46.8±13.6 and most were in the age group of 40 - 60. The most prevalent

pathologic form was infiltrative ductal carcinoma with 316 cases (67.4%), the largest proportion being grade II

(30.6%), but very many belonged to grades III and IV (40.5%). Breast cancer in Ardabil province appeared to

slightly increase over the period studied. The results were similar to other places in Asia. With regard to this,

more widespread studies are required to determine factors influencing the prevalence at low age and also how

to promote early detection

امانی, فیروز

علیمحمدی, حسین

فولادی, نسرین

لطفی, ایلشن

مظاهری, عفت

پورفرضی, فرهاد

English

ArUMS Digital Repository (سامانه اطلاعات زیست پزشکی و سلامت)

Asian Pacific Journal of Cancer Prevention, Vol 13, 2012 1543
              DOI:http://dx.doi.org/10.7314/APJCP.2012.13.4.1543
Breast Cancer in Ardabil Province North-West of Iran: An Epidemiological Study 
Asian Pacific J Cancer Prev, 13, 1543-1545
Introduction
 Cancers considered as the third causes of mortality. 
Breast cancer (BC) is the most frequent cancer (23% of 
all cancers) (Parkin et al., 2002) and the most fatal form 
of malignancy among women (Anderson et al., 2008; 
Fouladi et al., 2011), accounting for 16% of cancer deaths 
(Who report., 2008). Therefore, BC remains a major health 
problem worldwide. Annually, over one million new cases 
of breast cancer are diagnosed in the world. The breast 
cancer incidence increasing in the world which is related 
to longevity, change of life style and mortality reduction 
from other diseases. Despite the increased prevalence 
of breast cancer, its mortality rate is declining, which 
is due to the early diagnosis using screening method by 
mammography and therapeutic advances (Brunicardi et 
al., 2010). Although, the incidence of breast cancer in 
white-skinned females is more common, the mortality 
rate in American black women was 20% higher than white 
women. Death from breast cancer increased with age and 
54% of breast cancer deaths occur in women aged 65 and 
above (Mousavi et al., 2009). Breast cancer is of the most 
prevalent cancer and the major cause of death resulting 
from cancer in women aged 20-59 which generally form 
26% of all newly diagnosed cancers in women. The 
risk  of breast cancer in United States women was 1 in 
8 in 2004. The incidence and mortality rates from breast 
cancer in Asian, African, underdeveloped countries, and 
Ardabil University of Medical Science, Ardabil, Iran   *For correspondence: f.amani@arums.ac.ir 
Abstract
 Breast cancer accounts for about 26% of all newly diagnosed cancers in women aged 20 to 59 years. As part of 
a basic program for cancer control, the present cross sectional descriptive study was conducted with the objective 
of determining the epidemiology of breast cancer in Ardabil province during 2003-2010. Necessary information 
on 469 recorded cases of breast cancer in the registry were collected by check list from patient’s files and then 
analyzed by statistical methods with SPSS.16 software. Some 455 of the patients (97%) were female, 329 (70.1%) 
residing in Ardabil. The mean age was 46.8±13.6 and most were in the age group of 40 - 60. The most prevalent 
pathologic form was infiltrative ductal carcinoma with 316 cases (67.4%), the largest proportion being grade II 
(30.6%), but very many belonged to grades III and IV (40.5%). Breast cancer in Ardabil province appeared to 
slightly increase over the period studied. The results were similar to other places in Asia. With regard to this, 
more widespread studies are required to determine factors influencing the prevalence at low age and also how 
to promote early detection. 
Keywords: Breast cancer - epidemiology - incidence rate - Ardabil cancer registry - Iran
RESEARCH COMMUNICATION
Breast Cancer in Ardabil Province in the North-West of Iran: 
an Epidemiological Study 
Nasrin Fouladi, Farhad Pourfarzi, Firooz Amani*, Hossein Ali-Mohammadi, 
Ilshan Lotfi, Effat Mazaheri
the societies that don’t follow the western lifestyle and 
dietary regimen is low but it is more in European, North 
American, and industrial countries women (Townsend 
et al., 2004). The risk of breast cancer in United States, 
European countries, and Iran, was 1 out of 8, 1 out of 12, 
and 1 out of 35; respectively (Hoel et al., 1983). Breast 
cancer rates in urban areas is higher. The incidence and 
age-adjusted mortality rates of breast cancer vary by 
5 times between different countries. The highest rate 
can be seen in the northern America, and the Western 
Europe, whereas the lowest amount can be found in Japan 
(Mousavi et al., 2009).  Although, the difference between 
far eastern and western countries is decreasing but a five-
fold extent of difference still remains between them. The 
African black’s less than American blacks are diagnosed 
with cancer.  The reported incidence rate of breast cancer 
in most of the Asian countries is very low (Sadjadi et al., 
2003). Annually, more than 70000 new cases of cancer 
occur in Iran, and from them 30000 cases lose their lives 
from cancer. According to the studies conducted in Iran, 
the breast cancer is the most common cancer and ranked 
first malignancies among women and includes 24.4% of 
the all cancers that its crude incidence is approximately 
17.81% and an ASR of 23.65 in the year of 2006 (Sadjadi 
et al,.2005; Goya et al., 2007; Mousavi et al., 2009). The 
breast cancer, after esophageal and stomach cancers, is the 
Nasrin Fouladi et al
Asian Pacific Journal of Cancer Prevention, Vol 13, 20121544
most pervasive type of cancer among women in Ardabil 
province, and its incidence rate is rising (Babaei et al., 
2009). Insofar as the fundamental programming for the 
control of cancers includes screening, early diagnosis, 
treatment, palliative service, and data collection system; 
the present study was conducted, aiming at investigating 
the epidemiology of breast cancer in Ardabil province 
during the years of 2003-2010. 
Materials and Methods
 This is a cross-sectional descriptive study that has been 
done on 469 breast cancer cases which were recorded in 
cancer registry center of Ardabil province, from 2003 to 
2010. The necessary information containing age, place of 
living, type of malignancy pathology and grading were 
extracted from the records and entered into a checklist. 
Collected data were analyzed using table, graph and 
statistical tests such as chi-square, t-test, and ANOVA 
in SPSS.16 software. The level of significance was 
considered p<0.05. For estimating the annual incidence 
rate of the disease in these years, the statistical report of 
the province population was drawn on.
Results 
 During the study period, 2003-2010, 469 cases of 
breast cancer were documented in the cancer registry unit. 
Of the cases, 455 (97%) were female and 14 (3%) were 
0
25.0
50.0
75.0
100.0
N
ew
ly
 d
ia
gn
os
ed
 w
ith
ou
t 
tr
ea
tm
en
t 
N
ew
ly
 d
ia
gn
os
ed
 w
ith
 t
re
at
m
en
t 
Pe
rs
is
te
nc
e 
or
 r
ec
ur
re
nc
e
Re
m
is
si
on
N
on
e
Ch
em
ot
he
ra
py
Ra
di
ot
he
ra
py
Co
nc
ur
re
nt
 c
he
m
or
ad
ia
tio
n
10.3
0
12.8
30.025.0
20.310.16.3
51.7
75.0
51.1
30.031.3
54.2
46.856.3
27.625.0
33.130.031.3
23.7
38.0
31.3
Table 1. Pathological Type of Breast Cancer in Patients
Pathological type                          Frequency    Percentage
Infiltrative ductal carcinoma  316 67.4
Invasive ductal carcinoma 68 14.5
Breast carcinoma in situ 6 1.3
Medullary carcinoma 12 2.6
Metastatic breast cancer 4 0.9
Paget’s… 7 1.5
Other pathological types 20 4.1
Unspecified pathology 36 7.7
Total 469 100.0 
Figure 1. Breast Cancer Incidence Per 100000 in Age 
Groups
Figure 2. The Incidence Rate of Breast Cancer Per 
100000 in Ardabil Province  
Table 2. Grade Type of Breast Cancer in Patients at 
the Time of Diagnosis
Malignancy grading        Frequency      Percent
Grade I (Well Diff) 85 18.1
Grade II (Mod Diff) 144 30.6
Grade III (Poor Diff) 123 26.2
Grade IV (Un diff) 67 14.3
Without grading 50 10.7
Table 3. The Incidence Rate of Breast Cancer Per 
100000 in Ardabil Province During the StudyYears 
Year Incidence rate Number of cases Population
2003 3.92 49 1247996
2004 4.09 51 1245107
2005 5.60 71 1254249
2006 4.37 55 1256980
2007 4.85 58 1265988
2008 4.89 49 1002399
2009 5.55 70 1262027
2010 5.16 67 1193338 
male. 329 cases (70.1 %) resided in Ardabil city and the 
rest were from other parts of the province. The mean age 
of the patients was 46.80 ± 13.64. Most of them with 240 
patients (51.2%) belonged to the age group 40-60. The 
mean age of male was 61.92± 16.90 and female 46.34 ± 
13.28 years and there was a significant difference between 
two groups (P=0.001). Infiltrative ductal carcinoma 
with 316 cases (67.4%) was the most prevailing form 
of pathology among patients (Table 1). The majority of 
individuals with 144 cases (30.6%) were at grade two of 
breast cancer (Table 2). The highest rate of breast cancer 
incidence in women related to the years 2005 and 2010, 
while the lowest incidence rate linked to 2008. The rate 
of breast cancer incidence in age group 40-59 was higher 
than other age groups (Figure 1). The rate of breast cancer 
incidence during the study years has extended from 3.92 
per 100000 to 5.61 per 100000 (Table 3). The rate of breast 
cancer incidence in females during the study years has 
been increased from 8.1 per 100000 to 11.8 per 100000 
(Figure.2). 
Discussion
In this study, the highest rate of breast cancer incidence 
has been occurred in the age group 40 - 59. It seems 
that the common incidence age of the breast cancer in 
Ardabil province is a decade lower than those in western 
countries; on the other hand by comparing the incidence 
rate of breast cancer with other studies, it can be noticed 
that the incidence age of this cancer has been decreased. 
This fall might be taken as a result of changes in peoples’ 
life styles and nutrition, the increase of carcinogen factors 
and also improves screening and the early diagnosis of 
disease (Peto et al., 2000; Hill et al., 2005; Mousavi et al., 
2009). It was seen that in the current study, the highest of 
Asian Pacific Journal of Cancer Prevention, Vol 13, 2012 1545
              DOI:http://dx.doi.org/10.7314/APJCP.2012.13.4.1543
Breast Cancer in Ardabil Province North-West of Iran: An Epidemiological Study 
0
25.0
50.0
75.0
100.0
N
ew
ly
 d
ia
gn
os
ed
 w
ith
ou
t 
tr
ea
tm
en
t 
N
ew
ly
 d
ia
gn
os
ed
 w
ith
 t
re
at
m
en
t 
Pe
rs
is
te
nc
e 
or
 r
ec
ur
re
nc
e
Re
m
is
si
on
N
on
e
Ch
em
ot
he
ra
py
Ra
di
ot
he
ra
py
Co
nc
ur
re
nt
 c
he
m
or
ad
ia
tio
n
10.3
0
12.8
30.025.0
20.310.16.3
51.7
75.0
51.1
30.031.3
54.2
46.856.3
27.625.0
33.130.031.3
23.7
38.0
31.3
0
25.0
50.0
75.0
100.0
N
ew
ly
 d
ia
gn
os
ed
 w
ith
ou
t 
tr
ea
tm
en
t 
N
ew
ly
 d
ia
gn
os
ed
 w
ith
 t
re
at
m
en
t 
Pe
rs
is
te
nc
e 
or
 r
ec
ur
re
nc
e
Re
m
is
si
on
N
on
e
Ch
em
ot
he
ra
py
Ra
di
ot
he
ra
py
Co
nc
ur
re
nt
 c
he
m
or
ad
ia
tio
n
10.3
0
12.8
30.025.0
20.310.16.3
51.7
75.0
51.1
30.031.3
54.2
46.856.3
27.625.0
33.130.031.3
23.7
38.0
31.
incidence rate and frequency of breast cancer was reported 
on Ardabil city which is related to the high population 
of this city, more medical facilities, on time screening, 
and the greater exposure of women with carcinogenic 
agents that should be considered. Results revealed that 
the mean age of patients was 46.34 ± 13.28. Likewise, 
the studies run in the different areas of Iran have come 
up with similar mean ages for breast cancer, ranging from 
46 to 48 (Zafarghandi et al ., 1998; Bakhtiari., 2006). It 
shows that the average age of patients will follow the 
same pattern.  In two studies conducted in Iran the mean 
age of breast cancer diagnosis has been reported 61 years 
(Yaghmayee et al., 2007; Sadjadi et al., 2009). The low 
mean age of breast cancer diagnosis in Ardabil (nearly 
two decades)  than these countries can be related to the 
low age of the cancer incidence in Ardabil province than 
developed countries or age in different races that confirms 
the necessity of planning and conducting extensive breast 
cancer screening programs for the lower age in Iran 
than other societies. Similar to other studies, the present 
study, found Ductal Carcinoma (Invasive and infiltrative 
types) as the most frequent type of breast cancer which 
comprised 81.9 % of the whole cases (Norsaadah et 
al., 2005; Ayadi et al., 2008). By compare the result of 
current study with other studies showed that the incidence 
of breast cancer increased which might be as a result 
of cancer registry system improvement, breast cancer 
diagnosis improvement, and the increasing of the disease 
risk factors during these years. The results showed that 
the breast cancer incidence in Ardabil province is lower 
than other areas (17-18). According to the obtained 
Annual percentage change) APC), an increase is seen in 
2010 compared to 2003 that it can be related to complete 
registration system, life style changes and environmental 
risk factors.
In conclusion, breast cancer incidence and age in 
the Ardabil province is less than other countries that is 
require to doing more detailed investigations on the factors 
affecting the incidence of the disease at the lower age. The 
lowness of breast cancer incidence rate in Ardabil province 
can probably be attached to the imperfectness of cancer 
registry system, the deficiency in screening, late diagnosis, 
racial difference, nutrition, and other environmental risk 
factors and lower age mean of the people in this area. 
Therefore, the stage of the cancer in the patients should be 
determined and discussed. Since the high incidence rate is 
likely to be due to on time and proper undertaking of the 
screening programs, while there isn’t any efficient system 
on this issue in Iran.  At the final point, the improvement of 
cancer registry system, breast cancer screening and doing 
different studies on the role of environmental risk factors 
affecting on age changes have been suggested. 
References
Anderson BO, Jakesz R (2008). Breast cancer issues in 
developing countries: an overview of the Breast Health 
Global Initiative. World J Surg, 32, 2578–85.
Ayadi L, Khabir A, Amouri H, et al (2008). Correlation of HER- 
2 over- expression with clinic – pathological parrameters in 
Tunisian breast carcinoma. World J Surg Oncol, 22, 112-4.
Babaei M, Jaafarzadeh H, Sadjadi AR, et al (2009). Cancer 
Incidence and Mortality in Ardabil: Report of an Ongoing 
Population-Based Cancer Registry in Iran, 2004-2006. 
Iranian J Publ Health, 38, 35-45.
Bakhtiari A, Haj- Ahmadi M (2006). 5 year assessment of breast 
cancer at Rajaii hospital, Baboolsar (1991-1996). The Iranian 
Journal of obstetrics, Gynecology & Infertility, 9, 47-52.
Brunicardi FC, Schwartz SI (2010). Schwartz’s principles of 
surgery. MC Graw Hill press, New York pp 424-69.
Fouladi N, Amani F, Sharghi A, et al (2011). Five year survival of 
women with breast cancer in Ardabil. APJCP, 12, 1799-801.
Goya M (2007). Iranian Annual Cancer Registration Report 
2005/2006. Ministry of Health and Medical Education, 
Health Deputy, Center for Disease Control and Prevention 
(In Persian). Tehran, Iran.
Hill T, Khamis H (2005). Comparison of Male and Female 
Breast Cancer Incidence Trends, Tumor Characteristics, and 
Survival. AEP, 15, 773-80.
Hoel DG, Wakabayashi T, Pike MC (1983). Secular trends in the 
distributions of the breast cancer risk factors-menarche, first 
birth, menopause, and weight – in Hiroshima and Nagasaki, 
Japan. Am J Epidemiol, 118, 78-89.
Mousavi SM, Gouya MM, Ramazani R, et al (2009). Cancer 
incidence and mortality in Iran. Ann Oncol, 20, 556-63.
Mousavi SM, Gouya MM, Ramazani R (2009). Cancer incidence 
and mortality in Iran. Ann Oncol, 20, 556-63.
Mousavi M (2009). Age distribution of breast cancer in the 
middle east, implications for screening. The Breast J, 15, 
677-9.
Norsaadah B, Rusli BN, Imran AK, et al (2005). Risk factors of 
breast cancer in women in Kelantan, Malaysia. Singapore 
Med J, 46, 698-705.
Parkin DM, Bray F, Ferlay J (2005). Global cancer statistics 
2002. CA Cancer J Clin, 55, 74-108.
Peto R, Boreham J, Clarke M (2000). UK and USA breast cancer 
deaths doen 25% in year 2000 at age 20-69 years. Lancet, 
355, 1822-4.
Sadjadi A, Nouraie M, Mohagheghi MA (2005). Cancer 
occurrence in Iran in 2002: an international perspective. 
APJCP, 6, 359-63.
Sadjadi A,  Malekzadeh R, Derakhshan MH, et al (2003). Cancer 
Occurrence In Ardabil: Results Of A Population-Based 
Cancer Registry from Iran. Int J Cancer, 107, 113-8. 
Sadjadi A, Nouraie M, Hislop T, et al (2009). Comparison of 
breast cancer survival in two populations: Ardabil and British 
Columbia. BMC Cancer, 28, 381-6.
The Top 10 Causes of Death in 2004, Fact Sheet of WHO Report. 
World Health Organization, 2008.
Townsend CM, Sabiston DC (2004). Sabiston textbook of 
surgery. Elsevier Saunders press,  Philadelphia , pp 867-946.
Yaghmayee S, Bani-Hashemi G, Gorbani R (2007). The 
investigation of survival rate and some factors affecting it in 
female breast cancer sufferers who had undergone surgery in 
Emdad Hospital of Semnan during 1991- 2002: Regression-
Cox application. Sci J Semnan University Med Sci, 9, 111-5.
Zafarghandi A, Harirchi I, Ebrahimi M, et al (1998). Breast 
cancer in Iran: A review of  pathological records. J Tehran 
Faculty of Med, 56, 42-7.


5 year assessment of breast cancer at Rajaii hospital,

Age distribution of breast cancer in the middle east, implications for screening.

Breast cancer in Iran: A review of pathological records.

Breast cancer issues in developing countries: an overview of the Breast Health Global Initiative.

Cancer Incidence and Mortality in Ardabil: Report of an Ongoing Population-Based Cancer Registry in Iran,

Cancer incidence and mortality in Iran.

Cancer Occurrence In Ardabil: Results Of A Population-Based Cancer Registry from Iran.

Cancer occurrence in Iran in 2002: an international perspective.

Comparison of breast cancer survival in two populations: Ardabil and British Columbia.

Correlation of HER2 over- expression with clinic – pathological parrameters in Tunisian breast carcinoma.

Five year survival of women with breast cancer in Ardabil.

Global cancer statistics

Iranian Annual Cancer Registration Report 2005/2006. Ministry of Health and Medical Education, Health Deputy, Center for Disease Control and Prevention (In Persian).

Risk factors of breast cancer in women in

Sabiston textbook of surgery.

Schwartz’s principles of surgery.

Secular trends in the distributions of the breast cancer risk factors-menarche, first birth, menopause, and weight

The investigation of survival rate and some factors affecting it in female breast cancer sufferers who had undergone surgery in Emdad Hospital of Semnan during 1991- 2002: RegressionCox application.

The Top 10 Causes of Death in

UK and USA breast cancer deaths doen 25% in year

World Health Organization,

Breast Cancer in Ardabil Province in the North-West of Iran: an Epidemiological Study

Breast Cancer in Ardabil Province in the North-West of Iran: an Epidemiological Study

Abstract

Similar works

Full text

Available Versions

ArUMS Digital Repository (سامانه اطلاعات زیست پزشکی و سلامت)

Crossref