The current report is the first of a population-based breast cancer screening program of its kind in Saudi Arabia. This study aimed at presenting an overview of the acceptance level of Saudi women for breast cancer screening and evaluating the relationship between common risk factors and breast cancer in Saudi population, in addition to evaluating the association between BI-RADS score and breast cancer diagnosis.
Approximately 10 years ago, the WHO predicted that an increase in life expectancy41
and drastic changes in life style are expected to lead to an epidemic of breast cancer in the majority of developing countries by the first quarter of the next century. In line with this prediction, it is estimated that 70% of the new cases of cancer, including breast cancer, will be diagnosed in people living in developing countries by the year 2020.42
In a recent publication, Ibrahim et al estimated that the future burden of breast cancer in Saudi Arabia is expected to increase by approximately 350% by 2025.21
The available data in Saudi Arabia is predominantly related to awareness and perceptions of women and health professionals about screening, as well as their attitude towards it,24,39
but there is no data on actual screening programs. The only available screening program is established in Al-Qaseem, Saudi Arabia, run by the local health department in cooperation with the King Abdulaziz Women’s Charity Committee. This program employed a mobile mammography van to reach remote areas in the province. Results of this ongoing screening program are not yet available; however, they will be important as the program is the first in the world to screen a population under the age of 40.43
What we can learn from this program so far is that with well-conducted breast cancer awareness programs, women themselves will be encouraged to come for screening. Another pilot study was conducted by our group in Riyadh in 2006 as an outreach program. Our main conclusion was the dire need for health education and constant awareness campaigns, in addition to making the test accessible.44
The involvement of primary healthcare physicians is very important for the success of the screening program.
In addition, our observations during the visit to the country by U.S. former first lady Laura Bush, along with all of the accompanying media coverage, highlight the importance of the role of media in the advertising/ awareness campaigns. After the inauguration of the center till the arrival of Mrs. Bush, a few women per day were being screened at the center; however, after Mrs. Bush’s visit, those numbers increased noticeably. The use of media is especially important in our population due to the high percentage of illiteracy.
Finally, the strong correlation between mammographic findings and breast cancer confirmation is an encouraging finding for the center. This means that mammogram is an effective tool in detecting breast cancer in our patient population, which is generally young and may have denser breast tissue compared to elderly women. Long-term follow-up is required to assess the actual benefit; however, results are promising. Out of 16 confirmed malignancies, 8 cases were localized disease and 3 were regional disease. It is noteworthy that the detection rate of localized stages of breast cancer is double the rate revealed on the basis of the National Cancer Registry data. Although the sample size was small, the study is encouraging as it authenticates the goal of screening programs, which is to detect cancer at earlier, potentially more curable stages. There was also one case of ductal carcinoma in situ. Long-term follow-up is definitely needed to assess the impact on outcome. In addition, diagnosis of ductal carcinoma in situ and Stage I disease is an encouraging sign since diagnosis of disease at a lower stage will have a significant effect on outcomes.
Our study has a few limitations, including the fact that we had to include women with symptoms, which may contaminate what is supposed to be a “pure screening study.” However, our concerns about the well-being of our patients made us accommodate these patients who may not otherwise have had their cancer detected at an earlier stage for many reasons, including lack of access to care, among other aforementioned barriers.
This issue will face any pioneer programs in areas where new tests are being introduced and people find easy access to address their concerns through such programs. The fact that many women with symptoms came to the center raises concerns about the available options for these women outside the center and requires further evaluation. The study did not confirm the value of the well-established and known risk factors of breast cancer. It is too early to accept this as a matter of fact, and analysis of a larger cohort or longer follow-up or a different study design may be needed to address this issue.
In conclusion, breast cancer screening is acceptable to our female population, which responded to the media campaign. Using BI-RADS was helpful in identifying malignant lesions with high accuracy. Determining breast cancer risk factors requires further investigations.