Asian Pacific Journal of Cancer Prevention, Vol 11, 2010 825 Breast Cancer Pattern and Chemotherapy Response - an Institutional Study in Pakistan Asian Pacific J Cancer Prev, 11, 825-830 Introduction Breast cancer is the most common malignancy in females worldwide and has shown a global rise in prevalence (Althuis et al., 2005) that is attributable to rising incidence (Remontet et al., 2003). Similarly, carcinoma of breast is the most frequent malignancy among Pakistani females (Hanif et al., 2009; Bhurgri et al., 2006; Azia et al., 2003). Indeed, Pakistan has shown one of the highest frequencies of breast cancer (Bhurgri et al., 2006). Anticancer chemotherapy is an important treatment modality for breast cancer. Usually FAC regimen comprising of 5-fluorouracil (5FU), doxorubicin (Adriamycin®) and cyclophosphamide is employed as adjuvant, neoadjuvant or palliative chemotherapy. In developed countries, taxanes have largely replaced 5FU (Ahern et al., 2005). Various studies have suggested differences in chemotherapy outcomes as well as severity of adverse effects in different populations (Weinshilboum, 2003; Evans and McLeod, 2003). For example, African- Americans run a greater risk of chemotherapy-induced neutropenia than Caucasians (Hershman et al., 2003; Grann et al., 2008). 1 Ziauddin Medical College, Ziauddin University, Clifton, 2 Karachi Institute of Radiotherapy and Nuclear Medicine, Karachi, Pakistan. * For correspondence : drnasirpk@yahoo.com, nasirali@zu.edu.pk Abstract Background: This study was planned to audit female breast cancers and their chemotherapy in a busy public sector institution. As a case-study, Pakistan provides an opportunity to explore the issue in a low-GDP, low-literacy, populous developing country. Method: Retrospective analysis of the records at Karachi Institute of Radiotherapy and Nuclear Medicine. Results: A total of 3,431 female breast cancer patients presented during 2001-2008, half being <45 years, mostly suffering from infiltrating ductal carcinoma of breast. Further analyzing a subgroup of 183 consecutive patients over six months revealed that only 1.6% were at stage-I, whereas 75% had node-positive disease, including 19.1% with distant metastases. Some 41.6% were either high grade or poorly differentiated. The low grade tumors showed a two-fold likelihood of ER and PR positivity as compared to high grade lesions. 5-Flourouracil, doxorubicin and cyclophosphamide (FAC) constituted the most common chemotherapy. Earlier diagnosis was associated with complete remission. Overall, 33% developed myelotoxicity, more often if age ≥45 years (p=0.012), out of which 60% needed active correction. All those patients who did not experience a drop in total leukocyte count (TLC) below 4×10 9 /L did not show complete remission. Conclusions: Infiltrating ductal carcinoma of the breast is the most common type. FAC is the most common chemotherapy. Tendency for late diagnosis, metastatic disease, treatment failure as well as leukopenia especially in ≥45 years is present. Failure to show leukopenia is suggestive of poor therapeutic outcome. Keywords: Breast cancer - chemotherapy response - asian - leukopenia To date no account is available regarding the chemotherapy trends and adverse effect profile in Pakistan. As a case-study, Pakistan provides an opportunity to explore the issue in a low-GDP, developing country, where (a) a large proportion of the population lives below the poverty line, thereby limiting the access to health facilities, (b) literacy and health awareness is inadequate, (c) health and education sectors do not get the due attention from the government, and (d) the treatment is planned on the basis of the available data from West, without due consideration of local perspectives. Thus, majority of the population relies on the public sector institutes for cancer treatment. The port city of Karachi, one of the largest agglomerations in the world, is the largest and most modern city in Pakistan, spread over 3000 square kilometers. It is a provincial capital with a population of more than 18 million. Karachi is often termed ‘Mini Pakistan’ because all ethnicities are found here. Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) is a specialized center in public sector for oncology services that caters a large part of the city. Thus, the institute is a good representation of the problem in local population and its statistics could be safely generalized. This is also supported by Hanif et al., (2009). This study RESEARCH COMMUNICATION Breast Cancer Pattern and Chemotherapy Response - an Institutional Study in Pakistan Nasir Ali Afsar 1* , Bibi Kulsoom 1 , Ahmed Mateen 2 , Saeed Ahmed 2 , Mahwish Tahseen 2 , Adeel Ahmed 2