Asian Pacific Journal of Cancer Prevention, Vol 5, 2004 223 Breast Cancer Survival in Iran Asian Pacific J Cancer Prev, 5, 223-225 RESEARCH COMMUNICATION Introduction Breast cancer remains the most common cancer among women. Compared with western countries the incidence of breast cancer in Iran is low but patients are relatively young and present with advanced disease (Harirchi et al., 2000; Harirchi et al., 2004). Furthermore despite improvements in survival for breast cancer patients in many countries (Taylor et al., 2003; Giordano et al., 2004; Thomson et al., 2004), it appears that the survival in Iranian breast cancer is poor. It has been suggested that both earlier diagnosis and changes in breast cancer treatment have contributed to improved breast cancer survival (Webb et al., 2004). However, studies have shown that variations in breast cancer survival partly depend on several etiological factors (Quinn et al., 1998; Thomson et al., 2001; Bradley et al., 2002; Shavers et al., 2003; Henson et al., 2003). The objective of this study was to determine the 5-year survival in Iranian breast cancer patients who referred to the Cancer Institute in Tehran, Iran. It was thought a study on survival might help to find out factors that contribute to the present situation in Iran. Breast Cancer in Iran: a Survival Analysis Mariam Vahdaninia 1 , Ali Montazeri 1,2* 1. Iranian Institute for Health Sciences Research, Tehran, Iran 2. Iranian Centre for Breast Cancer (ICBC), Tehran, Iran Address for correspondence: Dr. Ali Montazeri, P.O. Box 13185-1488, Iranian Centre for Breast Cancer, Tehran Iran. Tel: 0098 21 6409786, Fax: 6411575. E-mail: ali@jdcord.jd.ac.ir Abstract A prospective study was undertaken to examine survival in Iranian breast cancer patients. One hundred and sixty-seven breast cancer patients diagnosed in 1997 were entered into the study and followed up for five years. The mean age of thr patients at diagnosis was 47.2 (SD = 13.5), ranging from 24 to 81 years. A total of 39 patients were lost in the follow-up period, leaving 128 for analysis of data. Of these, 79 were alive and 49 were dead after five years. Most patients (61%) presented with advanced disease. Using life table analysis, the overall relative 5-year survival rate was found to be 62% (SE = 0.04). In addition, after adjustment for age at diagnosis, initial treatment (mastectomy, breast conserving surgery, and neo-adjuvant therapy), and disease stage, using Cox’s regression model, it was found that receiving neo-adjuvant therapy as the initial treatment was an independent predictor of poorer survival (Hazard ratio = 4.56, 95% CI 2.20-9.44, P<0.0001). The other variables (older age and late stage disease), although associated with high hazards rates, were not significant. The study findings suggest that overall relative survival rate in Iranian breast cancer patients stands between western and eastern European countries and needs to be improved. It seems that early detection and better management using standard guidelines might contribute considerably to improvement of survival in women experiencing breast cancer. Key Words: Breast cancer - Survival - Life table - Kaplan-Meier analysis - Cox Proportional Hazards Model - Iran Materials and Methods This was a prospective study to examine survival rate in Iranian breast cancer patients. One hundred and sixty-seven breast cancer patients with a confirmed pathological report diagnosed at 1997 were entered into the study and followed up for five years. Data were collected on demographic and available clinical characteristics of the patients and were analyzed using Life table analysis to estimate the overall relative survival rate, and by Kaplan-Meier analysis to indicate survival with reference to the disease stage and initial treatment, and by the Cox’s proportional hazards model to investigate the interaction between variables on survival. Results Of the 167 patients with breast cancer studied, in all 39 patients were lost in the follow-up period. This led to analysis of data for the 128 remaining patients. The demographic and clinical data for the initial and the follow-up samples are shown in Table 1. The mean age of patients at diagnosis