Breast Cancer Diagnosis and Management in an Area of Protracted Conflict: A Case Series from Northwest Syria

Abstract

Background Breast cancer remains a significant public health challenge in conflict-affected regions. This study aims to investigate the impact of armed conflict on the burden of breast cancer in female patients in northwest Syria, focusing on clinical presentations, management, diagnosis, access to care, and treatment outcomes.

Methods We conducted a retrospective analysis of breast cancer patients diagnosed at the Idlib Oncology Center between March 2017 and January 2022. Data were extracted from clinical files and analyzed in R. The study was conducted at the Idlib Oncology Center, the main referral center for cancer care in northwest Syria, serving a population of 4.6 million.

Results A total of 192 patients were included, with a median age of 45.5 years (interquartile range [IQR]: 40–56). Of 108 patients, 56.5% were internally displaced. Most patients were diagnosed with invasive ductal carcinoma (81.3%), and the majority presented at stages II and III (34.8 and 59%, respectively). Among 192 patients, 95.8% underwent surgery, with 96.6% having a mastectomy and 90.7% receiving chemotherapy. The median interval from symptom onset to diagnosis was 100.5 days, that from diagnosis to surgery was 14.5 days, and that from surgery to radiotherapy was 229 days. No significant effect was observed for chemical weapon exposure or family loss on survival. Displacement was associated with significantly lower predicted survival (p = 0.0038; 95% confidence interval [CI]: 0.05064–0.2570).

Conclusions This study highlights a high prevalence of late-stage breast cancer, a high rate of mastectomies, delayed access to radiotherapy, and long delays between diagnosis and treatment in northwest Syria. Displacement negatively affects survival rates. Additionally, the substantial lack of radiotherapy in patients needing it and prolonged intervals between treatments contribute to poorer outcomes. Establishing localized oncology services and increasing funding for cancer medications and radiotherapy would improve access to necessary oncology care in this region.

Keywords

armed conflict - breast cancer - clinical presentation - northwest Syria - oncology service

Authors' Contributions

A.A., A.C., B.A., F.A., and K.K. contributed to the design of the study. A.C. supervised the students from Yale, while A.A. and M.H. supervised the students from Syria. A.A.S., A.N.A., and N.M.A.A. collected the data, and F.A., B.A., and M.H. contributed to its analysis. M.H. and J.A. led the development of the final manuscript. J.D., A.J., and M.K. contributed to the review of the manuscript as well as the collection of medical data. All the authors participated in the interpretation of data and revisions to the manuscript.

Data Availability Statement

All data relevant to the study are included in the article or uploaded as supplementary information. Additional data are available from the authors upon reasonable request.

Publikationsverlauf

Artikel online veröffentlicht:
19. Mai 2025

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