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CC BY 4.0 · Avicenna J Med 2025; 15(01): 009-016
DOI: 10.1055/s-0045-1802585
Original Article

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

Mohamed Hamze 
1   Department of Research, Syrian American Medical Society, Washington DC, United States
,
Jude Alawa
2   School of Medicine, Stanford University, Stanford, California, United States
,
Fares Alahdab 
3   Department of Biomedical Informatics, Biostatistics, Epidemiology, University of Missouri-Columbia, Columbia, Missouri, United States
4   Department of Medicine, Division of Cardiovascular Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas, United States
,
Alaa Al-Shemali
5   Faculty of Medicine, Free Aleppo University, Aleppo, Syria
,
Ahmed Najeb Alhussein
5   Faculty of Medicine, Free Aleppo University, Aleppo, Syria
,
Nour Muhammed Ali Arab
5   Faculty of Medicine, Free Aleppo University, Aleppo, Syria
,
Bayan Galal
6   Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Jamil Debel 
7   Department of Oncology - Idlib National Hospital , Syrian American Medical Society, Idlib, Syria
,
Ayham Jemo
7   Department of Oncology - Idlib National Hospital , Syrian American Medical Society, Idlib, Syria
,
Molham khalil
7   Department of Oncology - Idlib National Hospital , Syrian American Medical Society, Idlib, Syria
,
Anees Chagpar
8   Department of Surgery, Yale University, New Haven, United States
,
Bassel Atassi
9   Chicago Medical School - OSF Little Company of Mary Medical Center, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, United States
10   Oncology Committee, Syrian American Medical Society, Washington DC, United States
,
Kaveh Khoshnood
11   Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States
,
Aula Abbara
12   Department of Infectious Diseases, Imperial College, London
13   Research Committee, Syrian American Medical Society, Washington DC, United States
› Institutsangaben
Funding This work received a research grant from the MacMillan Center Program on Refugees, Forced Displacement, and Humanitarian Studies. It provided stipends for undergraduate students from Yale University who participated in this research.
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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

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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