Nishtman Strategy Institute

Tackling Breast Cancer in Kurdistan: Epidemiology, Early Detection, and Intervention Strategies

By Helin Hussein

Introduction

In Kurdistan, as in many parts of the world, breast cancer is a pressing health concern that demands attention and action. Breast cancer has garnered widespread attention and concern as this insidious disease is the most frequently diagnosed cancer with the highest mortality rate in women (Murray & Lopez, 1997; Wilkinson & Gathani, 2022). The epidemiological insights underscore the importance of age, genetics, hormonal factors, and lifestyle choices in shaping the breast cancer landscape in Kurdistan. Studies conducted in cities like Hewler, Duhok, and Sulaymaniyah reveal alarming statistics, emphasizing the necessity of early detection and screening, particularly among young women. This article explores the origins of breast cancer, risk factors, and the imperative need for early detection, effective screening methods, and awareness campaigns.

Discussion

A neoplasm, commonly referred to as a tumor, is an abnormal tissue mass characterized by uncoordinated cell growth that persists after the known inducing stimulus is removed. Neoplasms can be benign (noncancerous) or malignant (cancerous). Neoplasms can occur in various organs and tissues throughout the body and are categorized based on their origin and behavior (Ajmiree, 2023). Breast cancer is a malignant neoplasm that originates in the cells of the breast tissue, primarily in the milk ducts or lobules. This type of cancer typically presents as a lump or mass in the breast (Makki, 2015; Alkabban, 2022). There are several subtypes of breast cancer, including invasive ductal carcinoma and invasive lobular carcinoma, each with distinct characteristics and treatment approaches (Sariego, 2010). It is one of the most common cancers affecting women worldwide (Wilkinson & Gathani, 2022). Breast cancer can also occur in men, although it is a scarce case (Yalaza, 2016). 

The epidemiology of breast cancer is a complex web of many contributing factors. To start with, the incidence rate of breast cancer increases with age; however this rate is more significant up to the age of 50 than after (Kelsey & Berkowitz, 1988). It was recorded in Hewler and Duhok, that breast cancer was the most commonly registered cancer type for the age demographic of 30-59 (M-Amen et al., 2021). Hereditary or genetic factors, such as mutations in the BRCA1 and BRCA2 genes, can significantly increase the risk. Individuals with BRCA1 mutations have a 72% cumulative risk of developing breast cancer by the age of 80, while those with BRCA2 mutations have a 69% risk; moreover, men with BRCA2 mutations also face an increased risk of breast cancer, although the risk is lower at 6% (Harbeck et al., 2019). Other hormonal factors also increase susceptibility such as earlier onset of menstruation, later onset of menopause, having fewer children, and less breastfeeding (Hamajima et al., 2012; Beral et al., 2002). This is due to prolonged exposure to the hormones estrogen and progesterone which play an important role in regulation of cancer stem cells (Chen et al., 2020). Lifestyle choices, such as poor diet, alcohol consumption, smoking, obesity and a lack of physical activity, have been recorded to also elevate the risk of breast cancer (Danaei et al., 2005; Kelsey & Berkowitz, 1988). 

The impacts of the region's political state and affairs and the subsequent changes in lifestyle have led to a rising incidence of breast cancer in the Kurdistan Region (Khuder & Mahmod, 2020). Breast cancer was the most prominent cancer type in females from the years 2013 to 2019 in both Hewler and Duhok; furthermore, in Sulaymaniyah, it had the highest incidence rate of 17.1 between 2006 to 2014 (M-Amen et al., 2021; Khoshnaw et al., 2015). According to another study that was implemented at Hiwa Cancer Hospital, breast cancer among young women constitutes 13% of all reported breast cancer cases (Ahmed et al., 2021). These studies emphasize the importance of early breast cancer detection and screening programs, especially at an earlier age, to address this type of cancer effectively. 

To address the challenge of breast cancer, there is a pressing need for increased awareness and effective screening methods. Mammography and clinical breast examination are vital tools for early detection; early detection is crucial for early diagnosis and treatment (Balali, 2020). Breast cancer can be detected through methods including self-examination, clinical exams, mammograms, ultrasounds, MRIs, genetic testing, biopsies, and clinical risk assessments (Elmore, 2005). These detection methods play a pivotal role in the prognosis of the individual and also broadens treatment options.  Self-examination is often the starting point for many individuals in monitoring their breast health, enabling them to check for any changes or abnormalities. On the other hand, clinical breast examinations, performed by healthcare professionals, offers a comprehensive evaluation, with a particular emphasis on distinguishing between different types of breast abnormalities, such as true lumps, cysts, fibroadenomas, and carcinomas Axillary lymph nodes are also examined for signs of metastasis, although clinical assessment alone can be inaccurate in this regard (Weledji and Tambe, 2018). 

Mammography is considered the standard and most extensively studied method for breast cancer screening. Also, it stands out as the most effective approach in identifying small breast cancers and diseases (Weledji and Tambe, 2018). Digital mammography, an advancement over traditional film mammography, captures x-ray images digitally and offers advantages such as ease of image storage and manipulation(Patlak, 2001). Computed Tomography (CT) imaging and Magnetic Resonance Imaging (MRI) are both valuable diagnostic tools for breast cancer. CT imaging, also known as CAT scanning, provides cross sectional images based on x-ray absorption, making it reliable for detecting cancer nodules but it can face challenges, such as variations in image intensity and potential anatomical misjudgment. On the other hand, MRI is widely used for breast cancer screening and treatment selection, offering higher sensitivity and being unaffected by breast density. Like CT, MRI also relies on detecting anatomical changes for diagnosis, staging, and follow up in cancer patients (Soleiman & Yari, 2020). In conclusion, these screening tests, when used in combination and tailored to an individual's risk profile, play a crucial role in the early detection of breast cancer, ultimately increasing the chances of successful treatment and survival.

A breast cancer diagnosis has profound emotional and psychological effects on women, including fear, anger, anxiety, and suffering. Patients often struggle to find meaning in their illness and may experience spiritual loneliness due to a loss of hope and faith(Ghaemi, 2019; Khuder & Mahmod, 2020).Patients with breast cancer in the Kurdistan Region face challenges in accessing healthcare services. This includes issues related to infrastructure, resources, and the availability of specialized centers for cancer care (Khuder & Mahmod, 2020).

Lack of awareness about available healthcare services and the importance of regular breast cancer screenings can be a significant barrier. Launching educational and public awareness campaigns, such as those done by medical student associations and local news outlets, through television, social media, and social events, can help spread awareness about breast cancer, its risk factors, and the importance of early detection. These campaigns should target a broad audience, including women of all ages. Furthermore, introducing breast health education in schools can instill awareness from a young age. This can include age appropriate lessons on breast self-examination and discussions on the importance of regular checkups. In many regions, especially rural areas, the availability of healthcare facilities can be limited. Ensuring that women have access to healthcare services, including mammography and clinical exams, regardless of their location is essential. 

Conclusion

In summary, breast cancer poses a significant health challenge in Kurdistan. This article has illuminated the alarming incidence and mortality rates among women in the region and has underscored the critical role of factors like age, genetics, hormones, and lifestyle choices in shaping breast cancer patterns. The need for early detection and screening, particularly for young women, has been emphasized through data from various cities in Kurdistan. The article has delved into the intricacies of breast cancer, its subtypes, and the importance of raising awareness and implementing effective screening methods, including mammography and clinical examinations. Additionally, it recognizes the emotional and psychological toll of a breast cancer diagnosis and highlights the healthcare access challenges in the Kurdistan Region. To combat breast cancer effectively, this research emphasizes the importance of widespread awareness campaigns, breast health education, and ensuring healthcare services are accessible to all women, regardless of their location. Succinctly, a comprehensive, multipronged approach is imperative to address the pressing issue of breast cancer in Kurdistan.





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